Establishing a Sick-Child Policy
By Jill Dickey

One way to help prevent the spread of infectious diseases among children in your care is to establish and firmly enforce a written "exclusion for illness" policy. Provide a handout and make adhering to your policy part of your written contract when signing up new clients.

But in the real world, there are always desperate parents who downplay their child’s warm forehead, green nose and irritability to get them admitted to day care. Handling their insensitivity requires a straightforward conversation in a calm moment. Focus on what’s best for their child. Explain that the policy benefits their child in two ways: first, by ensuring that the child gets adequate care. Point out that they can offer their child the most comfort when he or she is ill and make the best decisions about care, including taking him or her to the doctor if necessary. Second, a firm exclusion policy protects their child from contagion when another child is ill.

The easiest policy to enforce is one based on visual evidence of symptoms. According the the Centers for Disease Control handbook The ABCs of Safe and Healthy Child Care, if a child arrives with any of the following symptoms or develops them during the day, he or she should be excluded from care.

• Fever (100°F underarm; 101°F oral or 102°F rectal) AND sore throat, rash, vomiting, diarrhea, earache, irritability or confusion. In babies 4 months or younger, a 101°F rectal temperature is a fever threshhold.
• Diarrhea (runny, watery or bloody stools)
• Vomiting (twice or more in 24 hours)
• Body rash with fever
• Sore throat with fever and swollen glands
• Severe coughing (child gets red or blue in the face and makes a high-pitched whoop after cough)
• Eye discharge (thick mucus or pus draining from eye, or pink eye)
• Yellowish skin or eyes
• Child is irritable, continuously crying, or requires more attention than you can provide without risking the health and safety of other children in your care.

The ABCs of Safe and Healthy Child Care was written for child care providers in any setting. It’s available from the National Technical Information Service and has excellent, up-to-date information including:

• How infectious diseases are spread.
• What to do to keep yourself and children healthy.
• What disease and injury prevention practices you should follow.
• What disease and injury prevention practices providers should require parents to follow.

In addition to establishing policies, protective practices, and facility maintenance considerations, special sections in the handbook provide:

• 40+ fact sheets on the most common childhood diseases and conditions, explaining how to recognize them and what to do when they occur
• Additional resources, including federal agencies and professional organizations
• A list of regional poison control centers

The ABCs of Safe and Healthy Child Care is available from NTIS, 1-800-553-NTIS, for $19 plus handling fee; quote order number PB97-104723KCU. A 25 percent discount ($14.25 each) is available when purchasing five or more copies. Fax order to: 703-321-8547. Order via e-mail by sending your ordering information in a message to: orders@ntis.fedworld.gov. Access information on additional NTIS products by visiting the NTIS Home Page: http://www.ntis.gov.