If your child has been ill with fever, vomiting, or diarrhea, please keep him or her at home for at least a full day (24 hours) to allow time for a full recovery. Similarly, if a child complains of feeling ill during the night, it is probably not a good idea to bring that child in to the Center the next day. Children who are on medication may attend the Center if the child’s physician approves. Generally, it is a good idea for children to have been on medication for at least 24 hours before returning to the Center.
If a child has been exposed to a communicable disease, the Center should be notified at once. If appropriate, the Center will notify the families of all children known to have been exposed during attendance at the program. Children who are ill with a communicable disease should be kept home until they are no longer contagious. Exclusion policies are specific to the various infectious diseases. All exclusion policies are consistent with state recommendations and with the standards of the Centers for Disease Control, the American Academy of Pediatricians, and the American Public Health Association.
Children who have head lice or nits must be treated and all nits removed before returning to the Center. We have to maintain a firm “no-nits” policy in order to keep head lice from spreading, and we do make periodic informal checks for lice if we hear of local cases or if a child appears to be showing symptoms. If a child has been sent home with lice or nits, they may not return until we confirm through a visual check that all the lice and nits have been removed.
In the event that your child suffers an accident or injury requiring medical care, or has surgery, we would appreciate your talking with us before they return to the Center so that we can be sure that we follow the physician’s advice regarding your child’s diet, participation in activities, etc.
Criteria for Excluding an Ill or Infected Child From an Early Childhood Program
When a child becomes ill but does not require immediate medical help, a determination must be made regarding whether the child should be sent home (be temporarily “excluded” from child care). The teacher needs to determine if the illness:
- Prevents the child from participating comfortably in activities;
- Results in a need for care that is greater than the staff can provide without compromising the health and safety of other children;
- Poses a risk of spread of harmful diseases to other children.
If any of the above criteria are met, the child should be excluded, regardless of the type of illness. The child will be removed from direct contact with other children and will be monitored and supervised by a single staff member known to the child until dismissed from care to the care of the family or someone designated by the family.
Children will be excluded from care when they have the following illness and symptoms:
- Temperature: Oral temperature 101 degrees or greater, rectal temperature 102 degrees or greater, auxiliary (armpit) temperature 100 degrees or greater, accompanied by behavior changes or other signs or symptoms of illness, until medical evaluation indicates inclusion in the facility.
- Signs of possible severe illnesses: Unusual lethargy, irritability, persistent crying, difficulty breathing, and uncontrolled coughing
- Diarrhea: Defined by watery stools or decreased form of stool that is not associated with changes of diet. Exclusion is required for all diapered children whose stool is not contained in the diaper and toilet-trained children if the diarrhea is causing soiled pants or clothing. In addition, diapered children with diarrhea should be excluded if the stool frequency exceeds two or more stools above normal for that child. Readmission after diarrhea can occur when diapered children have their stool contained by the diaper (even if the stools remain loose) and when toilet-trained children are continent.
- Blood or Mucus in stools not explained by dietary change, mediation or hard stools.
- Vomiting: Two or more times in the previous 24 hours unless the vomiting is determined (by a physician) to be due to a noncommunicable condition and the child is not in danger of dehydration.
- Mouth sores with drooling unless the child’s primary care provider or local health department authority states the child is non-infectious.
- Abdominal pain that continues for more than two hours or intermittent pain associated with fever or other signs or symptoms of illness.
- Rash with fever or behavior change until a primary care provider has determined the illness not to be a communicable disease.
- Purulent conjunctivitis: Defined as pink or red conjunctiva with white or yellow eye discharge, often with matted eyelids after sleep, and including a child with eye pain or redness of the eyelids or skin surrounding the eye, until 24 hours after treatment has begun and/or a note from the child’s physician stating they may return to school.
- Infestation (e.g., scabies): Until 24 hours after treatment has begun.
- Tuberculosis: Until the child’s primary care provider or local health department authority states the child is on appropriate treatment and can return.
- Impetigo: until 24 hours after treatment was begun.
- Streptococcal pharyngitis (strep throat or other streptococcal infection): Until 24 hours after treatment has been initiated, and until the child has been afebrile for 24 hours.
- Ringworm infection: Until 24 hours after treatment was begun.
- Varicella/Chicken Pox: Until all lesions have dried or crusted (usually six days after onset of rash).
- Shingles: Only if sores cannot be covered by clothing or a dressing, until the sores have crusted.
- Pertussis: Until five days of appropriate antibiotic treatment.
- Mumps: Until 5 days after onset of parotid gland swelling.
- Hepatitis A Virus Infection: Until 1 week after onset of illness or jaundice if the child’s symptoms are mild or as directed by the health department.
- Measles: Until 4 days after the rash appears.
- Rubella: Until 6 days after the rash appears.
Source: American Academy of Pediatrics, & American Public Health Association. (2011). Caring for our child-National health and safety performance standards: Guidelines for early care and education programs, 3rd. ed.
Please note that in the case of a flu pandemic, the Center will follow the response guidelines as recommended by NH Health and Human Services. If you would like to review these guidelines, please see the director.