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).