Caring for Our Children (CFOC)

Chapter 7: Infectious Diseases

7.4 Enteric (Diarrheal) Infections and Hepatitis A Virus (HAV)

7.4.0 Staff Education and Policies on Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections

Content in the STANDARD was modified on 4/5/2017 and 09/13/2022.


Diarrheal (enteric) infections are illnesses where someone develops more watery or more frequent stools than what is normal for them. Diarrhea is caused by intestinal infections and is more common in early care and education programs because these infections spread easily through diapering, poor hand hygiene, and toileting.1 These infections can cause outbreaks in early care and education programs. To prevent and control the spread of diarrheal infections and hepatitis A, programs should follow procedures and have staff education that includes

  • Routine education for staff, food handlers, and maintenance workers on proper hand hygiene, proper food preparation and storage, proper diapering, and cleaning, sanitizing, and/or disinfecting surfaces and materials.2–3 
  • Regular staff education on how to decrease spread of diarrheal illness through information on
    • How germs that cause diarrheal illnesses and hepatitis A are spread
    • Symptoms of diarrheal illness and hepatitis A
    • How to prevent spread of diarrheal illness and hepatitis A
  • Proper use and cleaning of water play materials3
  • Information on appropriate choice of and handling of animals in programs4
  • Guidelines for routine administration of hepatitis A and rotavirus vaccines should be enforced to prevent infection and spread in programs.3

At least annually, early care and education programs should review all procedures for preventing diarrheal infections. All staff, food handlers, and maintenance workers should review procedures on preventing diarrheal infections. Staff should review age-specific criteria for inclusion and exclusion of children who have a diarrheal illness or hepatitis A, and infection control procedures.


Viruses, bacteria, and parasites in stool can cause disease in children and staff in early care and education programs. Infections are spread in these settings from contact with stool during diapering and toileting. Although many intestinal infections can cause diarrhea, rotavirus, other intestinal viruses, Giardia intestinalis, Cryptosporidium, shigella, and E. coli are the most common causes of outbreaks in children in early care and education programs.3 Proper diapering and toileting, and infection control measures can reduce infections.4 Following program procedures and regular staff education can reduce spread of diarrheal illnesses.

Routine childhood vaccination for rotavirus and hepatitis A have decreased outbreaks from these viruses.1 Children and staff in early care and education programs should receive all recommended age-appropriate vaccines. Staff should watch children for signs of disease to detect it early and to carry out steps to control it. Programs should consult the local health department to find out if the increased frequency of diarrheal illness needs public health intervention.

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 Assisting Children with Hand Hygiene Training and Monitoring for Hand Hygiene Hand Sanitizers Routine Cleaning, Sanitizing, and Disinfecting Cleaning and Sanitizing Toys Cleaning and Sanitizing Objects Intended for the Mouth Cleaning Individual Bedding Cleaning Crib and Other Sleep Surfaces Inclusion/Exclusion/Dismissal of Ill Children Staff Exclusion for Illness Guidelines for Taking Children’s Temperatures Infectious Disease Outbreak Control Control of Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections
Appendix G: Recommended Childhood Immunization Schedule
Appendix H: Recommended Adult Immunization Schedule
Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting
  1. American Academy of Pediatrics. Section 2: Recommendation for care of children in special circumstances; children in group childcare and schools. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2021:117-118. 

  2. American Academy of Pediatrics. Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. Aronson SS, Shope TR, eds. 6th ed. 2022.

  3. Collins JP, Shane AL. Infections associated with group childcare. Principles and Practice of Pediatric Infectious Diseases. 5th ed. 2018;25–32.e3.

  4. Shane AL, Mody RK, Crump JA, et al. Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clinical Infectious Diseases. 2017;65(12):e45-e80.


Content in the STANDARD was modified on 4/5/2017 and 09/13/2022.