3.6.4.4: List of Excludable and Reportable Conditions for Parents/Guardians

The facility should give to each parent/guardian a written list of conditions for which exclusion and dismissal may be indicated (1).

For the following symptoms, the caregiver/teacher should ask parents/guardians to have the child evaluated by a primary care provider. The advice of the primary care provider should be documented for the caregiver/teacher in the following situations:

1. The child has any of the following conditions: fever, lethargy, irritability, persistent crying, difficult breathing, or other manifestations of possible severe illness;
2. The child has a rash with fever and behavioral change;
3. The child has tuberculosis that has not been evaluated;
4. The child has scabies;
5. The child has a persistent cough with inability to practice respiratory etiquette.

The facility should have a list of reportable diseases provided by the health department and should provide a copy to each parent/guardian.

RATIONALE

Vomiting with symptoms such as lethargy and/or dry skin or mucous membranes or reduced urine output may indicate dehydration, and the child should be medically evaluated. Diarrhea with fever or other symptoms usually indicates infection. Blood and/or mucus may indicate shigellosis or infection with E. coli 0157:H7, which should be evaluated. Effective control and prevention of infectious diseases in child care depend on affirmative relationships between parents/guardians, caregivers, health departments, and primary care providers (2).

COMMENTS

 If there is more than one case of vomiting in the facility, it may indicate either contagious illness or food poisoning.

If a child with abdominal pain is drowsy, irritable, and unhappy, has no appetite, and is unwilling to participate in usual activities, the child should be seen by that child’s primary care provider. Abdominal pain may be associated with viral, bacterial, or parasitic gastrointestinal tract illness, which is contagious, or with food poisoning. It also may be a manifestation of another disease or illness such as kidney disease. If the pain is severe or persistent, the child should be referred for medical consultation (by telephone, if necessary).

If the caregiver/teacher is unable to contact the parent/guardian, medical advice should be sought until the parents can be located.

The facility should post the health department’s list of infectious diseases as a reference. The facility should inform parents/guardians that the program is required to report infectious diseases to the health department.

For information on assisting families in finding a medical home or primary care provider, consult the local chapter of the American Academy of Pediatrics (AAP), the facility’s child care health consultant, the local public health department, or the American Academy of Family Physicians (AAFP). For more information, see also the current edition of Managing Infectious Diseases in Child Care and Schools, available at here.

TYPE OF FACILITY

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

RELATED STANDARDS

3.6.1.1 Inclusion/Exclusion/Dismissal of Ill Children
Appendix P: Situations that Require Medical Attention Right Away

REFERENCES

1. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, 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