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Recommendations for Developing
Child Care Health Policies
by Judy Matthews, RNBS, Certified Child Care Health
Consultant,
Deciding whether or not to allow children to remain in
childcare due to mild illness is sometimes difficult. When it comes to
health and safety, parents and childcare providers want what is best for
children in out-of-home care. When making a decision or developing a
policy it is important to know or be able to find current health and
safety information, communicate with parents and staff, and keep accurate
records. While a child’s illness presents difficulties for working
parents, it is the job of a child care provider to maintain a healthy and
safe environment for all the children enrolled.
There are many resources to help you formulate a health
policy on this topic. To
help you think of your own practice, please read the following scenario
and try to decide what you would do. Following the scenario is a list of
resources that may be of help as you continue to design high quality
childcare health policies for your program.
To get you started, please think about and consider the
following statement:
Mild illness is common among children, and most children
will not need to be excluded from their usual source of care for mild
respiratory tract illness, because transmission is likely to have
occurred before symptoms developed in the child or is a result of
contact with children with asymptotic infection. (The Red Book, 2001)
Scenario:
Sara’s mother brings her to the childcare center. You
observe Sara’s symptoms when you perform her daily health check:
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Nose is running with clear mucous.
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Coughs every so often.
-
Rubbing left eye. Eye is red and has yellow drainage
from it.
-
Child lies on the carpet and does not want to join
the other children
-
Skin is not warm to the touch
Would you allow her to stay in childcare?
To assist you in making your decision, let’s look at a
list of conditions requiring exclusion due to illness adapted from, The
Red Book, The ABC’s of Safe and Healthy Care (CDC, 2001 and the
National Health and Safety Performance Standards APHA, AAP, 1992). These
resources can provide you with some guidance related to whether Sara
should attend childcare today and are listed below.
List of conditions that indicate a child might need to
be temporarily out of child care due to mild illness:
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Illness that prevents the child from participating
comfortably in program activities.
-
Illness that results in a greater need for care than
the staff can provide without compromising the health and safety of
other children
-
The child has any of the following conditions: fever,
lethargy; irritability, persistent crying, difficult breathing, or
other manifestations of possible severe illness
-
Vomiting 2 or more times during the previous 24 hours,
unless the vomiting is determined to be caused by a non communicable
condition and the child is not in danger of dehydration.
-
Purulent conjunctivitis (defined as pink eye or red
conjunctivitis with white or yellow eye discharge, often with matted
eyelids after sleep and eye pain or redness of the eyelids or skin
surrounding the eye, until examined by a physician and approved for
readmission, with treatment.)
Certain conditions do not require that children
stay out of childcare unless
recommended by the child’s health care provider or the public health
department.
Here is a partial list of conditions that do not
warrant exclusion due to mild illness unless recommended by a health care
professional:
-
Presence of bacteria or viruses in urine or feces in
the absence of illness or symptoms (i.e., diarrhea). Exceptions
include potentially serious bacteria such as E. coil, shigella or
salmonella.
-
Nonpurulent conjunctivitis, which is pink eye with a
clear, watery discharge and without fever, eye pain, or eyelid redness
-
Rash without fever and without behavior changes.
-
Diagnosed cytomegalovirus (CMV) infection
-
Carrier of Hepatitis B virus, as long as they have no
behavioral or medical risk factors such as unusually aggressive
behavior (frequent biting and or scratching), oozing, rashes or
bleeding.
-
HIV infection, provided the child’s health, immune
status and behavior are appropriate as determined by the child’s
medical provider and
When faced with health and safety decisions such as one
above, it is helpful to have written policies. Written health policies can
provide guidance to both parents and providers so that you become partners
in implementing healthy and safe practices. Writing health policies and
sharing them with families during enrollment, orientation or when illness
is on the increase can help get the message across that your program has
health policies that must be followed. What you write in your policy is as
important as how you share this information. Clear, simple, and direct
information that also includes resources about alternative or backup child
care if children are sick sends the message that you have important
procedures to follow, but that you understand and care about the
challenges parents face when their child is sick. For additional
information, it is recommended that you contact your child’s doctor
in helping you to weigh the benefits
and or risks of excluding children from childcare due to illness.
If your program does not have a health consultant or if
you have questions about health and safety resources or want assistance
developing health policies, I, as a part of the Center for Community
Inclusion and Disability Studies, may be a helpful resource.
In addition to training and background in health education
and nursing, I recently completed a course to become a Certified Child
Care Health Consultant through the National Training Institute at the
University of North Carolina, Chapel Hill. By attending and successfully
completing this program I became the only person in Maine with this
designation. I learned a lot, made some wonderful connections and have
some great resources. I am interested in sharing information on such
topics as injury prevention, nutrition, oral health, infectious disease,
cultural sensitivity, playground safety, environmental rating scales,
poison control, and including children with special health care needs in
community child care. I am part of the University of Maine Center for
Community Inclusion and Disability Studies (CCI) staff and work on the ChildCare Plus ME and LEARNS Early
Childhood projects. You can contact me directly at our toll free number
1-866-230-4520 (voice/tty) or by email at judy.matthews@umit.maine.edu.
I work with other CCI staff who provide telephone
consultation; video review and consultation; on-site consultation; staff
development and training activities and resource information related to
including all children birth through age twelve in community settings. The
Maine Department of Human Services’ Office of ChildCare and Head Start,
the Maine Department of Education and the University of Maine jointly fund
this project. Services are provided free of charge to the child care
community.
If you have a computer and use e-mail and the Internet,
you can also visit our web site at www.ccids.umaine.edu
To Find More Information:
The ABC’s of Safe and Health Child Care: A Handbook for
Child Care Providers (Revised 2001)
by the Centers for Disease Control (CDC)
This handbook has up-to-date information to help childcare
providers reduce sickness, injury and other health problems in childcare
settings. It includes recommended policies and brief fact sheets on many
common illnesses. Information in this handbook applies to all child care
providers in any setting, whether care is provided in a center or a home.
It is available on-line at www.cdc.gov/ncidod/hip/ABC/abc.htm
The spiral bond book costs $19.00 and can be ordered by
calling 1-800-553-NTIS (order #PB97-104723).
Model Child Care Health Policies – Revised 1997
by the Early Childhood Education Linkage System (ECELS)
This booklet is jointly
published and distributed by the National Association for the Education of
Young Children (NAEYC) and the American Academy of Pediatrics. It includes
model health policies for all child care settings. Information is provided
in reproducible forms and includes resource lists. The booklet costs $5.00
and can be ordered from NAEYC at 1-800-424-2460 or by visiting their
website at www.naeyc.org
References
The Red Book, Report of the Committee on Infectious
Diseases of the American Academy of Pediatrics (2001)
American Public Health Association and American Academy of
Pediatrics. Caring For Our Children: The National Health and Safety
Performance Standards: Guidelines for Out Of Home Childcare Programs.
Washington, D.C.: Authors, 2002
Department of Health and Human Services, U.S. Public
Health Service and Centers for Disease Control and Prevention. The ABC’s
of Safe and Healthy ChildCare: A Handbook for childcare Providers
Pennsylvania Chapter, American Academy of Pediatrics.
Model ChildCare Health Policies PA, ECELS, American Academy of Pediatrics,
3rd Edition, June 1997.
Return to FACTS Vol 5
This is an official publication of The University of
Maine
A member of the University of Maine System
Updated:
01/11/2007
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