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When to Exclude Sick Kids from Childcare Centers and Schools |
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| Disclaime |
Original Adapted from Red Books 2003, updated from AAP revised guidelines in 2009 (Pediatric News Feb.,2009)
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The page started on 02/2006, updated on 04/18/2009 |
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If you have, or suspect you have, a health problem you should consult your physician. |
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| Children should be excluded from the child care setting for the following medical conditions |
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Illness that prevents the child from participating comfortably in program activities.
Illness that results in a need for care that is greater than the staff can provide.
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The condition suggesting possible severe illness: fever, lethargy, inexplicable irritability or persistent crying, uncontrolled coughing, wheezing, difficult breathing, or unusual signs for a child
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Persistent abdominal pain or intermittent pain associated with fever or other signs or symptoms
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| AAP recommendations for inclusion & exclusion from out-of-home child care setting/Schools: |
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“Mild illness is common among children; 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. Disease may occur as a result of contact with children with asymptomatic infection. The risk of illness can be decreased by following common-sense hygienic practices.” - Red Book |
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Symptoms and signs |
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Re-admission until … |
| Abdominal pain persistent > 2 hours or intermittent pain with other symptoms or signs |
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The symptom resolves or/and a physician determines that the cause is not contagious |
| Cough- severe or persistent coughing, making a high-pitched whooping sound, or with difficulty breathing |
| Diarrhea with blood in the stool not explained by dietary changes, medications, or hard stools; diarrhea with frequent, runny, watery stools |
| Earache if the child requires more care than the staff can reasonably provide |
| Fever with behavior changes or other symptoms of illness such as a sore throat, rash, vomiting, diarrhea, earache, etc; infant <4 months old with unexplained fever |
| Irritable,unusaual tiredness, or other signs of possible severe illness |
| Pink eye with white or yellow eye discharge (Purulent conjunctivitis) |
| Rash with fever |
| Sore throat with fever and swollen glands or mouth sores with drooling |
| Vomiting with 2 or more episodes in the previous 24 hours |
| Wheezing |
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Medical conditions |
Re-admission until … |
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Fifth disease
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"Exclusion has no preventive benefit." |
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Hand, foot, andmouth disease |
no sores in the mouth with drooling, no fever or behavior change |
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Head lice
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After the first treatment. |
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Hepatitis A virus (HAV) infection |
1 week after an onset of illness or jaundice or as directed by the health department. |
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Impetigo (Skin infection) |
24 hours after initial antibiotic treatment. |
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Measles |
4 days after an onset of rash |
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Mump |
9 days after an onset of parotid gland swelling. |
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Pertussis |
5 days of appropriate antimicrobial therapy (which is to be given for a total of 14 days) |
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Rubella |
6 days after an onset of rash. |
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Scabies |
After treatment is initiated
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Strep throat or other strep infections |
24 hours after initial antibiotic treatment. |
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Tuberculosis |
An appropriate health care provider or health official certifies that the child is in approprite therapy and can attend care. |
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Varicella (Chickenpox) |
All lesions have dried and crusted (usually 6 days after onset of rash). |
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