Fecal-Oral Transmission: A-to-Z Guide

Kids playing on an indoor jungle gym. Little hands can promote fecal-oral transmission.

Introduction to fecal-oral transmission:

As parents, we don’t want to believe that stool from other children gets into our children’s mouths—but this is a very common mode of disease transmission. Understanding how diseases can spread makes them easier to prevent.

What is fecal-oral transmission?

Fecal–oral transmission occurs when bacteria or viruses found in the stool of one child (or animal) are swallowed by another child. This is especially common in group-daycare settings, where fecal organisms are commonly found on surfaces and on the hands of providers. Usually, the contamination is invisible.

With some infections, such as rotavirus, only a few viral particles are needed to cause an infection. These can spread directly through a group-care setting quite quickly, often spreading by fomites. Other infections, such as salmonella, require a larger number of organisms to establish an infection. In the absence of visible stool contamination, these infections often travel through infected food or beverages.

Swimming pools and water parks can also be locations of fecal–oral transmission. If the water is not visibly contaminated and is adequately chlorinated, just getting the water in the mouth is usually not enough to cause an infection; the risk is greatly increased by swallowing.

Many common infections can spread by fecal–oral transmission in at least some cases, including:
Adenovirus, Campylobacter infection, Coxsackievirus (hand-foot-mouth disease), Enteroviruses, E. coli infection, Giardia infection, Hepatitis A virus, Pinworms, PolioRotavirus Salmonella, Shigella, Tapeworms, and  Toxoplasmosis

How can fecal-oral transmission be prevented?

Frequent hand cleansing, especially with instant hand sanitizers, is the most significant step to help prevent fecal–oral transmission. Hand cleansing is most important after toileting or diapering and before eating.

Safe and careful food-handling practices are also vital.

Teach children never to swallow water in pools or water-play areas.

In daycare settings, the fewer children in diapers or under age 3, the smaller the risk for fecal–oral transmission of infections. Diaper-changing surfaces should never be close to food-preparation areas and should be sanitized between uses. Soiled diapers need to be properly disposed of.

Using disposable towels and cups reduces the risk for infection. Cleaning or disinfecting commonly touched, infected surfaces (doorknobs, faucet handles, shared toys, sleep mats) can also help.

Related concepts:

Dirty diapers, Stool contamination.

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched DrGreene.com, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of DrGreene.com, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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