Asthma: An Individual Health Plan needs to be completed on diagnosed children, with treatment plans clearly documented. Children with asthma will be allowed to stay in the center as long as all needed medications and equipment for treatment are provided. No child with asthma will be allowed to stay at the center without these items, unless written documentation is provided from the physician stating that treatment is no longer necessary. For more information regarding accommodations or restrictions recommended by your physician, please ask to see the sick child policy in the program procedures manual.

Chicken Pox: The child will be excluded for six (6) days after the start of the rash or until all sores have crusted over and the child is well enough to participate. Children who have had the vaccine but develop signs of chicken pox may return when the sores are gone or crusted over. This is typically a shorter period of time than for those children without the vaccine.

Cold Sores/Herpes Simplex/Shingles: The child will be excluded if sores are in the mouth and the child is drooling, biting or mouthing toys, until lesions are healed or can be covered. Lesions on other parts of the body must have treatment for 24 hours and be covered before returning to class.

Colds and Flu: Children will be excluded a minimum of 24 hours and until fever-free for 24 hours.

Fifth Disease: Exclusion of the child is not necessary unless a fever is present. The period of infectiousness is before the onset of rash. Once the rash appears, the person is no longer infectious. Hand, Foot, and Mouth Disease (Coxsackie A virus): The child must be excluded for 24 hours or until fever-free and blisters are healing.

HIV/AIDS: The child will not be excluded unless for symptoms and illnesses outlined in this policy.

Impaired Immune System: The child can attend if feeling well enough to participate. Child will be excluded for open sores that cannot be covered or any contagious conditions

. Impetigo: The child will be excluded for 24 hours after treatment begins and there is no discharge and fever is gone. Proof of treatment may be required to return to class.

Infectious Conjunctivitis (Pink Eye): The child will be excluded for 24 hours after antibiotic treatment begins. Proof of treatment may be required to return to class.

Infectious Diarrhea (Shigella, E coli, Enterovirus, Salmonella, Rotovirus): Children will be excluded after 2 diarrhea stools. They may return after a minimum of 24 hours, no fever, and diarrhea ceases. In cases of epidemic outbreaks, recommendations of the Health Department will be followed. In the presence of a known outbreak of diarrhea, the child may be sent home after 1 diarrhea stool. Children returning from being sent home for diarrhea will be excluded immediately upon the first diarrhea stool for another 24 hours. Any child with bloody diarrhea will need to be evaluated by a physician and have a statement of clearance in order to return to class.

Lice: Parents of children identified as having live lice will be contacted by a school or district representative who will advise them of the finding and explain and/or define the problem and recommend treatment. The child can return to school when one application of a special lice-killing shampoo has been applied to the child’s hair which may be the same day and no later than the next day. The child should bring a note signed by the parent that shampoo treatments and household requirements are being met, the bottle cap or box top of the shampoo as evidence of the treatment, and a designated person checks the child to determine they are lice-free. Your school district may have a nit-free policy in place. Check your school’s policy for further information.

Otitis Media (ear infection): These are not contagious and do not require exclusion unless the child is too ill to participate in normal activities or needs more care than the teacher can give without compromising the care of the other children. If fever is present, child must be excluded until fever-free for 24 hours.

Pinworm: The child will be excluded until seen by a physician and has received the first treatment. Ringworm (of the scalp): The child will be excluded for a minimum of 24 hours, and will require an oral medication and shampoo treatment. A physician's clearance indicating diagnosis and treatment prescribed is required prior to returning to the classroom. Scalp lesions must be covered, if possible.

Ringworm (of the skin): The child will be excluded for 24 hours after treatment begins and sores are covered. Proof of treatment (such as the label from appropriate medication) may be required for return to the classroom.

Roseola: A child with a fever and rash should be excluded until seen by a physician and fever-free for 24 hours. A child with a rash and no fever may return to the classroom.

RSV (respiratory syncytial virus): The child will be excluded a minimum of 24 hours and until fever-free for 24 hours. If symptoms include rapid breathing/breathing difficulty, severe wheezing and frequent use of breathing treatment, and required a level of care that would jeopardize the health and safety of other children, then the child will be excluded until symptoms are gone and he/she is well enough to participate.

Scabies: The child will be excluded for 24 hours after treatment has been completed.

Strep Throat/Scarlet Fever/Scarletina: The child may return to the classroom after the child has been on antibiotic therapy for 24 hours and has been fever-free for 24 hours. This is a minimum of 48 hours from when treatment began.

Thrush: The child will be excluded for 24 hours after treatment begins.

EXCLUSIONS FOR SYMPTOMS A child exhibiting the following symptoms shall be excluded unless a health care provider determines and documents all of the following:

1. the child is well enough to attend

2. the condition is not contagious

3. the condition is not harmful to others in the classroom, including staff and children

Coughing: If a child has severe coughing where the child turns red or blue in the face or make high-pitched whooping sounds or severe wheezing, the child must be excluded until the symptoms are no longer present.

Diarrhea: Changes from the child's normal stool patterns, stooling out of diapers/underwear, situations that require frequent diaper changes, or the child being unable to get to the bathroom in time will require exclusion. Children may have diarrhea resulting from food intolerance, medications, new foods, etc. that are not disease processes, but if these conditions result in any of the above situations, the child will be excluded until the diarrhea has ceased or is under control. (Under control means containable in diaper, not frequent, and clearance from physician that is not a disease process.) Note: stool in any form can be responsible for carrying diseases and must be handled according to #3–4: Hygiene Procedures regarding hand washing and #3–8: Body Fluid Guidelines for handling room contamination.

Fever: Temperature above 100 degrees axillary (under the arm, skin temperature) or 101 degrees (orally or ear) will require exclusion. Children must be fever-free for 24 hours without the use of fever reducing medications.

Pain: When a child is in obvious pain, the parent or guardian will be notified and child will be excluded until pain has been resolved.

Rash: If a child has a rash on the body that is not diaper rash, poison ivy, or a known allergic reaction, this child will be excluded until a health care provider determines the symptoms do not indicate a communicable disease. A statement of clearance will be required before the child may return to class.

Runny Nose: If a child has a runny nose, accompanied by a fever, child will be excluded for 24 hours or until fever-free.

Too Sick to Participate: If a child is generally not feeling well, irritable, contentiously crying, unable to participate in activities, or requiring one-on-one attention from staff, the parent/legal guardian will be notified and the child will be excluded until able to participate.

Vomiting or Upset Stomach: If a child vomits once and has no other symptoms, the child does not need to go home. If a child vomits once and there is a known outbreak of illness causing vomiting or if a child vomits twice, this child will be excluded for 24 hours or until vomiting ceases.

OTHER CONSIDERATIONS No child shall be excluded based solely on his/her health care needs, and/or medication requirements unless:

1. Keeping the child poses a significant health or safety risk to that child or others coming into contact with that child.

2. The risk cannot be eliminated or made acceptable through reasonable modifications of policies, procedures or practices or by providing auxiliary aids which would enable the child to participate without fundamentally altering the program.

We respect parental concerns regarding employment and the difficulties of finding alternative child care providers. These policies are for the protection of each individual child and the staff. We must consider the best interests of all the children that we serve, thus enforcing these policies without exception. We also respect the health of all our staff and caregivers and to the families that may be affected by the spreading of contagious diseases.

In cases of unusual or prolonged illness of a child or staff member, a medical doctor's statement may be required before returning to the classroom.

For clarification - “a day” means a 24 hour period of time. Example — A child may return to class when he has been fever free for a 24 hour period — without fever reducing medications.

*Policy guidelines were based on recommendations and standards from the American Academy of Pediatrics, American Public Health Association, The Kentucky Department of Education School Health Services Manual, and the U.S. Department of Health and Human