Mildly Ill Children In Child Care

DEFINITION

A "mildly ill" child is defined as a child with a "common temporary illness, non-progressive in nature and not on the Division of Health Communicable Disease Chart". This definition has been approved and adopted by the Department of Health and Family Services, Division of Regulation and Licensing.

Background - From national sources related to health and child care, the following information may be helpful in better understanding the issues:

Over seven million children under the age of 6 are in some type of out-of-home child care in the United States.

Employee absenteeism resulting from child care associated illness is estimated to cost business between $160 - $400 million dollars annually. One source cited the costs to be as high as $2-$12 billion dollars annually.

The incidence of illness in preschool children averages <5 - 12.8 days a year for each child. One source stated that children's illnesses for which parents must miss work, account for 5.6 - 28.8 days per year for a female employee.

The incidence of upper respiratory infections, earaches (otitis media), acute diarrhea, and Influenza is increased among children attending group day care centers as compared to children attending family day care or home reared children.

According to focus groups conducted by the Centers for Disease Control and Prevention (CDC) with providers and parents of children enrolled in child care, the most frequent sources of tension between child care providers and parents were conflict over whether a mildly ill child remains in child care and when a child recovering from an infectious illness may return to the usual child care arrangement.

Options - Parents of sick children usually have the following options to choose from for care when their children are ill:

In-home care provided by the parent, relative, friend or trained worker (trained workers tend to be very expensive)

Care at the child's regular child care provider (parents" preference)

Care for ill children in a separate program, i.e., family child care home, freestanding or satellite site to a group child care center, or work-site center (all relatively expensive).

Elements Necessary for a Suitable Arrangement for the Care of Mildly Ill Children

Care giver is able to match the child's activity level with the child's needs. The child must be able to rest in a quiet place away from other children with appropriate supervision, if necessary.

Good hygiene practices are in place to help prevent the spread of infection or illness. Separating ill children, including separate food handling and toileting, may help reduce the spread.

Adequate feeding and hydration is available including recognition by the care giver that additional oral fluids and nutritional foods are often needed.

Appropriate emergency procedures and practices are in place.

The setting and the care giver are familiar and comfortable for the child. The caregiver who knows the child is more able to judge the severity of the child's complaints, and illness signs.

Competent health personnel are readily available for consultation.

Care for the sick child is available at days and times when it is needed.

The cost to parents for this care is acceptable and reasonable.

Recognizing Illnesses in Children - The following behaviors may indicate the onset or presence of illness in children.

Alertness-decreased attention to environment; doesn't look around, doesn't look at the care giver.

Motor movement-decreased body movement; decreased kicking and waving of arms or limp arms and legs.

Playfulness-decreased spontaneous vocalization (cooing, laughing, gurgling); no smiling; face appears anxious or child has dull expression and doesn't attempt to play with toys/favorite objects.

Consolability-child does not stop crying when held by parent or care giver; unable to "settle"; constant "fussiness."

Quality of cry-whimpering, sobbing, moaning, high pitched cry or absence of crying.

Wakefulness-stays awake or wakes quickly to stimuli; eyes close only briefly then immediately awakens, only awakens with prolonged stimulation or unable to rouse.

Primary Precautions for Child Care Programs to Prevent the Spread of Disease

Good hand-washing

Regular cleaning and sanitizing of the child care environment

Following universal precautions as spelled out in the 1192 OSHA regulations

Requiring immunizations

Reporting illnesses to both enrolled families as well as to public health and/or licensing departments

Excluding children who are infectious from programs

Principles for Exclusion of Mildly Ill Children from Child Care - Children with minor illness need NOT be excluded unless one of the following exists:

The illness prevents the child from participating comfortably in program activities;

The illness results in a greater care need than the child care staff can provide without compromising the health and safety of other children in the program;

The illness is known to be transmitted among, by, and to children and exclusion has a potential for reducing the likelihood of secondary cases.

Children who shed intestinal pathogens in their stool, but exhibit no other symptoms, except for children diagnosed with Shigella or E. Coli in the stool.

Children with chronic Cytomegalovirus (CMV) infection. (Pregnant child care workers should be cautioned about the need for strict handwashing.)

Children with chronic Hepatitis B.

Children with HIV infection.

PLEASE USE THE EXCLUSION GUIDELINES EACH OF THE WISCONSIN DIVISION OF PUBLIC HEALTH AS YOUR PRIMARY SOURCE OF INFORMATION FOR EXCLUSIONS.
To obtain a copy, contact the Child Care Information Center (CCIC).
Phone: 800-362-7353 Email: ccic@dpi.state.wi.us

References:

Cohen, Abby J. Caring for Mildly Ill Children in Child Care, Information Exchange, January 1998

Cordell, Ralph, PhD,; Solomon, Steven L., MD.; Hale, Cynthia M.; Exclusion of Mildily Ill Children from Out-Of-Home Child Care Facilities, Infections in Medicine. January, 1996

Desguin, Barbara W. MD. And Murray, Dennis L., Triage Decision in Child Care for Sick Children, American Journal of Diseases in Children. Volume 144, February, 1990

Landis, Suzanne E., MD. MPHH.; Chang, Albert, MD., MPH.: Child Care Options for Ill Children, Pediatrics. Volume 88, No. 4, October 1991

WCCIP • 2109 S. Stoughton Road, Madison WI 53716 • Ph 800.366.3556 • Fx 608.224.6178
These tip sheets developed by WCCIP, March 1998 with funding from the WI Dept. of WFD, Office of Child Care, and DHFS

Mildly Ill Children In Child Care Colleen Cantlon, RN, M.Ed Infant, Young Child Consultant Bureau of Family and Community Health, Division of Public Health

Mildly Ill Children In Child Care
Colleen Cantlon, RN, M.Ed Infant, Young Child Consultant
Bureau of Family and Community Health, Division of Public Health