Exclusion and Readmission
Children excluded from a school or child-care facility for a communicable disease may be readmitted by a written note from a Health Care Worker. A school or child-care facility administrator may require a note from a parent or HCW for readmission regardless of the reason for the absence.
The major criterion for exclusion from attendance is the probability of spread from person to person. A child may have a noncommunicable illness yet require care at home or in a hospital.
When to Keep Your Child Home from School
The American Academy of Pediatrics recommends that your child be kept home from a child-care facility or school if any of the following conditions exist:
- Signs of severe illness, including fever, irritability, difficulty breathing, crying that doesn’t stop with the usual comforting, or extreme sleepiness.
- Diarrhea or stools that contain blood or mucus.
- Vomiting two or more times in 24 hours, unless a physician feels the cause of vomiting is not an infectious disease and the child is in no danger of becoming dehydrated.
- Mouth sores and drooling until a physician or the health authority does not feel the condition is infectious.
- Fever or rash or a change in behavior until a physician has determined that the problem is not caused by an infectious disease.
Many different viral and bacterial agents may cause diarrhea. Exclude until diarrhea has resolved or until cleared by child’s physician or health department. Antibiotic treatment may be recommended in some cases when outbreaks occur.
When a Communicable Disease is Diagnosed or Suspected
Segregate the ill child from well children at the facility until he/she can be taken home. q Adhere to the exclusion and readmission recommendations provided on the chart.
- Children or adults with fever should not be readmitted until fever subsides.
- Children or adults with diarrhea should not be readmitted until diarrhea subsides.
- Children or adults with conjunctivitis, bacterial meningitis, or tuberculosis should not be readmitted without a note from their HCW.
- Inform all parents of exposed children about the illness. Ask parents to watch their children for signs and symptoms of the disease.
- Observe the appearance and behavior of exposed children and be alert to the onset of disease. Let parents know immediately so that medical advice and treatment can be sought.
- Utilize a sanitizing procedure (see below) and encourage staff and children to take extra precautions with handwashing, foodhandling, dishwashing, and general cleanliness. Immediately wash, rinse, and sanitize any object or surface that has been soiled with discharge (such as nasal discharge or feces). Sanitize diaper-changing tables, toilets, and potty chairs after each use.
Each day, sanitize all toys and play equipment that are handled or mouthed by children, as follows:
- Wash the surface with soap and water.
- Submerge in a fresh solution of 1/4 cup of household bleach per gallon of water or an approved product (spray or wipe those items which cannot be submerged).
- Rinse in clean water and air dry. Diapering
- The diapering surface should have a plastic-covered pad with no cracks or tears. If the diapering surface cannot be easily cleaned after each use, then use a disposable material such as a paper sheet, shelf paper, wax paper, scrap computer paper, or paper base on the changing table; discard after each diapering.
- Sanitize the diapering surface after each use and at the end of each day.
- Wash hands with soap and warm water immediately after diapering each child. Be careful to clean under the fingernails.
So-called “nuisance” diseases, such as scabies, head lice (pediculosis), ringworm of the body or scalp, and pinworms are highly contagious and can cause problems in a group-care setting. Children and adults with these conditions (except ringworm of the body and pinworms) should be excluded until treated. Family members, as well as adult caregivers and their families, should be aware of symptoms and treated if they become infected.
Vaccine Preventable Diseases
Many diseases are preventable by vaccination. Child-care facilities and schools are required to have an immunization record on file for each child enrolled to ensure that each child has received age-appropriate immunizations. Required vaccines include: DTaP (diphthe- ria, tetanus and pertussis); Hib (Haemophilus influenzae type b); polio; MMR (measles, mumps, and rubella); hepatitis B; chickenpox (varicella) and hepatitis A in some areas. Vaccines are also available for flu (influenza) and pneumococcal disease. For immunization information, contact your local health department or call (800) 252-9152.
To Minimize the Spread of Communicable Disease
- Encourage children and adults to wash their hands frequently, especially before handling or preparing foods and after wiping noses, diapering, or using toilets. Sinks, soap, and disposable towels should be easy for children to use. The diapering area should be close to a handwashing area.
- Provide facial tissue throughout the facility and encourage both children and adults to cough or sneeze into the tissue.
- Regularly clean and sanitize all food service utensils, toys, and other items used by children. Discourage the use of stuffed toys or other toys that cannot be sanitized.
- Diapering and food preparation areas should be physically separate from one another and their surfaces should be kept clean, unclut- tered, and dry.
- Discourage children and adults from sharing items such as combs, brushes, jackets, hats, and bedding. Maintain a separate container to store clothing and other personal items and, if possible, provide a separate sleeping area for each child.
- Wash bedding frequently. Keep changes of clothing on hand and store soiled items in a non-absorbent container that can be sanitized or discarded after use.
- Keep in mind that having staff members diaper children and prepare food contributes to the spread of illness, especially diarrheal illnesses. Therefore, whenever possible, the same staff member should not perform both tasks.
Antibiotics are used to treat bacterial infections. Since most common colds, coughs, runny noses, and sore throats are caused by viruses, not bacteria, treatment with antibiotics is not indicated. Unnecessary antibiotic use can lead to the development of drug-resistant strains of bacteria. Diseases caused by resistant bacteria are often difficult to treat and can be especially severe and prolonged.
Manage any draining wound as a potential antibiotic-resistant infection. Do not allow staff and children with a draining wound (infection) to have physical contact with others until the wound has stopped draining and has healed. Separate other children from the infected child’s wound or a contaminated physical environment. Keep the wound covered. Do not share soap, towels, lotions, and other personal care items. Disinfect reusable items such as desks, chairs, pencils, and scissors. Use proper procedures for disposal of contaminated items. Encourage parents to take the child to a physician for a culture and susceptibility test of the drainage. Contact the Infectious Disease Control Unit for Staphylococcus aureus Guidelines in Child Care Setting: School or Day Care.