Caring for Our Children (CFOC)

Chapter 7: Infectious Diseases

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

7.4.0 Reporting Requirements for Diarrheal Infections

STANDARD was last modified on 09/13/2022.

Diarrheal infections are more common in early care and education programs because infection is spread through diapering, poor hand hygiene, and toileting.1 Certain infections can cause outbreaks in programs. If a program has a diarrhea outbreak (more than two children or staff) or a child or staff member has been diagnosed with hepatitis A or diarrheal infection¾including Shiga toxin-producing E. coli (STEC), shigella, salmonella, campylobacter, Giardia intestinalis, or Cryptosporidium¾programs should1–2

  • Tell the program’s child health consultant who can give guidance.
  • Report the infection to the state, local, tribal, or territorial health department.
  • Work with the health department to tell parents/guardians and staff about exposure and any treatment that is needed to control spread in early care and education programs.
  • Watch exposed children for signs of illness, and refer them to medical care if symptoms develop.

Viruses, bacteria, and parasites in stool can cause disease in children and staff in early care and education settings. Infections spread in these settings from contact with stool during diapering and toileting and from poor hand hygiene. 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 settings.3 Routine childhood vaccination for rotavirus and hepatitis A have decreased outbreaks from these viruses.1 All 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 Inclusion/Exclusion/Dismissal of Ill Children Infectious Disease Outbreak Control Control of Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections Staff Education and Policies on Enteric (Diarrheal) and Hepatitis A Virus (HAV) Infections Maintenance of Records on Incidents of Diarrhea
Appendix G: Recommended Childhood Immunization Schedule
  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. Elk Grove Village, IL: American Academy of Pediatrics; 2022.

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

STANDARD was last modified on 09/13/2022.