Young children frequently become mildly ill. Infants, toddlers and preschoolers experience a yearly average of six respiratory infections (colds) and can develop one to two gastrointestinal infections (vomiting and/or diarrhea) each year.

Deciding whether to keep your child at home or when to send a child home from child care or school can be difficult. It is important for parents and caregivers to discuss what observations have been made and agree on a plan of action.

Parents should contact the child care program or school when their child is sick and describe the illness and symptoms. If the health care provider makes a specific diagnosis (such as strep throat, conjunctivitis or chicken pox), let program staff know so other families can be alerted.

Sometimes it is necessary for a child to remain at home.

1. The child does not feel well enough to participate comfortably in usual activities (such as extreme signs of tiredness, unexplained irritability or persistent crying).
2. The child requires more care than program staff is able to provide without effecting the health and safety of the other children.
3. The illness is on the list of symptoms or illness for which exclusion is recommended.

ILLNESS OR SYMPTOM	EXCLUSION IS NECESSARY
DIARRHEA with illness (vomiting, fever) Diarrhea: stools that are watery and frequency is twice what is usual	Yes - diarrhea that is not contained in the diaper or by the child’s ability to use the toilet, should also be excluded
CHICKEN POX	Yes - until blisters have dried and crusted (usually 6 days)
CONJUNCTIVITIS (pink eye) OR EYE DISCHARGE (thick mucous or pus draining from the eye)	Yes - until 24 hours after treatment If your health provider decides not to treat your child, a note is needed
COUGHING (severe, uncontrolled coughing or wheezing, rapid or difficulty in breathing)	Yes - medical attention is necessary. Note: Children with asthma may be cared for in child care/school with a written health care plan and authorization for medication/treatment
COXSACKIE VIRUS (hand, foot and mouth disease)	No - may attend if able to participate in child care or school activities, unless the child has mouth sores and is drooling
CROUP (see COUGHING)	Seek medical advice Note: May not need to be excluded unless he/she is not well enough to participate in usual activities
FEVER with behavior changes or illness Fever is as an elevation of body temperature above normal. Note: An unexplained temperature of 100°F or above is significant in infants 4 months of age or younger and requires immediate medical attention	Yes - when fever is accompanied by behavior changes or other symptoms of illness, such as rash, sore throat, vomiting, etc. Note: Fever alone is not a reason to exclude from care
FIFTH’S DISEASE	No - child is no longer contagious once rash illness appears
HEAD LICE OR SCABIES	May return after treatment starts
HEPATITIS A	Yes – until 1 week after onset of illness or jaundice and when able to participate in child care/ school activities
HERPES	Yes – if area is oozing and cannot be covered, e.g., mouth sores
IMPETIGO	Yes – until 24 hours after treatment starts
Body RASH with fever	Yes - seek medical advice. Any rash that spreads quickly, has open, weeping wounds and/or is not healing should be evaluated Note: Body rash without fever or behavior changes usually does not require exclusion from child care or school, seek medical advice
Mild RESPIRATORY OR COLD SYMPTOMS (stuffy nose with clear drainage, sneezing, mild cough)	No – may attend if able to participate in child care/school activities
Upper RESPIRATORY COMPLICATIONS large amount of yellow-green nasal discharge extreme sleepiness ear pain fever (above 1010 axillary (under arm))	Yes – seek medical advice and decide whether your child should be in child care or school
RINGWORM	May return after treatment starts Keep area covered for the first 48 hrs of treatment
ROSEOLA	Yes – seek medical advice Note: A child with rash and no fever may return to child care or school
RSV (Respiratory Syncytial Virus)	Seek medical advice. Once a child in the group has been infected, spread is rapid Note: A child does not always need to be excluded unless he/she is not well enough to participate in usual activities
STREP THROAT	Yes - until 24 hours after treatment and the child has no fever for 24 hours
VACCINE PREVENTABLE DISEASES	Yes – until judged not infectious by the health care provider
VOMITING (2 or more episodes of vomiting in the past 24 hrs)	Yes – until vomiting resolves or a health care provider decides it is not contagious Observe for other signs of illness and for dehydration
YEAST INFECTIONS (thrush or Candida diaper rash)	No – may attend if able to participate in child care/school activities Follow good hand washing and hygiene practices

Handout developed by The Children’s Hospital School Health Program, Denver, CO (303)-281-2790, 1995, revised 1999, 2001, 2003

References
- American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care, Caring for Our Children: National Health and Safety Performance Standards, Second Edition, Elk Grove Village, IL 2002
- Centers for Disease Control and Prevention, ABC’s for Safe and Healthy Child Care. A Handbook for Child Care Providers. Atlanta, GA. U. S. Department of Commerce; 1996
- Colorado Department of Public Health and Environment, Communicable Disease Epidemiology Program, Infectious Disease in Child Care Settings: Guidelines for Child Care Providers, Denver, CO., December 2002
- Kendrick AS, Kaufman R., Messenger KP, Eds. Healthy Young Children: A Manual for Programs. Washington, D.C. National Association for the Education of Young Children; 2002