TIPS - Table of Contents

What to do with a mildly ill child while the parent works, or attends school, is one of the dilemmas confronting parents, employers and child care providers today. With the advent of the Wisconsin Works, or W-2 program, more parents are entering the workforce than ever before. The child care licensing rules attempt to address what must happen if children who show signs of a mild illness are to receive care in a child care setting. The definition of a mild illness, for licensing purposes, is any common, temporary illness, non-progressive in nature, that is not listed on the Division of Public Health Communicable Disease chart.1 Most mild illnesses tend to be respiratory in nature, primarily cold and flu type illnesses. However, children suffering from ear infections or similar types of illness or recovering from chronic illness episodes may also seek care in a mildly ill child care facility. If a center wishes to offer care for mildly ill children, it will need to meet the requirements of HFS 46.07 (6)(d) which specify that the room for the mildly ill child must be self contained and separate from children who are well. In addition, the parent must consent, in writing, to the provision of care of the mildly ill child, and the health policy of the center must allow a mildly ill child to remain in care at the center. The center will need to develop a written plan outlining the procedures to be followed when offering care for a mildly ill child. Some of the items that must be addressed in a center's written plan for the provision of care to mildly ill children include the following items:

Admissions and Exclusion Policy:

The center must identify the illnesses that can be accommodated in the mildly ill room. A child who is suffering from a communicable disease listed on the Department of Public Health Communicable Disease chart must be excluded from child care as indicated on the chart. A child may return to the child care setting (perhaps in a mildly ill room) once the child has been excluded for the length of time indicated on the chart. Some examples of a mild illness may include a fever of 104 degrees or less with no symptoms of a communicable disease and controlled by the use of anti-fever medications, physician diagnosed ear infection or other infections for which an antibiotic has been prescribed, care for children who have completed the required absence period for a contagious disease, but are still not feeling his/her normal self or children who are recovering from a episode of chronic illness such as asthma and who may need a little more rest than they could get in the regular child care room. Other questions that must be answered when developing the admission and exclusion policy relate to advance registration requirements including whether a parent must call by a certain time to ensure a spot for the mildly ill child and acceptance of children from those not regularly enrolled in the child care center.

Staffing Procedures:

Decisions must be made on how the room will be staffed and provisions for ensuring that the correct staff-to-child ratio is met at all times. Consideration must be given to the admissions and exclusions policy that will be developed to help determine whether staff will be "on call" for an admission into the room. Staff may not be pulled from another classroom in the center to meet staff-to-child ratio in the mildly ill care room unless there is sufficient staff present in the center to ensure that staff-to-child ratios in all rooms or areas of the center are met.

Staff Training:

In addition to the entry level training requirements for child care workers as indicated in HFS 46.05 (1)(a), (b), (c) &(d), what type of training will you require for staff who work in the mildly ill room? Will staff need to have First Aid and CPR certification or other training?

Monitoring and Evaluation:

Parents of mildly ill children need to be kept informed about the child's condition. The center will need to develop tools to be used by staff that include evaluation of a child attending the mildly ill room, fever or lack thereof, food and liquid intake, medications given, activity level of the child, any naps taken by the child and other information that may be of interest to the child or parent.

Programming:

A center that offers care of the mildly ill child will need to develop appropriate programs for the children attending the room on any given day. Developmentally appropriate activities will need to be available to each child with a minimum of three activities to choose from at any given time. Some children may be well enough to play outdoors and the center must accommodate these children. Television may be offered as an activity, but no child may be required to watch TV. Since children of varying ages may be receiving care in the mildly ill room at the same time, care must be taken to ensure that materials used do not present a hazard to the youngest child in the room.

Infectious Disease Control:

A center must develop procedures for handling body wastes such as vomitus or diapers using the standard (universal) precautions as specified in the Occupational Safety and Health Administration (OSHA) materials. Hand washing is particularly critical in disease control and prevention. A sink with hot and cold running water must be located in the room designed to serve mildly ill children. This sink may not be used for food preparation. Sanitizing and disinfecting procedures must be developed and implemented in the mildly ill room.

Emergency Procedures:

The center must develop procedures on how to handle medical emergencies related to the children cared for in a mildly ill room. Some types of medical emergencies might include fever that rises quickly, dehydration due to lack of fluid intake or high fever, abrupt worsening in a child's condition, appearance of other symptoms that might relate to a worsening of a present condition or a new condition presenting itself. (See the attached Appendix H Get Medical Help Immediately, from the American Red Cross Child Care Course, 1990, for additional information on when to seek medical help.) In addition, emergency evacuation procedures need to be developed taking into account the circumstances that may affect prompt evacuation from the mildly ill room.

Rooms for mildly ill children, which are incorporated into regular child care programs, are not allowed to be used for care of healthy children, even if there are no ill children in care on any given day. The regular licensed capacity of a center will be determined by the space available for regularly enrolled children with an additional capacity for the mildly ill room. In other words, the license will be issued to serve X number of children, plus X number in the mildly ill room.

Financial considerations are a major concern when a center offers space for mildly ill children. Since the attendance in this room may be sporadic and small, there are particular financial challenges that must be incorporated into the budget. These budgetary items may be the cost to staff the room on an as needed basis given the possibility that only one child will need care on a given day, which would require one staff person for the mildly ill room and the expenses related to having a room available but being unable to enroll children on a regular basis to occupy that room.

There is anecdotal evidence to suggest that parents indicate they will use a mildly ill child care program, but when their child becomes ill, will attempt to find care in their own home for the sick child. Therefore, centers considering this type of care arrangement need to carefully consider the results of a needs assessment study.

Providing care to mildly ill children in a child care setting can provide great challenges for the center. Centers are attempting to meet the needs of children and their families and balance these needs with those of employers. Care for mildly ill children in a child care setting is certainly an area that is beginning to emerge on the child care scene.

1. Available free from the Wisconsin Child Care Information Center (CCIC)
Phone: 608-224-5388 @ 800-362-7353 @ Fax: 608-224-6178