Exclusion Chart Adapted from Managing Infectious Diseases in Child Care and Schools, 3rd Edition by the American Academy of Pediatrics Symptoms Common Causes Complaints or What Notify Health Notify Temperarily Exclude? If Excluded, Readmit Might Be Seen Consultant Parent When

Cold Symptoms (early stage • Runny or stuffy Not necessary YES NO, unless: • Exclusion criteria are of many viruses) nose unless • accompanied by resolved. • Adenovirus • Scratchy throat epidemics behavior change • Coxsackievirus • Coughing occur (i.e., • Child looks or acts • Enterovirus • Sneezing RSV) very ill • Parainfluenza • Watery eyes • Child has difficulty • Respiratory • Fever breathing syncytial • Child has blood-red or (RSV) purple rash not • Rhinovirus associated with injury • Coronavirus • Child meets other • exclusion criteria Bacteria • Mycoplasma • Bordetella pertussis • • Dry or wet cough Not necessary YES NO, unless: • Exclusion criteria are • Lower • Runny nose unless a • Severe cough resolved respiratory (clear, white, or - • Rapid or difficult infection (e.g., yellow-green) preventable breathing pneumonia, • Sore throat disease is • Wheezing if not bronchiolitis) • Throat irritation occurring, such already evaluated and • • Hoarse voice, as pertussis treated • Asthma barking cough • Cyanosis (i.e., blue • Sinus infection • Coughing fits color of skin and • Bronchitis mucous membranes) • Pertussis • Child is unable to participate in classroom activities Diarrhea • Usually viral, • Frequent loose YES, if 1 or YES YES, if: • Cleared to return by less commonly or watery stools more cases of • Stool is not contained health professional for bacterial or compared to bloody in the diaper for all cases of bloody parasitic child’s normal diarrhea or 2 diapered children diarrhea and diarrhea • Noninfectious pattern or more • Diarrhea is causing caused by Shiga toxin – causes such as • Abdominal children with “accidents” for producing E coli, dietary, cramps diarrhea in toileting children Shigella, Salmonella, medications, • Fever group within a • More than 2 incidents Cryptosporidium, or cystic fibrosis • Generally not week of diarrhea Giardia. feeling well • Blood/mucus in stool • Diapered children • Black stools have their stool • No urine output in 8 contained by their hours diaper (even if the • Jaundice (i.e., yellow stool remains loose) skin or eyes) and toileting children • Fever with behavior do not have toileting change accidents • Looks or acts very ill • Stool frequency is fewer than 2 diarrhea stools when the child seems otherwise well • Able to participate Eye Irritation, 1. Bacterial 1. Bacterial YES, if 2 or YES For bacterial • For bacterial Pink Eye infection of the infection: pink more children conjunctivitis: conjunctivitis: once membrane color instead of have red eyes NO. Exclusion is no longer parent has discussed covering the whites of eyes with watery required for this with health eye and eyelid and thick discharge condition. professional. (bacterial yellow/green may or conjunctivitis) discharge. For other forms: may not be prescribed. 2. Viral infection Eyelid may be NO, unless: • Exclusion criteria are of the irritated, • Child meets other resolved. membrane swollen, or exclusion criteria covering the crusted in the eye and eyelid morning. NOTE: One type of viral (viral 2. Viral infection: conjunctivitis spreads conjunctivitis) pinkish/red rapidly and requires 3. Allergic color of the exclusion. If 2 or more irritation of the whites of the children in the group have membrane eye; irritated watery red eyes without covering the swollen eyelids,; any know chemical eye and eyelid watery discharge irritant exposure, (allergic with or without exclusion may be required conjunctivitis) crusting around and health authorities 4. Chemical the eyelids; should be notified to irritation of the possible upper determine if the situation membrane respiratory involves the uncommon covering the infection epidemic conjunctivitis eye and eyelid 3. and 4. Allergic and caused by a specific (irritant chemical irritation: adenovirus. Herpes conjunctivitis) red, tearing, itchy, simplex conjunctivitis (e.g., swimming puffy eyelids; runny occurs rarely and would in heavily nose, sneezing; also require exclusion if chlorinated watery/stringy there is eye watering. water, air discharge with or pollution) without some crusting around the eyelids Fever • Any viral, Flushing, tired, Not necessary YES NO, unless • Able to participate bacterial, or irritable, decreased • Fever of 100° or • Exclusion criteria are parasitic activity higher resolved without the infection • Behavior change use of medication for • Overheating • Unable to participate 24 hours. • Reaction to • Care would medication compromise staff’s (e.g., vaccine, ability to care for oral) other children • Other noninfectious illnesses (e.g., rheumatoid arthritis, malignancy) Itching 1. Ringworm 1. Ringworm: itchy, Not necessary YES For chickenpox and scabies • Exclusion criteria are 2. Chickenpox ring-shaped YES resolved. 3. Pinworm patches on skin • On medication or 4. Head lice or bald patches For ringworm, impetigo, treated as 5. Scabies on scalp and head lice recommended by 6. Allergic or 2. Chickenpox: YES; health professional if irritant reaction blister-like spots • Children should be indicated for the 7. Dry skin or surrounded by referred to a health condition and for the eczema red halos on professional for time required to be 8. Impetigo scalp, face, and treatment readmitted. For body; fever; conditions that require irritable For pinworm, allergic or application of 3. Pinworm: anal irritant reactions like hives antibiotics to lesions itching and eczema or taking antibiotics by 4. Head lice: small NO, unless mouth, the period of insects or white • Appears infected as a treatment to reduce egg sheaths that weeping or crusty the risk of spread to look like rains of sore others is usually 24 sand (nits) in hours. For most hair NOTE: Although exclusion children with insect 5. Scabies: severely for these conditions is not infestations or itchy red bumps necessary, families should parasites, readmission on warm areas of seek advice from the as soon as the the body, child’s health care treatment has been especially professional for how to given is acceptable. between fingers care for these health or toes problems. 6. Allergic or irritant reaction: raised, circular, mobile rash; reddening of the skin; blisters occur with local reactions 7. Dry skin or eczema: dry areas on body. More often worse on cheeks, in front of elbows, and behind knees. If swollen, red, or oozing, think about infection. 8. Impetigo: areas of crusted yellow, oozing sores. Often around mouth or nasal openings, insect bites, or scrapes. Rash Many causes: • Skin may show For outbreaks, YES No, unless • Able to participate in 1. Viral: roseola similar findings such as • Rash with behavior daily activities infantum, fifth with many multiple change or fever • On disease, different causes. children with • Has oozing/open medication at least 24 chickenpox, Determining the impetigo wound hours (if needed) herpesvirus, cause of a rash within a group • Has bruising not • Exclusion criteria are molluscum requires a associated with injury resolved contagiosum, competent • Has joint pain and warts, cold health rash sores, singles, professional • Unable to participate and others evaluation. • Tender, red area of 2. Skin infections 1. Viral: usually skin, especially if it is and signs of general increasing in size or infestations: illness such as tenderness ringworm, funny nose, scabies, cough, and fever. impetigo, Some viral abcesses, and rashes have cellulitis more distinctive 3. Severe bacterial appearances infections: 2. Minor skin meningococcus, infections and pneumococcus, infestations: see staphylococcus “itching.” More aureus serious skin 4. Non-infectious infectiouns: causes: , redness, pain, eczema, contact fever, pus (irritant), 3. Severe bacterial dermatitis, infections: rare. medication These children related have fever with rash and may be very ill 4. Allergy may be associated with a raised, itchy, pink rash with bumps that can be as small as a pin-point or large welts known as hives. See also “itching.” Vomiting • Viral infection Diarrhea, vomiting, For outbreak YES YES, if • Vomiting ends of the stomach or cramping for viral • Vomited more than 2 • Able to participate or intestine gastroenteritis times in 24 hours • Exclusion criteria are • Coughing • Vomiting and fever resolved strongly • Vomit that appears • Other viral green/bloody illness with • No urine output in 8 fever hours Noninfectious • Recent history of head causes: dietary and injury medication related • Looks or acts very ill