3.6.2.10: Inclusion and Exclusion of Children from Facilities That Serve Children Who Are Ill

Facilities that care for children who are ill who have conditions that require additional attention from the caregiver/teacher, should arrange for a clinical health evaluation prior to admission, by a licensed primary care provider, for each child who is admitted to the facility. A child care health consultant can assist in arranging the evaluation. Facilities who serve children who are ill should include children with conditions listed in Standard 3.6.1.1: Inclusion/Exclusion/Dismissal of Children if their policies and plans address the management of these conditions, except for the following conditions which require exclusion from all types of child care facilities:

1. A severely ill appearance. This could include lethargy or lack of responsiveness, irritability, persistent crying, difficulty breathing, or having a quickly spreading rash;
2. Fever (temperature for an infant or child older than 2 months that is above 101° F [38.3° C] or, in infants younger than 2 months, a temperature above 100.4° F [38.0° F] by any method) and behavior change or other signs and symptoms;
3. Diarrhea (Defined by stool that is occurring with more frequency or is less formed in consistency than usual in the child and not associated with changes in diet.) Exclusion is required for all diapered children whose stool is not contained in the diaper. For toilet-trained children, exclusion is required when diarrhea is causing “accidents”. Exclude children whose stool frequency exceeds 2 stools above normal frequency) and one or more of the following:
   
   1. Signs of dehydration, such as dry mouth, no tears, lethargy, sunken fontanelle (soft spot on the head);
   2. Blood or mucus in the stool until it is evaluated for organisms that can cause dysentery;
   3. Diarrhea caused by Salmonella, Campylobacter, Giardia, Shigella or E.coli 0157:H7 until specific criteria for treatment and return to care are met.
4.  Vomiting 2 or more times in the previous 24 hours, unless vomiting is determined to be caused by a non-communicable or noninfectious condition and the child is not in danger of dehydration;
5. Contagious stages of pertussis, measles, mumps, chickenpox, rubella, or diphtheria, unless the child is appropriately isolated from children with other illnesses and cared for only with children having the same illness;
6. Untreated infestation of scabies or head lice; exclusion not necessary before the end of the program day;
7. Untreated infectious tuberculosis;
8. Undiagnosed rash WITH fever or behavior change;
9. Abdominal pain that is intermittent or persistent and is accompanied by fever, diarrhea, vomiting, or other signs and symptoms;
10. An acute change in behavior;
11. Undiagnosed jaundice (yellow skin and whites of eyes);
12. Upper or lower respiratory infection in which signs or symptoms require a higher level of care than can be appropriately provided; and
13. Severely immunocompromised children and other conditions as may be determined by the primary health care provider and/or child care health consultant (1,2).

RATIONALE

These signs and symptoms may indicate a significant systemic infection that requires professional medical management and parental care (1,2). Diarrheal illnesses that require an intensity of care that cannot be provided appropriately by a caregiver/teacher could result in temporary exclusion (1,2).

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

1.6.0.1 Child Care Health Consultants
3.6.1.1 Inclusion/Exclusion/Dismissal of Ill Children
3.6.1.4 Infectious Disease Outbreak Control

REFERENCES

1. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, pp. 43-48. 4^th Edition. Elk Grove Village, IL: American Academy of Pediatrics.

2. American Academy of Pediatrics. Out-of-home child care 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: 122-123

3. 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: 140-141

NOTES

Content in the STANDARD was modified on 8/9/2017.