▸ Fever. "Children with fever should not be excluded automatically, unless the fever is accompanied by behavior change or other signs or symptoms of illness," said Dr. Jana. The exception to this is children younger than 4 months old with unexplained fever.
▸ Respiratory illness. Most respiratory illnesses do not require exclusion; however, a child with persistent coughing or trouble breathing should be evaluated for pneumonia, asthma, or serious respiratory infection, such as whooping cough, Dr. Jana noted.
▸ Earache, no fever. "This child should be excluded if he or she requires more care than the staff can reasonably provide," said Dr. Jana.
▸ Lice. "Lice are a nuisance, but they're not a health hazard," she said. "Children with lice should be excluded, but they don't have to be sent home right away. It can wait until the end of the day."
Revised 'When to Exclude' Criteria
With the exception of the noted updates, most of the exclusion criteria outlined in the revised "Managing Infectious Diseases in Child Care and Schools" are consistent with the national illness exclusion guidelines published in 2002. These include:
▸ Tuberculosis, until an appropriate health care provider or health official certifies that the child is in appropriate therapy and can attend care.
▸ Impetigo, until 24 hours after treatment has been initiated.
▸ Chickenpox until all sores have dried and crusted (usually 6 days).
▸ Mumps, until 9 days after an onset of parotid gland swelling.
▸ Hepatitis A virus, until 1 week after an onset of illness or jaundice or as directed by the health department.
▸ Measles, until 4 days after rash onset.
▸ Rubella, until 6 days after rash onset.
▸ Fever, when accompanied by behavior changes or other symptoms.
▸ Diarrhea.
▸ Blood in the stool not explained by dietary change, medication, or hard stool.
▸ Vomiting two or more times in a 24-hour period.
▸ Body rash with fever.
▸ Sore throat with fever and swollen glands or mouth sores with drooling.
▸ Severe coughing with the child getting red or blue in the face or making a high-pitched whooping sound after coughing.
▸ Persistent abdominal pain (more than 2 hours) or intermittent pain with other signs and symptoms.
▸ Signs of severe illness such as irritability, unusual tiredness, or neediness that compromises caregivers' ability to care for other children.
▸ Uncontrolled coughing or wheezing, continuous crying, or difficulty breathing.