Caring for Our Children (CFOC)

Chapter 3: Health Promotion and Protection

3.6 Management of Illness

3.6.1 Inclusion/Exclusion Due to Illness Staff Exclusion for Illness

Content in the STANDARD was modified on 4/5/2017.
COVID-19 modification as of July 13, 2021

After reading the CFOC standard, see COVID-19 modification below (Also consult applicable state licensure and public health requirements).

Please note that if a staff member has no contact with the children, or with anything with which the children has come into contact, this standard does not apply to that staff member.

A facility should not deny admission to or send home a staff member or substitute with illness unless one or more of the following conditions exists:

  1. Influenza, until fever free for 24 hours. (Health care providers can use a test to determine whether an ill person has influenza rather than other symptoms. However, it is not practical to test all ill staff members to determine whether they have common cold viruses or influenza infection. Therefore, exclusion decisions are based on the symptoms of the staff member);
  2. Chickenpox, until all lesions have dried and crusted, which usually occurs by six days;
  3. Shingles, only if the lesions cannot be covered by clothing or a dressing until the lesions have crusted;
  4. Rash with fever or joint pain, until diagnosed not to be measles or rubella;
  5. Measles, until four days after onset of the rash (if the staff member or substitute has the capacity to develop an immune response following exposure);
  6. Rubella, until six days after onset of rash;
  7. Diarrheal illness, stool frequency exceeds two or more stools above normal for that individual or blood in stools, until diarrhea resolves, or until a primary care provider determines that the diarrhea is not caused by a germ that can be spread to others in the facility; For all cases of bloody diarrhea and diarrhea caused by Shiga toxin–producing Escherichia coli (STEC), Shigella, or Salmonella serotype Typhi  I, exclusion must continue until the person is cleared to return by the primary health care provider. Exclusion is warranted for STEC, until results of 2 stool cultures are negative (at least 48 hours after antibiotic treatment is complete (if prescribed)); for Shigella species, until at least 1 stool culture is negative (varies by state); and for Salmonella serotype Typhi, until 3 stool cultures are negative. Stool samples need to be collected at least 48 hours after antibiotic treatment is complete. Other types of Salmonella do not require negative test results from stool cultures. Vomiting illness, two or more episodes of vomiting during the previous twenty-four hours, until vomiting resolves or is determined to result from non-infectious conditions;
  8. Hepatitis A virus, until one week after symptom onset or as directed by the health department;
  9. Pertussis, until after five days of appropriate antibiotic therapy or until 21 days after the onset of cough if the person is not treated with antibiotics;
  10. Skin infection (such as impetigo), until treatment has been initiated; exclusion should continue if lesion is draining AND cannot be covered;
  11. Tuberculosis, until noninfectious and cleared by a health department official or a primary care provider;
  12. Strep throat or other streptococcal infection, until twenty-four hours after initial antibiotic treatment and end of fever;
  13. Head lice, from the end of the day of discovery until after the first treatment;
  14. Scabies, until after treatment has been completed;
  15. Haemophilus influenzae type b (Hib), prophylaxis, until cleared by the primary health care provider;
  16. Meningococcal infection, until cleared by the primary health care provider;
  17. Other respiratory illness, if the illness limits the staff member’s ability to provide an acceptable level of child care and compromises the health and safety of the children. This includes a respiratory illness in which the staff member is unable to consistently manage respiratory secretions using proper cough and sneeze etiquette.

Caregivers/teachers who have herpes cold sores should not be excluded from the child care facility, but should:

 1. Cover and not touch their lesions;
 2. Carefully observe hand hygiene policies; and

   3. Not kiss any children.


COVID-19 modification as of July 13, 2021
In response to the Centers for Disease Control and Prevention’s Guidance for Operating Child Care Programs during COVID-19, it is recommended that early childhood programs implement daily screening procedures for staff, or other support services, to self-screen with temperature checks at home or when they arrive to the program. Refer to COVID-19 modifications of CFOC Standard Daily Staff Health Check.

Staff who are experiencing any of the symptoms/exposures/testing listed below should not enter the program:

  • COVID-19 symptoms
  • Fever (100.4o F/38o C or higher); feeling feverish (chills, sweating)
  • New cough
  • Fatigue
  • New loss of taste or smell
  • Sore throat
  • Headache
  • Runny or stuffy nose
  • Muscle pain or body aches
  • Nausea, vomiting or diarrhea
  • Have had close contact (within 6 feet for at least 15 minutes) with someone who is COVID-19 positive
  • Are waiting for results of a COVID-19 test
  • Have been recently diagnosed with COVID-19 and not yet cleared to return to work.

If staff develop symptoms upon arrival or become sick during the day:

  • Immediately separate sick staff from others.
  • Use an isolation room or area with access to a separate restroom not used by others.
  • Send staff member home and encourage them to follow CDC guidance for caring for oneself and others who are sick.
  • Encourage sick staff to consult with their health care provider.
    • Sick individuals should consider getting COVID-19 tested.
  • Staff in contact with the sick individual should be appropriately protected with proper personal protective equipment (PPE) such as a well fitted facemask, eye protection, disposable gloves, and a gown.
  • Clean and disinfect the work area and any shared common areas (including restrooms) and any supplies, tools, or equipment handled by the sick staff member. Prior to cleaning, if possible, increase ventilation in the work area and any shared common areas.
  • Document who has been in close contact with the sick staff member to assist with future contact tracing efforts.

If the staff member is confirmed to have COVID-19:

  • Follow the Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes | CDC
  • Contact local public health authorities about contact tracing.
  • Maintain sick staff member’s confidentiality, as required by the Americans with Disabilities Act (ADA) and other applicable federal and state laws.
  • Work with local health officials to identify exposed and potentially exposed individuals, such as coworkers or enrolled children.
  • Refer to state and local agencies for guidance on when it is safe to discontinue self-isolation or end quarantine for staff or children who test positive or had close contact with an individual who tested positive for COVID-19.
  • Sick staff members should not return to work until they have met the CDC’s criteria to discontinue isolation.

Staff who have been close contacts (within 6 feet for a cumulative total of 15 minutes or more over a period of 24 hours) of an individual who tested positive for COVID-19 should not return to in-person work until they have completed their quarantine.

Programs may need to implement short term closure procedures if an infected person has been at the program and has had contact with others. Work with your local public health authorities to determine next steps.

Facilities are encouraged to develop policies that encourage sick employees to stay home without fear of negative consequences.

Additional Resources:

Centers for Disease Control and Prevention


Most infections are spread by children who do not have symptoms.
The terms contagious, infectious and communicable have similar meanings. A fully immunized child with a contagious, infectious or communicable condition will likely not have an illness that is harmful to the child or others. Children attending child care frequently carry contagious organisms that do not limit their activity nor pose a threat to their contacts.
Adults are as capable of spreading infectious disease as children (1,2). Hand and personal hygiene is paramount in preventing transmission of these organisms. 
Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Situations that Require Hand Hygiene Handwashing Procedure Cough and Sneeze Etiquette Inclusion/Exclusion/Dismissal of Children Infectious Disease Outbreak Control
  1. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, 4th Edition. Elk Grove Village, IL: American Academy of Pediatrics.
  2. American Academy of Pediatrics. School Health In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL:  American Academy of Pediatrics; 2018: 138-146


Content in the STANDARD was modified on 4/5/2017.
COVID-19 modification as of July 13, 2021