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• A child should NOT attend child care if they have the following:
• Any illness that prevents the child from participating comfortably in activities.



• The caregiver makes the decision about whether a child is participating comfortably relative to the staff's ability to provide care.


• Any illness that results in a greater need for care than the child care staff can provide without compromising the health and safety of the other children.



• The caregiver makes the decision about whether staff can care for the child without putting the other children at risk.


• The child has any of the following conditions, unless a health care professional has found that the child can be safely included in the child care program:



• Blood in stools not explainable by dietary change, medication, or hard stools.



• Chickenpox (Varicella-Zoster), until all sores have dried and crusted (usually 6 days).



• Diarrhea, defined by more watery stools, decreased form of stool that is not associated with changes of diet, and increased frequency of passing stool, that is not contained by the child's ability to use the toilet. Children with diarrheal illness of infectious origin generally may be allowed to return to child care once the diarrhea goes away.



• Children with diarrhea caused by Salmonella TYPHI must stay at home until 3 stool cultures test negative and the health department clears the child's return.



• Children with diarrhea caused by Shigella or E. coli 0157 must stay home until 2 stool cultures test negative, and the health department approves the child's return.


• Fever (above 101°F orally, above 102°F rectally, or 100°F or higher axillary (armpit), accompanied by behavior changes or other signs or symptoms of illness.



• Head lice (Pediculosis), from the end of the child care day until after the first treatment.



• Hepatitis A virus, until 1 week after beginning of illness, jaundice (yellow skin and eyes), or as directed by the health department when passive immunoprophylaxis (currently, immune serum globulin) has been administered to appropriate children and staff members.



• Herpes simplex lesions.



• Impetigo, until 24 hours after treatment has been initiated.



• Measles, until 4 days after onset of rash.



• Mouth sores with drooling, unless a health care provider or health department official determines that the child is not infectious.



• Mumps, until 9 days after onset of parotid gland swelling.



• Persistent abdominal pain that continues more than 2 hours or intermittent pain associated with fever or other signs or symptoms.



• Pertussis, until 5 of the 14 days of appropriate antibiotic treatment has been completed.



• Pink eye - Purulent conjunctivitis (defined as pink or red conjunctiva with white or yellow eye discharge), until after treatment has been initiated. In epidemics of pink eye without pus, exclusion shall be required only if the health authority recommends it.



• Rash with fever or behavior change, until a health care provider determines that these symptoms do not indicate a communicable disease.



• Rubella, until 6 days after onset of rash.



• Scabies, until after treatment has been completed.



• Shingles (herpes zoster), if the rash cannot be covered up.



• Strep throat or other streptococcal infection, until 24 hours after initial antibiotic treatment and cessation of fever.



• Symptoms and signs of possible severe illness, including:



• sluggishness that is more than expected tiredness.
• uncontrolled coughing.
• inexplicable irritability or persistent crying.
• difficult breathing.
• severe wheezing.
• other unusual signs for the child.


• Tuberculosis, until a health care provider or health official states that the child is on appropriate therapy and can attend child care.



• Vomiting - two or more episodes of vomiting in the previous 24 hours - until vomiting stops or until a health care provider determines that the cause of the vomiting is not contagious and the child is not in danger of dehydration.

• A CHILD MAY BE ABLE TO ATTEND child care with the following illnesses and conditions (unless a health care provider determines the child should not attend) including:

• Bacteria or viruses in urine or feces in the absence of illness symptoms, like diarrhea.



• CMV (Cytomegalovirus) infection.



• Common colds, runny noses, and coughs.



• Fifth disease (parvovirus B19 infection) in a person with a normal immune system.



• Hepatitis B virus carrier state, provided that children who carry HBV have no behavioral or medical risk factors, such as unusually aggressive behavior (biting, frequent scratching), generalized dermatitis, or bleeding problems.



• HIV infection, as determined on a case-by-case basis by the child's health care team.



• Mild fever without behavior changes.



• Pink eye (Conjunctivitis) without pus, defined as pink conjunctiva with a clear, watery eye discharge and without fever, eye pain, or eyelid redness.



• Rash without fever and without behavior changes.


• Recognizing Illness

• Daily Health Checks
  
• Do caregivers conduct a health check of each child every day?



• Health checks should include observing the child and talking with the parents and the child about:



• Changes in behavior or appearance.
• Skin rashes, itchy skin, itchy scalp, or (during a lice outbreak) nits.
• Elevated body temperature (determined by taking the child's temperature if a child feels warm).
• Complaints of pain or of not feeling well.
• Other signs or symptoms of illness (such as drainage from eyes, vomiting, diarrhea).
• Reported illness in child or family members, or injury of the child since last date the child attended child care.


• When to Get Immediate Medical Help
• Caregivers should call the Emergency Medical Services (EMS) - 911 - immediately if:



• You believe the child's life is at risk or there is a risk of permanent injury.
• The child is acting strangely, much less alert, or much more withdrawn than usual.
• The child has difficulty breathing or is unable to speak.
• The child's skin or lips look blue, purple, or gray.
• The child has rhythmic jerking of arms and legs and a loss of consciousness (seizure).
• The child is unconscious.
• The child is less and less responsive.
• The child has any of the following after a head injury: decrease in level of alertness, confusion, headache, vomiting, irritability, or difficulty walking.
• The child has increasing or severe pain anywhere.
• The child has a cut or burn that is large, deep, and/or won't stop bleeding.
• The child is vomiting blood.
• The child has a severe stiff neck, headache, and fever.
• The child is significantly dehydrated: sunken eyes, lethargic, not making tears, not urinating.


• The caregiver will call you after s/he calls EMS (911), and help arrives.



If possible, ask 2 co-workers to drive you to the hospital - one to take you and another to drive your car.



• Situations requiring medical attention within one hour
  
  
• Some children may have urgent situations that do not necessarily require an ambulance but still need medical attention. The list below contains some of these more common situations. If the caregiver or the parent cannot reach the child's physician within one hour, the child should be brought to a hospital.



• Fever in any age child who looks more than mildly ill.
• Fever in a child less than 2 months (8 weeks) of age.
• A quickly spreading purple or red rash.
• A large volume of blood in the stools.
• A cut that may require stitches.
• Any medical condition specifically outlined in a child's care plan requiring parental notification.

Source: American Academy of Pediatrics Committee on Pediatric Emergency Medicine, January 2001.


•Tips on Preventing the Spread of Illnesses

Immunizations


• Your child should be up-to-date on all of the required immunizations.
  
  See Immunization section for more details.

Handwashing


• All caregivers and children should wash their hands often, especially before eating and after using the bathroom or changing diapers.


See Handwashing section for more details.


Cleaning and sanitizing


• All caregivers should routinely clean and sanitize activity and surface areas, food preparation and service areas, toilet and diapering areas.


See Cleaning and Sanitizing and Food Preparation Sections for more information.


Staying home or planning for back up care when your child is sick


• Bed rest, fluids and a parent's TLC are often the best remedies.



• Your co-workers will thank you for keeping your child's illness away from the workplace.



• Talk to family, friends and neighbors ahead of time (5:30 am on the day of the big meeting is not a good time to start thinking about this).



• Ask your employer about swapping shifts, flex time and using your own sick leave in order to care for your sick child.



• Get to know and trust other parents in your child's program.



• You may be able to swap care with another family if your children are sick with the same illness (like chicken pox).



• Share family activities before kids get sick so that everyone is comfortable with the others' home.