|
State Guidelines
Guidelines for exclusion from child care or schools
vary greatly by state. Each child care center or home
within the state may adopt their own written rules as
long as they adhere to the minimal guidelines provided
by the state. Unfortunately, most of the state guidelines
are not very detailed and not based on medical evidence.
Frequently Asked Questions
When deciding whether to exclude an ill child from child
care, the two most important questions to consider are:
- Will (does) the illness prevent the child from
participating comfortably in activities?
- Will (does) the illness result in a need for
care that is greater than the staff can provide without
compromising the health and safety of other children?
If the answer to either of these questions is
yes, then the child should not go to child care or
school. If she/he is sent to child care or school,
then the caregiver or teacher has the authority to
exclude the child.
The third important question to ask is:
- Will (does) the illness pose a risk of spread
of a harmful disease to others?
Most common infections are not really harmful
(common cold) or are spread before, during, and well
after the time of symptoms, so preventing a child's
attendance or excluding a child does not significantly
reduce the chance of spread.
Keep in Mind:
- The parents/guardians should ask questions 1 and
2 above and apply their best judgment based on what
they see at the time. Keep in mind that vague abdominal
complaints could be the beginning of vomiting and
diarrhea (for which a child should not attend school)
but they can also be symptoms of anxiety about school
(for which attendance is recommended along with further
discussions about what may be promoting the anxiety).
- Ask questions 1 and 2. Common cold is not a reason
for exclusion if neither of the first two criteria
is met. The infection can be transmitted to others
but is not a harmful infectious disease. In fact,
there is probably some benefit to early exposure to
common cold respiratory infections because they appropriately
stimulate and mature the immune system.
- Decisions by parents about whether a mildly ill
child can or cannot go to child care or school are
difficult. In some cases the parent may have very
little time to observe the child before driving him
or her to a child care center or sending the child
off to school on a bus early in the morning. Parents
generally make decisions that are right for their
children, but very strong and conflicting factors
may consciously or unconsciously affect their decisions.
For example, parents on hourly wages may lose income
if they have to stay home for their child's illness.
And other parents may be negatively affected in their
job promotion and opportunities if they have frequent
absences due to illness in their child. In addition,
the condition of the child may change during the course
of the day. All of this is to say that parents make
decisions, but the child care and school personnel
also have a say in the matter about whether a child
sent to child care or school is allowed to stay there
through the day.
Read more about when sick children should stay home,
and how you can prevent the spread of illness here.
Resources and Standards from the AAP
The American Academy of Pediatrics and the American
Public Health Association first compiled a set of guidelines
on exclusion and return-to-care for ill children in
child care in 1992 with the publication, "Caring
for Our Children. National Health and Safety Performance
Standards: Guidelines for Out-of-Home Child Care Programs"
(CFOC). This publication set standards for much more
than handling infections but it was the first evidence-based
consensus guideline on this issue. CFOC was revised
in 2002. These guidelines are also accessible online.
Managing Infectious Diseases in
Child Care and Schools: A Quick Reference Guide
In 2005, Drs Susan Aronson and Timothy Shope
edited a more user-friendly version of these guidelines
and added to the content within the publication of "Managing
Infectious Diseases in Child Care and Schools: A Quick
Reference Guide." The resource includes easy-to-use
handouts for parents, teachers and administrators about
when children can and cannot attend child care or school
for all the common infectious diseases and conditions
(vomiting/diarrhea, common cold, fever, and many more)
and the rationale behind each recommendation.
|
