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Preventing the Spread of Illness in Child Care or School

In today’s world of two-income families and single parents, many young children spend a lot of their time in child care.

What’s the Policy?

When choosing a child care setting for your child, do not forget to take into account this crucial factor — what is the policy concerning sick children? 

To reduce the risk of becoming sick, your child, the child care providers, and all the children being cared for must be up-to-date with the recommended immunizations. To view the most up-to-date immunization schedules, click here.

Common Sicknesses in Child Care and School

The viruses responsible for colds or the flu cause the most common sicknesses in child care facilities and schools. Even though your child has had his immunizations, he can get other infectious diseases common in children such as colds, sore throats, coughs, vomiting, and diarrhea. In fact, most children in child care and school settings have as many as 8 to 12 colds a year. Diarrheal episodes occur once or twice a year in the typical child.

AAP Child Care Flu Exclusion Recommendation

Any child with respiratory symptoms (cough, runny nose, or sore throat) and fever should be excluded from their child care program. The child can return after the fever has resolved (without the use of fever-reducing medicine), the child is able to participate in normal activities, and staff can care for the child without compromising their ability to care for the other children in the group.

Whenever children are together, there is a chance of spreading infections. This is especially true among infants and toddlers who are likely to use their hands to wipe their noses or rub their eyes and then handle toys or touch other children. These children then touch their noses and rub their eyes so the virus goes from the nose or eyes of one child by way of hands or toys to the next child who then rubs his own eyes or nose. 

To reduce the risk of becoming sick with the flu, child care providers and all the children being cared for must receive all recommended immunizations, including the flu vaccine. The single best way to protect against the flu is to get vaccinated each year. This critically important approach puts the health and safety of everyone in the child care setting first. The flu vaccine is recommended for everyone 6 months of age and older, including child care staff.

Note: Children 6 months through 8 years of age may need two doses spaced one month apart to get the full benefit. These children should receive their first dose as soon as the vaccine is on hand in their community.

Questions to Ask Your Child’s School or Child Care Program 

  • When your child becomes sick, either at school or in a child care program, will you be notified in a timely manner? 
  • What plans are in place to lower the chances that your child will get sick from another child who is sneezing or sniffling, has diarrhea, or is vomiting?

Reducing Disease Transmission

In many child care programs, as well as public and private schools, parents are contacted right away when their child shows signs of even a mild illness, like a cold. In others, a child is allowed to stay at the facility as long as he doesn’t have a fever and can take part in most activities. Either way, be certain that the school or caregiver has a way to reach you at all times—make your phone numbers at home and work available, as well as your cell phone number.

In many child care facilities and schools, the staff simply cannot care for a sick child, although in others, the child is kept comfortable in a separate area so a cold, a cough, or diarrhea doesn’t spread throughout the facility. In these programs, a staff member is trained to care for ill children, often in a “get-well room” where they won’t pass the disease to others. There may also be a place to lie down while remaining within sight of a staff member if a child needs to rest. In some communities, special sick child care centers have been established for children with mild illnesses who should be kept apart from healthy children.

When to Keep Your Child Home

You can help prevent the spread of infectious diseases by keeping your contagious child home from school or child care until he can no longer spread his illness to others. Children should be kept home when they have: 

  • Diarrhea or stools that contain blood or mucus
  • An illness that caused vomiting 2 or more times during the previous 24 hours, unless the vomiting is known to be caused by a condition that’s not contagious
  • Mouth sores with drooling, unless caused by a noncontagious condition
  • Impetigo(a skin infection with erupting sores) until 24 hours after treatment has been started
  • Scabies(an itchy skin condition caused by mites) until after treatment has been given
  • Conditions that suggest the possible presence of a more serious illness, including a fever, sluggishness, persistent crying, irritability, or difficulty breathing

Even with all these safety measures, it is likely that some infections will be spread in the child care center. For many of these infections, a child is contagious a day or more before he has symptoms. That is another reason why it is important to wash your and his hands frequently. You never know when your child or another child is passing a virus or bacteria.

Fortunately, not all illnesses are contagious (eg, ear infections). In these cases there’s no need to separate your sick child from the other children. If he’s feeling well enough to be at child care or school, he can attend as long as a staff member can give him any medication he’s taking. Sometimes your child will become sick while at child care and need to go home. You will need to have a plan so someone can pick him up.

Measures Promoting Good Hygiene

To reduce the risk of disease in child care settings as well as schools, the facility should meet certain criteria that promote good hygiene. For example:

  • Are there sinks in every room, and are there separate sinks for preparing food and washing hands? Is food handled in areas separate from the toilets and diaper-changing tables?
  • Are the toilets and sinks clean and readily available for the children and staff? Are disposable paper towels used so each childwill use only his own towel and not share with others?
  • Are toys that infants and toddlers put in their mouths sanitized before others can play with them?
  • Are the child care rooms and equipment cleaned and disinfected at least once a day?
  • Is breast milk labeled and stored correctly?
  • Are children and their caregivers or teachers instructed to wash their hands throughout the day, including: 
    • When they arrive at the facility 
    • Before and after handling food, feeding a child, or eating 
    • After using the toilet, changing a diaper, or helping a child use the bathroom (Following a diaper change, the caregiver’s and child’s hands should be washed and the diaper-changing area should be sanitized.) 
    • After helping a child wipe his nose or mouth or tending to a cut or sore 
    • After playing in sandboxes 
    • Before and after playing in water that is used by other children 
    • Before and after staff members give medicine to a child 
    • After handling wastebaskets or garbage 
    • After handling a pet or other animal
  • Make sure your own child understands good hygiene and the importance of hand washing after using the toilet and before and after eating.

Additional Information:

Last Updated
Adapted from Immunizations & Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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