Know

Each child's day should begin with a simple health check. This is a quick way to make sure the child is healthy enough to be in your infant and toddler program. Children occasionally get a runny nose, cough, or mild fever. This usually causes little worry for teachers and families. However, at times, child's illness can become more severe. Programs have policies to guide decision-making when dealing with ill children. Because you know the children in your classroom well, you can most likely tell when a child in your care is well enough to participate in activities, and recognize when a child is too sick to stay in the program. Your program likely has guidelines to help you make this decision. The American Academy of Pediatrics (2019) offers three key factors in deciding whether a child is too sick for child care:

• The child cannot participate in activities
• The child's illness presents a risk to other children or staff
• You cannot care for the child while maintaining appropriate care for the other children

If a child meets any of these criteria, it is likely that they should be sent home. See the resources in the Learn Activites section below for a complete list of illnesses that do or do not merit exclusion from child care.

Daily health checks are a good time to evaluate an infant or toddler's health to make these decisions. Remember, it is up to your program--not the family--to decide whether a child is healthy enough to stay in child care. You must consider the health of the other children and staff in your program.

Daily health checks also provide a record of any changes in the child's appearance or behavior, which can be important if you suspect child abuse or neglect. This information can also be very useful for families if the child is suspected of having a long-term physical or mental health need. Health checks, if conducted sensitively and documented thoroughly, can help you build relationships with children and families. This lesson will answer questions many caregivers may have about health checks.

What Is a Health Check?

A health check is a quick evaluation of a child's body, mood, and behavior. As part of your health check, you should also gather information from families. You want to know if there are any health changes that affect the child or family members. A simple, "Is everyone feeling alright today?" can start the conversation. As you get to know a child well, you will quickly notice any differences from day to day. The purpose of a health check is to notice any illnesses or health concerns the infant or toddler might be experiencing.

When Should I Do a Health Check?

Health checks should be conducted as a part of your daily routine while welcoming infants, toddlers, and families to the program. Ideally, health checks should be completed before the parent or guardian leaves the building. This will give you a chance to talk with the parent or guardian if you suspect the child is ill or if you have questions about any changes in the child's appearance or behavior.

Quick health checks should also be conducted throughout the day. Observe children for changes in health or well-being. Infants' and toddlers' health can change quickly; it's important that you assess children's health and behaviors throughout the day for anything unusual. Unusual behaviors might signal that something is wrong; if so, you will want to address it right way.

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What Does a Health Check Look Like?

There are a lot of many ways to conduct a daily health check. What's important is, first, that families understand that a daily health check is part of your daily routine, and second, that children aren't made to feel uncomfortable while you conduct your health check. Watch this video to see an example of an infant and toddler caregiver checking a child's health.

What Should I Look For?

Your program may provide you with a daily health check form. If not, the Apply section of this lesson has two samples that you can adapt for your own use. When doing a health check, be sure to use all your senses.

• Look over the child's body. Do you see any bruises, cuts, scrapes, or burns? Do you see any open sores or any fluid coming from the child's eyes or nose? Do you see any scratching of the head or body? Do you see any unusual behaviors (sad, sleepy, irritable, lack of appetite)?
• Listen for a cough, wheezing, or a stuffy nose.
• Feel the child's skin for a fever or signs of dehydration if they appear ill.
• Use your sense of smell to check for any unusual odors.

Document any problems or changes on your daily health check form. If you think a child is ill and should not be in child care, talk with the parent or guardian immediately. This will allow them to make alternate plans.

Whether or not you see a problem, it is important to document daily health checks. Record that you did a health check each day, and mark anything unusual for the child or family. Be sure to save this documentation for at least 30 days. In the event of a disease outbreak, these records can be very useful to your program and public health officials.

Exclusion and Readmission Policies

Your Service's or program's exclusion and readmission policies take into consideration the health of the child, other children, staff, and the needs of the family. It's important that you adhere to your program's policy and help families understand your program's health-related expectations and requirements.

Your administrator is responsible for determining whether or not a child needs to be excluded from child care for health reasons and for how long. It's your responsibility to know:

• The conditions and symptoms that do not require exclusion
• The criteria for the exclusion of ill children
• The procedures for a child who requires exclusion

Contrary to popular belief, excluding a child with a mild illness is unlikely to reduce the spread of germs, as most children spread germs before or after their illness or don't exhibit any symptoms. However, if a child is sick and the decision is made for them to be sent home, remember to respond sensitively to the child and family. Contact the family right away, and ask them to pick up their ill child. When a family member or guardian arrives, describe the symptoms and provide any documentation the family might need to give a doctor. Include when you noticed the illness, a description of symptoms, any vital signs (like temperature), and any medications you provided that were prescribed by a physician and approved in writing by the family, or other actions you took. Also remind the family about your program's policies and when the child can return. Due to the unique nature of the COVID-19 worldwide pandemic, your Service or program may have additional policies currently in place to ensure the health & safety of the children, families and staff. The CDC has additional recommendations that can be used for child care programs as supplemental guidance during the pandemic. This includes additional options for screening children upon arrival to ensure children with signs of illness are not admitted to your center.

Your program is designed to help promote healthy practices. Take some time to learn about your program's policies and facilities for sick children. Watch this video to learn more.

Your program should notify the staff and families of children who have come into contact with a child who is ill with one of the following conditions:

• Meningitis
• Pertussis (whooping cough)
• Invasive infections such as strep
• Chickenpox
• Skin infections or infestations (head lice, scabies, and ringworm)
• Infections of the gastrointestinal tract (often with diarrhea) and hepatitis A virus (HAV)
• Haemophilus influenzae type B (Hib)
• Fifth disease (parvovirus B19)
• Measles
• Tuberculosis
• COVID-19

Families and staff should also be notified if two or more unrelated persons affiliated with the facility are infected with a vaccine-preventable or infectious disease.

If one of these diseases or conditions is suspected in your classroom, your program will need to notify all families and staff who have come in contact with the child or children. This notification should include (Caring for our Children, 2019):

• The names, both the common and the medical name, of the diagnosed disease to which the child was exposed, whether there is one case or an outbreak, and the nature of the exposure (such as a child or staff member in a shared room or facility)
• Signs and symptoms of the disease for which the parent/guardian should observe
• Mode of transmission of the disease
• Period of communicability and how long to watch for signs and symptoms of the disease
• Disease-prevention measures recommended by the health department (if appropriate)
• Control measures implemented at the facility
• Pictures of skin lesions or skin condition may be helpful to parents or guardians (e.g., chicken pox, spots on tonsils, etc.)

The notice should not identify the child who has the infec­tious disease.

In some cases, your program may need to contact medical professionals or public health officials. There are certain illnesses that are considered "reportable illnesses." Your program will need to follow health guidelines to notify families and staff about the occurrence of these types of illness. A list of reportable illnesses is updated annually by the Centers for Disease Control and Prevention (CDC) and is available at https://wwwn.cdc.gov/nndss/conditions/notifiable/2021/infectious-diseases/.

To make illness less stressful, work with families to make sure a plan is in place for an ill child. Families, staff, and programs should make sure:

• Families have an alternate child-care arrangement for days when their child is sick
• Programs have a safe place for sick children to wait until families can pick them up; this space should be supervised by an adult that the child knows
• A written policy is in place about exclusion and readmission following an illness; this policy is shared with families
• Lines of communication are open; staff share information with families about their child's wellness, and families share information with staff about a child's wellness. This includes communicating with the program when a child is diagnosed with an infectious disease.

Finally, remember that you as a staff member are capable of spreading illnesses, too. If you are sick, stay home. If you have any of the illnesses listed on the exclusion list, you should stay home from work until you meet the criteria for returning.

For details on returning to care; when a health visit is necessary; when department reporting is necessary; and signs and symptoms of illness, see Caring For Our Children (2019) Appendix A, Signs and Symptoms Chart at https://nrckids.org/Files/Appendix/AppendixA2019.pdf.

Immunizations

Immunizations help prevent serious diseases. For immunizations to be effective, they must be given as scheduled. Researchers regularly discover new information concerning immunizations, such as who should receive them and when, so it might be helpful for you to stay up to date on the latest recommendations. You can learn more about immunization on the Centers for Disease Control and Preventions website: http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Though it is helpful for you to be knowledgeable about immunizations, it is your manager's responsibility to get immunization information from families to ensure your program is in compliance with all health-related regulations. It is important for caregivers to be immunized also, so ensure that you follow your program's guidelines in terms of recommended immunizations for staff members.

Do

When it comes to following your Service's or program's health related policies, always:

• Conduct health checks as infants and toddlers enter the classroom every morning
• Observe infants and toddlers throughout the day to ensure there aren't health-related changes that need to be addressed
• Understand and follow your program's exclusion and readmission policy
• Make sure you feel comfortable talking to families about your program's exclusion and readmission policy