Excluding Children in Childcare Due to Illness (continued)

1. Fever along with behavior change or other signs of illness such as sore throat, rash, vomiting, diarrhea, earache, etc. Fever is defined as having a temperature of 100º F or higher taken under the arm. Oral temperatures should not be taken on children younger than four years of age. Rectal temperatures are no longer recommended in the child care setting, and mercury-containing thermometers should be avoided. A temperature over 99º F (under the arm) in an infant under 4 months of age should be evaluated by a medical professional.
2. Symptoms and signs of possible severe illness such as unusual tiredness, uncontrolled coughing or wheezing, continuous crying, or difficulty breathing.
3. Diarrhea — runny, watery or bloody stools.
4. Vomiting — more than once in a 24-hour period.
5. Body rash with fever.
6. Sore throat with fever and swollen glands or mouth sores with drooling.
7. Eye discharge — thick mucus or pus draining from the eye. (Viral conjunctivitis usually has a clear, watery discharge
   and may not require medication or exclusion.)
8. Head lice or nits (eggs)
9. Severe coughing — child gets red or blue in the face, or makes high-pitched whooping sound after coughing.
10. Child is irritable, continuously crying, or requires more attention and care than you can provide without
    compromising the health and safety of the other children in your care.

What to do when a child becomes ill in your program

• Attempt to keep the child from intimate contact with other children and staff. Remove and sanitize toys and other items they may have put into their mouth. WASH HANDS!
• Contact the parents to have the child picked up as soon as possible. Make the child as comfortable as possible. Do not isolate them in such a way that you cannot provide supervision at all times.
• Continue to observe the child for new or worsening symptoms.
• If the child does not respond to you, is having trouble breathing, or is having a seizure, call 9-1-1.
• Document your actions in the child’s file with date, time, symptoms, actions taken, by whom, and be sure to add your signature.

When to get immediate help

Some conditions require immediate medical help. If the parent can be reached, tell them to come right away and to notify their medical provider. If the parent or the child’s medical provider is not immediately available, call 9-1-1 (EMS) for immediate help.

Tell the parent to come right away, and get medical help immediately, when any of the following things happen:

• An infant under four months of age has an axillary (“armpit”) temperature of 100° F or higher (A child over four months of age has an axillary temperature of 105° F or higher).
• An infant under four months of age has two or more forceful vomiting episodes (not the simple return of swallowed milk or spit-up) after eating.
• A child looks or acts very ill, or seems to be getting worse quickly.
• A child has neck pain when the head is moved or touched.
• A child has a stiff neck or severe headache.
• A child has a seizure for the first time.
• A child acts unusually confused.
• A child has uneven, different-sized pupils (black center spots of the eyes).
• A child has a blood-red or purple rash made up of pinhead-sized spots or bruises that are not associated with injury.
• A child has a rash of hives or welts that appears quickly.
• A child breathes so fast or hard that he or she cannot play, talk, cry or drink.
• A child has a severe stomach ache that causes the child to double up and scream.
• A child has a stomach ache without vomiting or diarrhea after a recent injury, blow to the abdomen or hard fall.
• A child has stools that are black or have blood mixed through them.
• A child has not urinated in more than eight hours, and the mouth and tongue look dry.
• A child has continous, clear drainage from the nose after a hard blow to the head.

References

Caring for Our Children, National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs. Washington, D.C.: American Public Health Association and American Academy of Pediatrics (1992).

Keeping Kids Healthy: Preventing and Managing Communicable Disease in Child Care. CA Department of Education (1994).