GLOSSARY

Note: Some of these definitions were contained in the first edition in which they were reprinted with permission from Infectious Diseases in Child Care Settings: Information for Directors, Caregivers, and Parents or Guardians, by the Epidemiology Departments of Hennepin County Community Health, St. Paul Division of Public Health, Minnesota Department of Health, Washington County Public Health, and Bloomington Division of Health. Other definitions were supplied by our Technical Panels. Please see the Acknowledgments section for a list of the Technical Panels' members.

AAP Abbreviation for the American Academy of Pediatrics, a national organization of pediatricians founded in 1930 and dedicated to the improvement of child health and welfare.

ACIP Abbreviation for the U.S. Public Health Service Advisory Committee on Immunization Practices, which provides general recommendations on immunization against certain communicable diseases.

Acrocyanosis - Blueness or pallor of the extremities, usually associated with pain and numbness and caused by vasomotor disturbances.

Adaptive equipment - Equipment (such as eye glasses, hearing aids, wheelchairs, crutches, prostheses, oxygen tanks) that helps children with special needs adapt to and function within their surroundings. See also Appendix T.

Aflatoxin - Aflatoxin is a naturally occurring mycotoxin (fungus) produced by mold. The mold occurs in soil, decaying vegetation, hay, and grains undergoing microbiological deterioration. Favorable conditions include high moisture content and high temperature (USDA).

AIDS See Human immunodeficiency virus (HIV) disease.

Allergens - A substance (food, pollen, pets, mold, medication, etc.) that causes an allergic reaction.

Ambient measurements - Measurements that help assess the amount of air pollutants, noise, or lighting within a specific area.

Anaphylaxis - An allergic reaction to a specific allergen (food, pollen, pets, mold, medication, etc.) that causes dangerous and possibly fatal complications, including the swelling and closure of the airway that can lead to an inability to breathe.

ANSI Abbreviation for the American National Standards Institute, an organization that acts as a clearinghouse for standards, ensuring that any standard that comes out is created by a consensus process.

Andiropometric Relating to physical measurements of the human body, for example, height, weight, or head circumference.

Anthropometry The study of human body measurements.

Antibiotic prophylaxis - Antibiotics that are prescribed to prevent infections in infants and children in situations associated with an increased risk of serious infection with a specific disease (Red Book).

Antibody A protein substance produced by the body's immune defense system in response to something foreign. Antibodies help protect against infections.

Antigen Any substance that is foreign to the body. An antigen is capable of causing a response from the immune system.

Antisiphon ballcock An automatic valve in the toilet tank, the opening and closing of which is controlled by a spherical float at the end of a lever. The antisiphon ballcock does not allow dirty water to be admixed with clean water.

APHA Abbreviation for the American Public Health Association, a national organization of health professionals, which protects and promotes the health of the public through education, research, advocacy, and policy development.

Aseptic technique The use of procedures that prevent contamination of an object, fluid, or person with infectious microorganisms.

Asphyxial crib death Death attributed to an item within the crib that caused deprivation of oxygen or obstruction to normal breathing of an infant.

Asphyxiation Death or unconsciousness due to inadequate oxygenation, the presence of noxious agents, or other obstructions to normal breathing.

Aspiration - The inhalation of food, liquid, or a foreign body into a person's airway, possibly resulting in choking and respiratory distress.

Assessment An indepth appraisal conducted to diagnose a condition or determine the importance or value of a procedure.

ASTM Abbreviation for the American Society for Testing and Materials, an organization that provides voluntary standards through a consensus process for materials, products, systems, and services.

Asymptomatic Without symptoms. For example, a child may not have symptoms of hepatitis infection, but may still shed hepatitis A virus in the stool and may be able to infect others.

Autoerotism - Sexual self-stimulation through which an individual obtains self-gratification for his or her

own body.

Background checks - The process of checking for history of criminal charges of potential child care providers before they are allowed to care for children.

Bacteria Plural of bacterium. Bacteria are organisms that may be responsible for localized or generalized diseases and can survive in and out of the body. They are much larger than viruses and can usually be treated effectively with antibiotics.

Bacteriostatic Having the ability to inhibit the growth of bacteria.

Balusters - Vertical stair railings that support a horizontal handrail.

Bleach solution - For disinfecting environmental surfaces. Onequarter (1/4) cup of household liquid chlorine bleach (sodium hypochloride) in one gallon of water, prepared fresh daily. See also Disinfect.

Body fluids Urine, feces, saliva, blood, nasal discharge, eye discharge, and injury or tissue discharge.

Bottle propping - Bottle-feeding an infant by propping the bottle near the infant's mouth and leaving the infant alone rather than holding the bottle by hand.

Bronchitis - Most often a bacterial or viral infection that causes swelling of the tubes (bronchioles) leading to the lungs.

Campylobacter The name of a bacterium that causes diarrhea.

Campylobacteriosis A diarrheal infection caused by the campylobacter bacterium.

Capture velocity - Airflow that will collect the pollutant (such as dust or fumes) that you want removed. Airflow that will collect the pollutant (such as dust or fumes) that you want removed.

Cardiopulmonary resuscitation (CPR) Emergency measures performed by a person on another person whose breathing or heart activity has stopped. Measures include closedchest cardiac compressions and mouthtomouth ventilation in a regular sequence.

Care coordinator This term is used by some agencies or caregivers in place of, or in association with, the term case manager. The term care coordinator implies that someone is assigned to work with the child's family or alternative caretaker to assist in coordinating services, either internally within an agency directly providing services or with other service providers for the child and family. The term care coordinator is usually preferred these days over the term case manager, since the latter implies management of a case rather than assistance in ensuring coordinated care.

Caregiver Used here to indicate the primary staff who work directly with the children, that is, director, teacher, aide, or others in the center and the child care provider in small and large family child care homes.

Carrier A person who carries within his/her body a specific diseasecausing organism, who has no symptoms of disease, and who can spread the disease to others. For example, some children may be carriers of Haemophilus influenzae or giardia and have no symptoms.

Case manager See Care coordinator.

Catheterization The process of inserting a hollow tube into an organ of the body, either for an investigative purpose or to give some form of treatment (such as to remove urine from the bladder of a child with neurologic disease).

CCFP Abbreviation for the U.S. Department of Agriculture's Child Care Food Program, a federally sponsored program whose child care component provides nutritious meals to children enrolled in centers and family child care homes throughout the country.

CDA Abbreviation for Child Development Associate, a credential awarded by a program that trains workers in Head Start, centers, and small and large family child care homes to help them achieve professional status in the child care field. The CDA credential is based on the caregiver's ability to work with young children, rather than on formal academic credits.

CDC Abbreviation for the Centers for Disease Control and Prevention, which is responsible for monitoring communicable diseases, immunization status, injuries, and congenital malformations, and for performing other disease and injury surveillance activities in the United States.

Ceftriaxone - An antibiotic often prescribed for those exposed to an infection caused by Haemophilus influenzae type b (Hib) or Neisseria meningitidis (meningococcus).

Center A facility that provides care and education for any number of children in a nonresidential setting and is open on a regular basis (for example, it is not a dropin facility).

Child abuse For the purposes of this set of standards, its definition is considered to be that contained in the laws of the state in which the standards will be applied. While these differ somewhat, most of them contain basic elements as follows:

Emotional abuse Acts that damage a child in psychological ways, but do not fall into other categories of abuse. Most states require for prosecution that psychological damage be very definite and clearly diagnosed by a psychologist or psychiatrist; this category of abuse is rarely reported and even more rarely a cause of protective action.

Neglect - Neglect is divided into two categories: general neglect and severe neglect.

General neglect Failure to provide the common necessities, including food, shelter, a safe environment, education, and health care, but without resultant or likely harm to the child.

Severe neglect Neglect that results or is likely to result in harm to the child.

Physical abuse An intentional (nonaccidental) act affecting a child that produces tangible physical harm.

Sexual abuse Any sexual act performed with a child by an adult or by another child who exerts control over the victim. (Many state laws provide considerable detail about the specific acts that constitute sexual abuse.)

Child:staff ratio The maximum number of children permitted per caregiver.

Children with special needs Children with developmental disabilities, mental retardation, emotional disturbance, sensory or motor impairment, or significant chronic illness who require special health surveillance or specialized programs, interventions, technologies, or facilities.

Childrens Health Insurance Program (CHIP) - CHIP is a state/federal partnership that gives states three options for covering uninsured children: designing a new children's health insurance program; expanding current Medicaid programs; or a combination of both strategies. The CHIP statute expands health insurance to children whose families earn too much to qualify for Medicaid, yet not enough to afford private insurance.

Chlordane An insecticide that has been used successfully against flies and mosquitoes that are resistant to DDT, and for the control of ticks and mites. Chlordane requires special handling, as it is toxic to humans when applied to the skin.

Chronic Adjective describing an infection or illness that lasts a long time (months or years).

Ciprofloxacin - An antibiotic often prescribed for those exposed to an infection caused by Haemophilus influenzae type b (Hib) or Neisseria meningitidis (meningococcus).

Clean To remove dirt and debris (such as blood, urine, and feces) by scrubbing and washing with a detergent solution and rinsing with water.

CMV See Cytomegalovirus.

Cohorting toys Keeping toys used by a group of children together for use only by that group of children.

Communicable disease A disease caused by a microorganism (bacterium, virus, fungus, or parasite) that can be transmitted from person to person via an infected body fluid or respiratory spray, with or without an intermediary agent (such as a louse, mosquito) or environmental object (such as a table surface). Many communicable diseases are reportable to the local health authority.

Communicable period The period of time when an infected person is capable of spreading infection to another person.

Compliance The act of carrying out a recommendation, policy, or procedure.

Congenital Existing from the time of birth.

Conjunctivitis - "Pink eye"; Inflammation (redness and swelling) of the delicate tissue that covers the inside of the eyelids and the eyeball.

Contact dermatitis - Contact dermatitis is a skin inflammation that results when the skin comes in direct contact with substances that can cause an allergic or inflammatory reaction.

Contamination The presence of infectious microorganisms in or on the body, on environmental surfaces, on articles of clothing, or in food or water.

Contraindication Something (as a symptom or condition) that makes a particular treatment or procedure inadvisable.

Contractual relationship - A signed and written contract between parents and child care providers that documents child care agreements involving policies and procedures and educational programming goals.

Corporal punishment Pain or suffering inflicted on the body (such as spanking).

CPR See Cardiopulmonary resuscitation.

CPSC Abbreviation for the U.S. Consumer Product Safety Commission, created in 1972 and charged with the following responsibilities: (1) to protect the public against unreasonable risks of injury associated with consumer products; (2) to assist consumers in evaluating the comparative safety of consumer products; (3) to develop uniform safety standards for consumer products and to minimize conflicting state and local regulations; and (4) to promote research and investigation into the causes and prevention of productrelated deaths, illnesses, and injuries.

Croup Spasms of the airway that cause difficult breathing and a cough sounding like a seal's bark. Croup can be caused by various bacteria and viruses.

Cryptosporidium A parasite that causes cryptosporidiosis, a diarrheal illness.

Cytomegalovirus (CMV) A very common virus, which often infects young children. In most cases, CMV causes no symptoms. When symptoms are experienced, they typically consist of fever, swollen glands, and fatigue. CMV can infect a pregnant woman who is not immune and damage the fetus, leading to mental retardation, hearing loss, and other nervous system problems in the unborn child.

Decibel (db) - The unit of measure of the loudness of sounds; one decibel is the lowest intensity of sound at which a given note can be heard. The decibel level is the number of decibels of noise perceived or measured in a given place.

De-institutionalization - This term is commonly used to refer to the process by which persons with mental retardation or mental illness have been removed from large residential facilities and placed in various forms of communitybased care.

Demand feeding - The feeding of infants whenever they indicate that they need to be fed, rather than feeding according to a clock schedule.

Dental caries - Tooth decay resulting in localized destruction of tooth tissue. Also known as dental cavities.

Dental sealants - Dental sealants are clear protective coatings that cover tooth surfaces and prevent bacteria and food particles from settling into the pits and grooves. Dental sealants are usually applied after a child reaches the age of six when the first permanent molars come in. Dental sealants last for 4-5 years and can be reapplied when they wear off.

Dermatitis An inflammation of the skin due to irritation or infection.

Diarrhea An increased number of abnormally loose stools in comparison with the individual's usual bowel habits.

Diphtheria A serious infection of the nose and throat caused by the bacterium Corynebacterium diptheriae, producing symptoms of sore throat, low fever, chills, and a grayish membrane in the throat. The membrane can make swallowing and breathing difficult and may cause suffocation. The bacteria produce a toxin (a type of poisonous substance) that can cause severe and permanent damage to the nervous system and heart. This infection has been almost entirely eliminated in areas where standard infant immunizations and boosters are performed.

Disease surveillance Close observation for the occurrence of a disease or infection. Surveillance is performed to discover a disease problem early, to understand a disease problem better, and to evaluate the methods used to control the disease.

Disinfect To eliminate virtually all germs from inanimate surfaces through the use of chemicals (e.g., products registered with the U.S. Environmental Protection Agency as "disinfectants") or physical agents (e.g., heat). In the child care environment, a 1:64 dilution of domestic bleach made by mixing a solution of 1/4 cup household liquid chlorine bleach with I gallon of tap water and prepared fresh daily is an effective method to remove germs from environmental surfaces and other inanimate objects that have been contaminated with body fluids (see Body fluids), provided that the surfaces have first been cleaned (see Clean) of organic material before applying bleach and at least 2 minutes of contact time with the surface occurs. (Since complete elimination of all germs may not be achieved using the 1:64 dilution of domestic bleach solution, technically, the process is called sanitizing, not disinfecting. The term sanitize is used in these standards most often, but disinfect may appear in other or earlier publications when addressing sanitation in child care. See Appendix I.To achieve maximum germ reduction with bleach, the precleaned surfaces should be left moderately or glistening wet with the bleach solution and allowed to air dry or be dried only after at least 2 minutes of contact time. A slight chlorine odor should emanate from this solution. If there is no chlorine smell, a new solution needs to be made, even if the solution was prepared fresh that day. The 1:64 diluted solution will contain 500800 parts per million (ppm) chlorine.

Two minutes of contact with a coating of a sprayed 1:64 diluted solution of 1/4 cup household liquid chlorine bleach in one gallon of tap water prepared fresh daily is an effective method of surface-sanitizing of environmental surfaces and other inanimate objects that have first been thoroughly cleaned of organic soil. By itself, bleach is not a good cleaning agent. Household bleach is sold in the conventional strength of 5.25% hypochlorite and a more recently marketed "ultra" bleach that contains 6% hypochlorite solution. In child care, either may be used in a 1:64 dilution.

Bleach solutions much less concentrated than the recommended dilution have been shown in laboratory tests to kill high numbers of bloodborne viruses, including HIV and hepatitis B virus. This solution is not toxic if accidentally ingested by a child. However, since this solution is moderately corrosive, caution should be exercised in handling it and when wetting or using it on items containing metals, especially aluminum. DO NOT MIX UNDILUTED BLEACH OR THE DILUTED BLEACH SOLUTION WITH OTHER FLUIDS, ESPECIALLY ACIDS (E.G., VINEGAR), AS THIS WILL RESULT IN THE RAPID EVOLUTION OF HIGHLY POISONOUS CHLORINE GAS.

Commercially prepared detergent -sanitizer solutions or detergent cleaning, rinsing and application of a non bleach sanitizer that is at least as effective as the chlorine bleach solution is acceptable as long as these products are nontoxic for children, are used according to the manufacturer's instructions and are approved by the state or local health department for use as a disinfectant in place of the bleach solution.

These methods are used for toys, children's table tops, diaper changing tables, food utensils, and any other object or surface that is significantly contaminated with body fluids. Sanitizing food utensils can be accomplished by using a dishwasher or equivalent process, usually involving more dilute chemicals than are required for other surfaces.

Drop-in care A facility providing care that occurs for fewer than 30 days per year per child either on a consecutive or intermittent basis or on a regular basis.

DTP - Abbreviation for the immunization against diphtheria, tetanus, and pertussis.

Dyspnea Difficulty in breathing or shortness of breath.

E. coli 015 7. H7 - E. coli O157:H7 is one bacterium of hundreds of strains of Escherichia coli. Although most strains are harmless and live in the intestines of healthy humans and animals, this strain produces a powerful toxin and can cause severe illness, including bloody diarrhea and abdominal cramps. The organism can live in the intestines of healthy cattle. Meat can become contaminated during slaughter, and organisms can be thoroughly mixed into beef when it is ground. Eating undercooked meat, drinking unpasteurized milk, and swimming in or drinking sewage-contaminated water can cause infection (CDC).

Ectoparasite An organism that lives on the outer surface of the body.

Emergency response practices Procedures used to call for emergency medical assistance, to reach parents or emergency contacts, to arrange for transfer to medical assistance, and to render first aid to the injured person.

Emetic - An agent that induces vomiting (such as Syrup of Ipecac).

Encapsulated asbestos Asbestos fibers that are coated with a material that makes them not easily inhaled.

Encephalitis Inflammation (redness and swelling) of the brain, which can be caused by a number of viruses, including mumps, measles, and varicella.

Endonuclease tracking The laboratory process of examining the genetic material of viruses and bacteria, often used to determine similarities and differences among viruses or bacterial strains that appear to be the same.

Endotracheal suctioning - Endotracheal suctioning involves the mechanical aspiration and removal of mucous from a person's airway through a tracheostomy (an artificial opening in the trachea).

Enteric - Describes the location of infections affecting the intestines (often with diarrhea) or the liver.

EPA Abbreviation for the U.S. Environmental Protection Agency, established in 1970, which administers federal programs on air and water pollution, solid waste disposal, pesticide regulation, and radiation and noise control.

Epidemiology The scientific study of the occurrence and distribution of diseases.

Epiglottis Tissue lid of the voice box. When this organ becomes swollen and inflamed (a condition called epiglottitis), it can block breathing passages. Haemophilus influenzae that commonly causes epiglottitis. This infection has been greatly reduced in areas where standard infant immunizations and boosters are performed.

EPSDT Abbreviation for Medicaid's Early Periodic Screening and Diagnostic Treatment program, which provides health assessments and followup services to incomeeligible children.

Ergot - A toxic fungus found as a parasite on grains of rye and other grains. Consumption of food contaminated with ergots may cause vomiting, diarrhea and may lead to gangrene in serious cases. Chronic exposure through consumption of contaminated food can lead to health complications.

Erythromycin An antibiotic medication used to treat many upper respiratory illnesses. It is often prescribed for people exposed to pertussis.

Evaluation Impressions and recommendations formed after a careful appraisal and study.

Exclusion Denying admission of an ill child or staff member to a facility.

Excretion Waste material that is formed and not used by the body, such as feces and urine.

Facility A legal definition. The buildings, the grounds, the equipment, and the people involved in providing child care of any type.

Failure to Thrive Syndrome Failure of a child to develop mentally and/or physically. This syndrome may be due to a variety of causes, but often is associated with a disturbed parent/child relationship and inadequate feeding and attachment.

Febrile - The condition of having an abnormally high bodily temperature (fever), often as a response to infection.

Fecal coliforms Bacteria in stool that normally inhabit the gastrointestinal tract and are used as indicators of fecal pollution. They denote the presence of intestinal pathogens in water or food.

Fecaloral transmission Transmission of an organism from an infected person's stool (bowel movement) into another person's mouth to infect him/her. This transmission usually occurs when the infected person fails to wash his/her hands after having a bowel movement and then handles things (such as food or toys) that other people subsequently put in their mouths. Many diseases are spread this way, including hepatitis A, campylobacteriosis, shigellosis, and salmonellosis.

Fever An elevation of body temperature The body temperature can normally be as high as 99.3' oral, 100' rectal, or 98 0 axillary. A fever mists when the body temperature is higher than these numbers. The amount of temperature elevation varies at different body sites, and the height of the fever does not indicate a more or less severe illness. The method chosen to take a child's temperature depends on the need for accuracy, available equipment, the skill of the person taking the temperature, and the ability of the child to assist in the procedure. Oral temperatures should not be taken on children younger than 4 years. Rectal temperatures should be taken only by persons with specific health training in performing this procedure. Axillary temperatures are only accurate in young infants Electronic devices for measuring temperature in the ear canal give temperature results similar to rectal temperature, but these devices require specific training and are not widely available in child care settings.

First aid See Pediatric first aid.

Fomites Environmental surfaces or objects that may serve as reservoirs for spreading disease from person to person.

Foodborne pathogen A germ contained in a food product that is transmitted to persons eating the food.

Footcandles - The amount of illumination produced by a standard candle at a distance of one foot.

Friable - Readily crumbled; brittle.

Functional outcomes - Health status measures that go beyond traditional physiological assessments. By incorporating a multidimensional definition of health that encompasses physical, psychological and social aspects, functional outcome measures can capture the broader impact of disease and treatment on life from a child's (or parent's) own perspective. Such tools enable children and parents to offer input on their quality of life and their capacity to function in normal social

roles (AAP).

Fungi (singular fungus) Plantlike organisms, such as yeasts, molds, mildews, and mushrooms, which get their nutrition from other living organisms or from dead organic matter.

Gastric tube feeding- The administration of nourishment through a tube that has been surgically inserted directly into the stomach.

Gestational Occurring during or related to pregnancy.

Giardia lamblia A parasite that causes giardiasis, a diarrheal illness. Commonly referred to as "Giardia."

Gross-motor skills - Large movements involving the arms, legs, feet, or the entire body (such as crawling, running, and jumping).

Ground-fault circuit-interrupter (GFCI) A piece of equipment in an electrical line that offers protection against electrocution if the line comes into contact with water.

Group A streptococcus (GAS) - Group A streptococcus is a bacterium commonly found in the throat and on the skin that can cause a range of infections, from relatively mild sore throats and skin infections to life-threatening disease.

Group size The number of children assigned to a caregiver or team of caregivers occupying an individual classroom or welldefined space within a larger room. See also Child:Staff Ratio.

Haemophilus influenzae type b (Hib) - Before introduction of effective vaccines in 1988, Hib was the most common cause of bacterial meningitis in children in the United States. Since 1988, the incidence of diseases caused by Hib have declined by 99%. Other infections caused by Hib include epiglottitis, otitis media (ear infections), sinus infections, skin infections, and pneumonia. When two or more cases of Hib disease appear in a child care center within 60 days, a prophylactic antibiotic and immunization is indicated for all children and employees (Red Book).

HbCV Abbreviation for the Haemophilus b Conjugate Vaccine, one of the vaccines available against Haemophilus influenzae type b (Hib).

HBIG Abbreviation for hepatitis B immunoglobulin, preventive treatment for those that have been exposed to hepatitis B virus carriers.

HBV An abbreviation for hepatitis B virus. See also Hepatitis.

Health care provider A health care professional practices medicine by an established licensing body with or without supervision. The most common types of health care providers include physicians, nurse practitioners, and physician's assistants.

Health consultant A physician, certified pediatric or family nurse practitioner, or registered nurse who has pediatric or child care experience and is knowledgeable in child care, licensing, and community resources. The health consultant provides guidance and assistance to child care staff on health aspects of the facility.

Health plan A written document that describes emergency health and safety procedures, general health policies and procedures, and policies covering the management of mild illness, injury prevention, and occupational health and safety.

Hepatitis Inflammation of the liver caused by viral infection. There are five types of infectious hepatitis: type A; type B; nonA, nonB; C; and D. Hepatitis type A infection has been documented as a frequent cause of hepatitis in child care settings and is often asymptomatic in children. Chronic carriers of hepatitis B may be found in child care settings. NonA, nonB, and C hepatitis are associated with blood transfusions and intravenous drug abuse, and have not been identified as a problem in child care settings. Hepatitis D occasionally accompanies hepatitis B infections.

Herpes simplex virus - A viral organism that causes a recurrent disease which is marked by blister-like sores on mucous membranes (such as the mouth, lips, or genitals) that weep clear fluid and slowly crust over.

Herpetic gingivostomatitis Inflammation of the mouth and lips caused by the herpes simplex virus.

Hib see Haemophilus influenzae type b.

HIV see Human Immunodeficiency Virus disease.

Human Immunodeficiency Virus (HIV) disease HIV disease leads to a failure of the human immune system, leaving the body unable to fight infections and cancers. It is characterized by a relatively long (up to 10 years) asymptomatic stage and a brief acute stage. Gradually, an HIVinfected person develops multiple symptoms and infections that progress to the end stage of the disease, called acquired immunodeficiency syndrome (AIDS). HIV is transmitted by sexual contact or bloodtoblood contact, or from an infected mother to her baby during pregnancy, labor, delivery, or breastfeeding. Hygiene Protective measures taken by individuals to promote health and limit the spread of infectious diseases. These measures include (1) washing hands with soap and running water after using the toilet, after handling anything contaminated, and before eating or handling food; (2) keeping hands, hair, and unclean items away from the mouth, nose, eyes, ears, genitals, and wounds; (3) avoiding the use of common or unclean eating utensils, drinking glasses, towels, handkerchiefs, combs, and hairbrushes; (4) avoiding exposure to droplets from the noses and mouths of other people, such as the droplets spread by coughing or sneezing; (5) washing hands thoroughly after caring for another person; and (6) keeping the body clean by frequent (at least daily) bathing or showering, using soap and water.

IEP - See Individualized Education Program.

IFSP - See Individualized Family Service Plan.

Immune globulin (Gamma globulin, immunoglobulin) An antibody preparation made from human plasma. It provides temporary protection against diseases such as hepatitis type A. Health officials may wish to give doses of immune globulin to children in child care when cases of hepatitis appear

Immunity The body's ability to fight a particular infection. For example, a child acquires immunity to diseases such as measles, mumps, rubella, and pertussis after natural infection or by immunization. Newborn children initially have the same immune status as their mothers. This immunity usually disappears within the first 6 months of life.

Immunizations Vaccines that are given to children and adults to help them develop protection (antibodies) against specific infections. Vaccines may contain an inactivated or killed agent or a weakened live organism. Childhood immunizations include protection against diphtheria, pertussis, tetanus, polio, measles, mumps, rubella, and Haemophilus influenzae type b. Adults need to be protected against measles, rubella, mumps, polio, tetanus, and diphtheria.

Immunocompromised The state of not having normal body defenses (immune responses) against diseases caused by microorganisms.

Immunosuppression Inhibition of the body's natural immune response, used especially to describe the action of drugs that allow the surgical transplantation of a foreign organ or tissue by inhibiting its biological rejection.

Impervious Adjective describing a smooth surface that does not become wet or retain particles.

Incubation period Time between exposure to an infectious microorganism and beginning of symptoms.

Individualized Education Program (IEP) - A written document, derived from Part B of IDEA (the Individuals with Disabilities Education Act-PL 94-142), that is designed to meet a child's individual educational program needs. The main purposes for an IEP are to set reasonable learning goals and to state the services that the school district will provide for a child with special educational needs. Every child who is qualified for special educational services provided by the school is required to have an IEP.

Individualized Family Service Plan (IFSP) - A written document, derived from Part C of IDEA (the Individuals with Disabilities Education Act), that is formulated in collaboration with the family to meet the needs of a child with a developmental disability or delay, to assist the family in its care for a child's educational, therapeutic, and health needs, and to deal with the family's needs to the extent to which the family wishes assistance.

Infant A child between the time of birth and the age of ambulation (usually between the ages from birth to 18 months).

Infant walkers - Infant walkers, or baby walkers, consist of a wheeled base supporting a rigid frame that holds a fabric seat with leg openings and usually a plastic feeding/play tray. The device is designed to support a preambulatory infant, with feet on the floor, and allow mobility while the infant is learning to walk. Walkers are not safe for infants and children and are not recommended for use.

Infection A condition caused by the multiplication of an infectious agent in the body.

Infectious Capable of causing an infection.

Infectivity - The ability to spread infection from person to person.

Infested - Common usage of this term refers to parasites (such as lice or scabies) living on the outside of the body.

Influenza ("flu") An acute viral infection of the respiratory tract. Symptoms usually include fever, chills, headache, muscle aches, dry cough, and sore throat. Influenza should not be confused with Haemophilus influenzae infection caused by bacteria, or with "stomach flu," which is usually an infection caused by a different type of virus.

Ingestion - The act of taking material (whether food or other substances) into the body through the mouth.

Injury, intentional Physical damage to a human being resulting from an intentional event (one done by design) including a transfer of energy (physical, chemical, or heat energy).

Injury, unintentional Physical damage to a human being resulting from an unintentional event (one not done by design) involving a transfer of energy (physical, chemical, or heat energy).

Intradermal - Relating to areas between the layers of the skin (as in intradermal injections).

IPV Abbreviation for "Inactivated Polio Virus," as in the inactivated (Salktype) polio virus vaccine. The immunization is given by way of a subcutaneous injection.

Isolation The physical separation of an ill person from other persons in order to prevent or lessen contact between other persons and the ill person's

body fluids.

Jaundice Yellowish discoloration of the whites of the eyes, skin, and mucous membranes caused by deposition of bile salts in these tissues. It occurs as a symptom of various diseases, such as hepatitis, that affect the processing of bile.

Large family child care home Usually, care and education for 7 to 12 children (including preschool children of the caregiver) in the home of the caregiver, who employs one or more qualified adult assistants to meet the child:staff ratio requirements. This type of care is likely to resemble center care in its organization of activities. Applicable terms are abbreviated here to large family home or large family home caregiver

Lead Agency - This term refers to an individual state's choice for the agency that will receive and allocate the federal and state funding for children with special educational needs. The federal funding is allocated to individual states in accordance with the Individuals with Disabilities Educational Act (IDEA).

Lethargy Unusual sleepiness.

Lice Parasites that live on the surface of the human body (in head, body, or pubic hair). Louse infestation is called pediculosis.

Listeriosis A term applied to the diseases caused by Listeria bacterium. Listeria can cause meningitis, blood infections, heart problems, and abscesses, and can cause a pregnant woman to miscarry These diseases are usually acquired by eating or drinking unpasteurized milk or milk products.

Longitudinal study A research study in which patients are followed and examined over a period of time.

Mainstreaming A widely used term that describes the philosophy and activities associated with providing services to persons with disabilities in community settings, especially in school programs, where such children or other persons are integrated with persons without disabilities and are entitled to attend programs and to have access to all services available in the community.

Mantoux intradermal skin test - The Mantoux intradermal skin test involves the intradermal injection of a standardized amount of tuberculin antigen. The reaction to the antigen on the skin can be measured and the result used to assess the likelihood of infection with tuberculosis.

MD Abbreviation for Doctor of Medicine. An MD is a health practitioner who has received a degree from a college of medicine.

Measles (red measles, rubeola, hard measles, 8 to 10day measles) A serious viral illness characterized by a red rash, high fever, lightsensitive eyes, cough, and cold symptoms. This infection has been almost entirely eliminated in areas where standard infant immunizations and boosters are performed.

Medicaid - Medicaid is a program which provides medical assistance for individuals and families with low incomes and resources. The program became law in 1965 as a jointly funded cooperative venture between the Federal and State governments to assist states in the provision of adequate medical care to eligible needy persons. Medicaid is the largest program providing medical and health-related services to America's poorest people (HCFA).

Medications - Any substance that is intended to diagnose, cure, treat, or prevent disease or is intended to affect the structure or function of the body of humans or other animals.

Meninges The tissue covering the brain and spinal cord. When this tissue becomes infected and inflamed, the disease is called meningitis.

Meningitis A swelling or inflammation of the tissue covering the spinal cord and brain. Meningitis is usually caused by a bacterial or viral infection.

Meningococcal disease Pneumonia, arthritis, meningitis, or blood infection caused by the bacterium Neisseria meningitidis

Methemoglobinemia - Methemoglobinemia, also known as blue baby syndrome, is a blood disorder caused when nitrite interacts with the hemoglobin in red blood cells and is characterized by the inability of the blood to carry sufficient oxygen to the body's cells and tissues. Although methemoglobinemia is rare among adults, it may affect infants, when nitrate-contaminated well water is used to prepare formula and other baby foods.

Midinfancy The middle of the infancy period or the first year of life, that is, approximately 9 to 15 months of life.

MMR Abbreviation for the vaccine against measles, mumps, and rubella.

Monilia A type of fungus, also know as Candida albicans. The infection may occur in the mouth, lungs, intestine, vagina, skin, or nails. If found in the mouth, it is known as oral thrush.

Morbidity - The incidence of a disease within a population.

Mucocutaneous Involving the skin and mucous membranes, such as the eye conjunctiva or the mouth.

Mumps A viral infection with symptoms of fever, headache, and swelling and tenderness of the salivary glands, causing the cheeks to swell. This infection has been almost entirely eliminated in areas where standard infant immunizations and boosters are performed.

NAEYC Abbreviation for the National Association for the Education of Young Children, a membership-supported organization of people who share a desire to serve and act on the needs and rights of children from birth through age 8.

Nasogastric tube feeding The administration of nourishment using a plastic tube that stretches from the nose to the stomach.

Nasopharyngeal Pertaining to the anatomical area of the pharynx and nose.

Neisseria meningitidis (meningococcus) A bacterium that can cause meningitis, blood infections, pneumonia, and arthritis.

Neurotoxicant - A substance or chemical that can damage the nervous system.

NFPA Abbreviation for the National Fire Protection Association, which provides specific guidance on public safety from fire in buildings and structures.

Nonprescription medications - Drugs that are generally regarded as safe for use if the label directions and warnings are followed. Nonprescription medications are also called "over-the-counter" (OTC) drugs because they can be purchased without a prescription from a health care provider. Foods or cosmetics that are also intended to treat or prevent disease or affect the functions of the human body (such as suntan lotion, fluoride toothpaste, antiperspirant deodorants, or anti-dandruff shampoo) are also considered to be nonprescription medications.

Nonpurulent conjunctivitis - "Pink eye" that is usually accompanied by a clear, watery eye discharge, without fever, eye pain, or redness of the eyelid. This type of conjunctivitis usually can be managed without excluding a child from a facility, as in the case of children with mild infection of the respiratory tract.

Nutrition Specialist As defined in these standards, a registered dietitian with I to 2 years' experience in infant and child health programs and coursework in child development, who serves as local or state consultant to child care staff.

Occupational therapy Treatment based on the utilization of occupational activities of a typical child (such as play, feeding, toileting, and dressing). Child specific exercises are developed in order to encourage a child with mental or physical disabilities to contribute to their own recovery and development.

OPV Abbreviation for oral polio virus, as in trivalent (Sabintype) polio virus vaccine.

Organisms Living things. Often used as a general term for germs (such as bacteria, viruses, fungi, or parasites) that can cause disease.

OSHA Abbreviation for the Occupational Safety and Health Administration of the U.S. Department of Labor, which regulates health and safety in the workplace.

Otitis media Inflammation or infection of the middle part of the ear. Ear infections are commonly caused by Streptococcus pneumoniae or Haemophilus influenzae.

Parasite An organism that lives on or in another living organism (such as ticks, lice, mites).

Parent - The child's natural or adoptive mother or father, guardian, or other legally responsible person.

Particulate resilient material - Cushioning material made up of loose surfacing materials (like bark, wood chips, mulch, gravel, sand) designed to help absorb the shock if a child falls off playground equipment.

Pediatric first aid Emergency care and treatment of an injured child before definite medical and surgical management can be secured. Pediatric first aid includes rescue breathing and first aid for choking.

Pertussis A highly contagious bacterial respiratory infection, which begins with coldlike symptoms and cough and becomes progressively more severe, so that the person may experience vomiting sweating, and exhaustion with the cough. Although most older children and adults with pertussis whoop with coughing spells (hence the common term whooping cough), infants with pertussis commonly do not whoop but experience apneic spells, during which the infant becomes blue and stops breathing. The cough and apnea may persist for 1 to 2 months. This infection has been almost entirely eliminated in areas where standard infant immunizations and boosters are performed.

Pesticides - A chemical used to kill pests, particularly insects.

Physical therapy The use of physical agents and methods (such as massage, therapeutic exercises, hydrotherapy, electrotherapy) to assist a child with physical or mental disabilities to optimize their individual physical development or to restore their normal body function after illness or injury.

Picocuries A measure of concentration of radiation per liter of air.

Pneumonia An acute or chronic disease marked by inflammation of the lungs and caused by viruses, bacteria, or other microorganisms and sometimes by physical and chemical irritants.

Poliomyelitis A disease caused by the polio virus with signs that may include paralysis and meningitis, but often with only minor flulike symptoms. This infection has been almost entirely eliminated in areas where standard infant immunizations and boosters are performed.

Post-traumatic stress disorder - Psychological stress resulting from a frightening or distressing experience (e.g. any kind of injury, a physical or sexual assault, car crash, fire or other disaster) where reactions from the experience last for more than a month and are strong enough to affect an individual's everyday functioning.

Postural drainage Body positioning resulting in the gradual flow of mucous secretions from the edges of both lungs into the airway so secretions can be removed from the lungs by coughing.

Potable Suitable for drinking.

PPD Abbreviation for purified protein derivative, a substance used in intradermal tests for tuberculosis. See also Mantoux skin test.

Prenatal - Existing or occurring before birth (as in prenatal medical care).

Preschooler A child between the age of toilet learning/training and the age of entry into a regular school; usually aged 3 to 5 years and related to overall development.

Prescription medications - Medications that can only be dispensed by a licensed practitioner (such as a physician or nurse practitioner) because it may be unsafe if not used under professional supervision.

Prodromal Pertaining to the earliest signs and symptoms of a disease or those that give warning of its presence.

Projectile - A fired, thrown, or otherwise propelled object.

Prosthetic devices - A prosthetic device is an artificial body replacement adapted to reproduce the form and, as much as possible, the function of the missing part.

Pseudomonas aeruginosa A type of organism that is commonly a contaminant of skin sores but that occasionally causes infection in other parts of the body and is usually hospitalacquired; the most serious infections occur in debilitated patients with lowered resistance due to other diseases and/or therapy.

Psychosocial - Involving aspects of social and psychological behavior (as in a child's psychosocial development).

Purulent Containing pus, a thick white or yellow fluid.

Purulent conjunctivitis - "Pink eye" with white or yellow eye discharge, often with matted eyelids after sleep, and including eye pain or redness of the eyelids or skin surrounding the eye. This type of conjunctivitis is more often caused by a bacterial infection, which may require antibiotic treatment. Children with purulent conjunctivitis, therefore, should be excluded until the child's health care provider has examined the child and cleared him or her for readmission to the facility.

Radon - A radioactive gaseous element formed by the disintegration of radium that occurs naturally in the soil. Radon is considered to be a health hazard that may lead to lung cancer.

Reflux - An abnormal backward flow of stomach contents into the esophagus.

Rescue breathing The process of breathing air into the lungs of a person who has stopped breathing. This process is also called artificial respiration.

Respiratory syncytial virus A virus that causes colds, bronchitis, and pneumonia.

Respiratory system The nose, ears, sinuses, throat, and lungs.

Rheumatic fever - A severe infectious disease often occurring after a strep infection. Rheumatic fever is characterized by fever and painful inflammation of the joints and may result in permanent damage to the valves of the heart.

Rhinovirus A virus that causes the common cold.

Rifampin An antibiotic often prescribed for those exposed to an infection caused by Haemophilus influenzae type b (Hib) or Neisseria meningitidis (meningococcus), or given to treat an infection caused by tuberculosis. This medication my be prescribed as a prophylactic treatment in a child care setting.

Rotavirus A viral infection that causes diarrhea and vomiting, especially in infants and children.

Rubella - A mild viral illness with symptoms of red rash, lowgrade fever, swollen glands, and sometimes achy joints. The rubella virus can infect and damage a fetus if the mother is not immune to the disease. Also known as German measles, 3day measles, or light measles. This infection has been almost entirely eliminated in areas where standard infant immunizations and boosters are performed.

Salmonella A type of bacteria that causes food poisoning (salmonellosis) with symptoms of vomiting, diarrhea, and abdominal pain.

Salmonellosis A diarrheal infection caused by Salmonella bacteria.

Sanitize To remove filth or soil and small amounts of certain bacteria. For an inanimate surface to be considered sanitary, the surface must be clean (see Clean) and the number of germs must be reduced to such a level that disease transmission by that surface is unlikely. This procedure is less rigorous than disinfection (see Disinfect) and is applicable to a wide variety of routine housekeeping procedures involving, for example, bedding, bathrooms, kitchen countertops, floors, and walls. To clean, detergent or abrasive cleaners may be used but an additional sanitizer solution must be applied to sanitize. A number of EPAregistered "detergentdisinfectant" products are also appropriate for sanitizing. Directions on product labels should be followed closely. See Appendix I on Selecting an Appropriate Sanitizer.

Scabies A skin disease that causes intense itching and is caused by a tiny parasite that burrows into the skin, particularly on the front of the wrist, the webs and sides of the fingers, the buttocks, the genitals, and

the feet.

Scarlet fever - An acute contagious disease caused by a streptococcal infection, occurring predominantly among children and characterized by a scarlet skin rash and high fever.

Schoolage child - This term describes a developmental period associated with a child who is enrolled in a regular school, including kindergarten; usually from 5 to 12 years of age.

Schoolage child care facility A center offering a program of activities before and after school and/or during vacations.

Screening Mass examination of a population group to detect the existence of a particular disease (such as diabetes or tuberculosis).

Secondary infection - When a person is infected by an organism that had originated from the illness of another person. The first person infected has the primary infection, and any persons infected from the originally infected person is said to have contracted a secondary infection.

Secretions Wet material, such as saliva, that is produced by a cell or a gland and that has a specific purpose in the body.

Seizure - A sudden attack or convulsion due to involuntary, uncontrolled burst of electrical activity in the brain that can result in a wide variety of clinical manifestations, including muscle twitches, staring, tongue biting, loss of consciousness and total body shaking.

Sepsis - An infection that involves the presence of pathogenic organisms or their toxins in the blood or body tissues.

Seroconversion The increase in serum antibody against a microorganism that occurs after an infection with the microorganism or after vaccination with all or a part of the microorganism.

Serologic Pertaining to the study of blood serum.

Seronegative Refers to the absence of serum antibodies against a specific microorganism.

Seropositive Refers to the presence of serum antibodies against a specific microorganism.

Serum The clear liquid that separates in the clotting of blood.

Shigella A type of bacterium that causes bacillary dysentery or shigellosis, a diarrheal infection.

Shigellosis A diarrheal infection caused by the Shigella bacterium.

SIDS See Sudden Infant Death Syndrome.

Small family child care home Usually, the care and education of one to six children (including preschool children of the caregiver) in the home of the caregiver. Caregivers model their programs either on a nursery school or on a skilled parenting model. Applicable terms are abbreviated here to small family home or family home caregiver.

Small family child care home network A group of small family child care homes in one management system.

Special facility for ill children A facility that cares only for ill children or a facility that cares for more than six ill children at a time. This is not the same as child care for ill children provided by the child's regular center, large family child care home, or small family child care home.

Staff Used here to indicate all personnel employed at the facility, including both caregivers and personnel who do not provide direct care to the children (such as cooks, drivers, and housekeeping personnel).

Standard precautions - Apply to contact with non-intact skin, mucous membranes, blood, all body fluids, and excretions except sweat, whether or not they contain visible blood. The general methods of infection prevention are indicated for all people in the child care setting and are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection. Although Standard precautions were designed to apply to hospital settings, with the exceptions detailed in this definition, they also apply in child care settings. Standard precautions involve use of barriers as in Universal Precautions (see separate definition) as well as cleaning and sanitizing contaminated surfaces.

Child Care Adaptation of Standard Precautions (exceptions from the use in hospital settings):

a) In child care settings, use of non-porous gloves is optional except when blood or blood containing body fluids may be involved.

b) In child care settings, gowns and masks are not required.

c) In child care settings, appropriate barriers include materials such as disposable diaper table paper, disposable towels, and surfaces that can be sanitized in child care settings.

See also Transmission-based precautions; Universal precautions.

Standing orders Orders written in advance by a health care provider that describe the procedure to be followed in defined circumstances.

Staphylococcus A common bacterium found on the skin of healthy people that may cause skin infections or boils.

Status epilepticus - A prolonged seizure or a series of seizures that continue uncontrolled for 20 minutes or more.

Streptococcus A common bacterium that can cause sore throat, upper respiratory illnesses, pneumonia, skin rashes, skin infections, arthritis, heart disease (rheumatic fever), and kidney disease (glomerulonephritis).

Substitute staff Caregivers (often without prior training or experience) hired for one day or for an extended period of time, who work under direct supervision of a trained, licensed/certified permanent caregiver.

Suction - Most commonly referring to the removal of respiratory secretions or mucous of a child to aid in breathing. This can be accomplished by a handheld suction bulb, or a machine powered vacuum attached to a suction tube. Both devices are commonly inserted into the nostrils and occasionally into the mouth or tracheostomy tub (a tube protruding from the front and center of the neck in children with major respiratory compromise).

Sudden Infant Death Syndrome (SIDS) The sudden and unexpected death of an apparently healthy infant, typically occurring between the ages of 3 weeks and 5 months and not explained by an autopsy.

Sulfa-drugs - A term most commonly referring to a certain class of antimicrobial medications containing sulfur. The most common childhood prescriptions of sulfa-drugs include antibiotic eye drops for the treatment of pink eye, and oral antibiotics for the treatment of urinary tract, ear and lung infections. This term is very important as it relates to a type of drug allergy that children may have. (It is important to note that other medications may contain sulfur, but are not "sulfa-drugs" and may not cause an allergic reaction in a child with a "sulfa-drug allergy."

Syrup of ipecac A type of medicine that induces vomiting in a person who has swallowed a toxic or poisonous substance.

Systemic Pertaining to a whole body rather than to one of its parts.

Tb See Tuberculosis.

Termiticide - A chemical used to kill termites.

Thermal injury - Bodily injury due to burns.

Toddler A child between the age of ambulation and the age of toilet learning/training, usually one aged 13 to 35 months.

Toxoplasmosis A parasitic disease usually causing no symptoms. When symptoms do occur, swollen glands, fatigue, malaise, muscle pain, fluctuating low fever, rash, headache, and sore throat are reported most commonly Toxoplasmosis can infect and damage an unborn child while producing mild or no symptoms in the mother.

Transmission The passing of an infectious organism or germ from person to person.

Transmission-based precautions - Precautions, in addition to Standard precautions, that are required where airborne, droplet, and contact transmission of infectious organisms may occur. In addition to handwashing, cleaning and sanitation of surfaces, transmission-based precautions include use of a room shared only by those who are infected with the same infectious agent (with negative-pressure ventilation when airborne spread is involved), use of masks for infections spread by the airborne and droplet routes, and use of gowns and gloves for diseases spread by contact. Use of gloves for diaper changing is not mandatory in these circumstances either. Transmission-based precautions are applicable to child care where children are receiving care who would otherwise be excluded because they have a communicable disease See also Standard precautions; Universal precautions.

Tuberculosis (Tb) A disease caused by the bacterium Mycobacterium tuberculosis that usually causes an infection of the lungs.

Underhydration - A condition of the body that occurs when it does not receive adequate fluid intake. Chronic underhydration can lead to severe problems that affect blood pressure, circulation, digestion, and kidney function.

Under-immunized A person who has not received the recommended number or types of vaccines for hi/her age according to the current national and local immunization schedules.

Unitary surface material - A cushioned surface material (such as rubber mats or a combination of rubberlike materials held in place by a binder) for placement under and around playground equipment that forms a unitary shock absorbing surface.

Universal precautions apply to blood, other body fluids containing blood, semen, and vaginal secretions, but not to feces, nasal secretions, sputum, sweat, tears, urine, saliva and vomitus unless they contain visible blood or are likely to contain blood. Universal precautions include avoiding injuries caused by sharp instruments or devices and the use of protective barriers such as gloves, gowns, aprons, masks, or protective eyewear, which can reduce the risk of exposure of the worker's skin or mucous membranes that could come in contact with materials that may contain blood-borne pathogens while the worker is providing first aid or care. See also Standard precautions; Transmission precautions.

Vacuum breaker A device put on a pipe containing liquid (such as drinking water) to prevent the liquid from being sucked backward within the pipe.

Varicella-zoster - Varicella (also know as chickenpox) is caused by the varicella-zoster virus and is highly infectious. Transmission occurs from person-to-person by direct contact or through the air. Varicella is characterized by a blister- and pimple-like rash that turns into noninfectious, dried crusts within approximately six days. A person with varicella is contagious from one to two days before the rash appears until all of the lesions have formed scabs.

Virus A microscopic organism, smaller than a bacterium, that may cause disease. Viruses can grow or reproduce only in living cells.

Volunteer In general, a volunteer is a regular member of the staff who is not paid and is not counted in the child:staff ratio. If the volunteer is counted in the child:staff ratio, he/she must be 16 years or older and preferably work 10 hours per week or more in the facility.

WIC Abbreviation for the U.S. Department of Agriculture's Special Supplemental Food Program for Women, Infants and Children, which provides food supplements and nutrition education to pregnant and breastfeeding women, infants, and young children who are considered to be at nutritional risk due to their level of income and evidence of inadequate diet.