7.3.11.1: Attendance of Children with Unspecified Respiratory Tract Infection

Children without fever who have mild symptoms associated with the common cold, sore throat, croup, bronchitis, rhinitis, runny nose (rhinorrhea), or ear infection (otitis media) should not be denied admission to child care, sent home from child care, or separated from other children in the facility unless their illness is characterized by one or more of the following conditions:
 
1.    The illness has a specified cause that requires exclusion, as determined by other specific performance
       standards in Child and Staff Inclusion/Exclusion/Dismissal, Standards 3.6.1.1-3.6.1.4;
2.    The illness limits the child’s comfortable participation in child care activities;
3.    The illness results in a need for more care than the staff can provide without compromising the health and
       safety of other children (1).
 
Treatment with antibiotics should not be required or otherwise encouraged as a condition for attendance of children with mild respiratory tract infections unless directed by the primary health care provider and/or local health officials.

RATIONALE

The incidence of acute diseases of the respiratory tract, including the common cold, croup, bronchitis, pneumonia, and ear infections (otitis media), is common in infants and young children, whether they are cared for at home or attend out-of-home facilities. However, children in child care experience more frequent respiratory tract infections when compared to children cared for at home (2). Infants and young children may have more upper respiratory infections when they first enter out-of-home group child care (1,2).
 
Routine hand hygiene and cough etiquette may reduce the incidence of most acute upper respiratory tract infections among children in child care. Frequently, infected children shed viruses before they are symptomatic, and some infected children never become overtly ill. Therefore, exclusion criteria based on symptoms will not reduce transmission of upper respiratory tract infections among child care attendees.
 
Parents/guardians may pressure their primary care provider to prescribe antibiotics because they believe that antibiotics will shorten the duration of exclusion from child care. Primary health care providers and caregivers/teachers should reinforce an understanding of the ineffectiveness of antibiotics on duration of viral upper respiratory tract infection and should attempt to ensure children remain in child care unless they meet exclusion criteria. Please reference Standard 3.6.1.1: Inclusion/Exclusion/Dismissal of Children for a comprehensive list of exclusion criteria. 

COMMENTS

Uncontrolled coughing, difficult or rapid breathing, and wheezing (if associated with difficult breathing) may represent severe illness requiring medical evaluation before readmission to the facility.
 
For additional information regarding unspecified respiratory tract infections, consult a child care health consultant, primary health care provider, and/or the local health department. For additional information, consult the current edition of the Red Book from the American Academy of Pediatrics (AAP) and Managing Infectious Diseases in Child Care and Schools (AAP).

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
3.6.1.2 Staff Exclusion for Illness
3.6.1.3 Guidelines for Taking Children’s Temperatures
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, 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. Dowell, S. M. Marcy, S. F., B. Schwartz, W. R. Phillips, et al. 1998. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics 101:163-65.
   

4. 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.