PATCHS PROGRAM
PUBLIC HEALTH NURSING ADVOCATES TEACHING CHILD HEALTH AND SAFETY
HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE (HCPCFC)

Volume 1, Issue 2 AUGUST 2001
Inside This Issue
1 Lice & Scabies
2 Meningitis
3 Osteogenesis Imperfecta
4 Updates and Announcements

Medical Information Fact Sheet

Lice:

A louse is a small wingless insect that feeds on human blood. There are three types according to the regions they inhabit. 1.) Head lice are limited to the head/scalp primarily the nape of the neck and behind the ears. 2.) Body lice burrow into your skin and are difficult to find, they are usually detected on clothing. 3.) Pubic lice (a.k.a. crabs) are found on the skin and hair of pubic regions and the eyelashes.

The focus of this information will be head lice since that is what is commonly seen on the children we encounter.

Head lice while feeding will inject saliva into the skin, which causes itching. The life cycle of head lice is between 3-4 weeks and is usually spent on the same individual. The adult female will lay about 100-150 eggs also called nits. These nits look like little white spots stuck on the hair. The nits will hatch in about 10 days. The nits can remain viable on clothing 14-30 days. Once the nits hatch they are called nymphs until they reach maturity which takes another 7-10 days. Once they become an adult they will begin laying their own eggs. Nymphs survive 24 hours without food. Lice can survive a week without food.

Lice are identified by red spots and severe itching that can lead to inflammation, scratching and possible secondary infection.

There are 3 types of treatment:

Following treatment, remove remaining nits with a comb or tweezers.

To prevent further infestations all bedding and clothing needs to be washed in hot water and dried in a clothes dryer on high heat. Vacuum furniture and wash all brushes and hair accessories. Avoid contact with infected individuals.

Schools should be informed of the infestation and the child should remain out of school for 24 hours following treatment and nit removal.

Scabies:

Scabies is a highly contagious skin disease caused by itch mites that infest the outer layer of the skin, where their waste products cause irritation. These mites are usually transmitted through close body contact, therefore being prevalent in crowded and unsanitary locations.

Shaking hands, exchanging clothing, sharing a bed or towels and sexual contact are ways of spreading scabies.

The mite burrows into the sensitive folds of the skin, such as between the fingers, wrists, elbows, navel or in the genital region. The mite can spread elsewhere as well, including the head, palms of the hands and soles of the feet.

The mite lives about 6 weeks and lays its eggs in the burrows it creates. A new generation is produced every three weeks. Intense itching begins about one month after initial infestation and the resultant scratching can lead to secondary infections.

Proper identification of scabies requires medical experience since it may resemble other skin diseases or conditions. An accurate diagnosis is needed because treatment of scabies requires direct application of a specific scabicide to the skin. Itching may continue for 2-3 weeks following treatment, so retreating with medication is NOT necessary unless eggs survive.

To prevent further infestations all clothes and bedding should be washed in hot water and dried on high heat and furniture should be vacuumed.

From HeadLice.Org. (2001), Lousology 101 and HeadLice.Org. (2001), I've Got You Under My Skin

Meningitis:

Meningitis is an inflammation of the tissue covering the brain and spinal cord. Bacteria or viruses can cause meningitis. Bacterial meningitis is more serious and can be fatal. Viral meningitis is a nonfatal form of meningitis that usually will recover spontaneously in one or two weeks. The focus in this article will be bacterial meningitis.

Bacteria that cause meningitis often live in the back of our nose and throats. Sometimes the bacteria overcome the body's immune defenses and pass through the lining in the throat or nose into the blood stream.

Meningitis can be treated if it is caught early on. The disease develops very quickly so it is important to know the signs and symptoms so treatment can be started immediately. Some forms of meningitis may lead to death if untreated in the first 24-72 hours.

Symptoms may include:

Treatment:

Antibiotics are used to treat bacterial meningitis. A majority of those who contract bacterial meningitis will make a full recovery; however, some may be left with after effect or serious disabilities. It may take months to recover from the illness. Some people have days where they feel good and other days where they feel so bad they fear they may become sick again.

Some after effects may include:

Emotional effects may include:

Not everyone suffers after effects and those who do find that they improve over time.

Prevention:

There are a number of vaccines that provide protection against meningitis but there cannot prevent all strains of the disease.

From Meningitis Research Foundation (2001), About Meningitis and Septicaemia; Meningitis Research Foundation (2001), Symptoms; Meningitis Research Foundation (2001), After Effects; Meningitis Research Foundation (2001), Are there Vaccinations for Meningitis and Septicaemia?

Osteogenesis Imperfecta:

Osteogenesis imperfecta (OI) is a genetic disorder characterized by bones that break easily, often from little or no apparent cause. There are at least four forms of the disorder representing extreme variation in severity.

The disorder is a genetic defect that affects the body's production of collagen. Collagen is the fibrous component of bone, cartilage and connective tissue. A person with OI will have less collagen than normal or a poorer quality than normal leading to weak bones that fracture easily.

It is possible to diagnose OI solely based on clinical features (see table on next page). Genetic and molecular tests can be run but often in individuals with less severe forms the test are negative even though the individual has the disorder.

The four forms of OI are available to view as a table.

Most cases of OI are a result of a dominant genetic defect. OI can be inherited from a parent or a result of a spontaneous mutation. Because the defect is usually dominant, a person with OI has a 50% chance of passing it on to each of his or her children.

There is no cure for OI. The treatment is aimed at preventing or controlling symptoms, maximizing mobility and developing optimal bone mass and muscle strength.

Care of fractures, extensive surgical and dental procedures and physical therapy are recommended for those with OI. The surgery typically considered is called "rodding" which involves placing metal rods in the long bones to strengthen them and to prevent or correct deformities. Medications may also be used. Part of rehabilitation includes exercising as much as possible to strengthen the bone and muscle to prevent fractures. Swimming and water therapy are encouraged since they allow independent movement with little or no risk for fractures.

Children and adults with OI are encourage to maintain a healthy weight, a nutritious diet and avoiding activities such as smoking, excessive alcohol, caffeine consumption and taking steroids since these may lead to depletion of bone and increase bone fragility.

Accusations of child abuse may occur in families where the child with OI has not been diagnosed.

The types of fractures that are typically observed in both OI and child abuse are

1). Fracture in multiple stages of healing
2). Rib fractures
3). Spiral fractures
4). Fractures for which there is no adequate explanation of trauma.

This information is to make the reader aware that in some cases children with multiple fractures may not be abused but instead have osteogenesis imperfecta.

NIH ORBD~NRC & The Osteogenesis Imperfecta Foundation (2000), Osteogenesis Imperfecta

 

HCPCFC PROGRAM UPDATES and ANNOUNCEMENTS!!!

HCPCFC and CASA have joined forces to ensure the best possible outcomes for the children in foster care. HCPCFC is going to make sure that all the children served through CASA have a Health and Education Passport.

Kristen Thompson attended the Kinship Care/KinGAP training in Ontario. As a result of networking at the training we have been asked by Riverside Community College to provide relative caregivers with information on health topics. We will update you in the future with any developments.

 

Editor: Kristen Thompson, PHN,Contributors: Hermia Parks, SPHN, MA, and Judy Earp, MHA, Director of Public Health Nursing.

 

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