Caring for Our Children: National Health and Safety Performance Standards A

Signs and Symptoms Chart . all do or

by by and for re the ccidents have are are by f a diarrhea loose) children caused

return criteria criteria criteria a (even i contained Salmonella, children toileting When bloody to participate. professional remain of stool to diarrhea diaper have xclusion ble Excluded, Exclusion resolved. Exclusion resolved. resolved.

E their stools toilet-trained not Diapered the Cleared health and Shigella, Giardia. cases A • • • If Readmit

• • • for not and (eg, and for and rash uids more child, diaper criteria hild good much eyes). or

skin hat the or evaluated for c too ill. body of behavior n purple

ours. breathing for t change. by h or skin “accidents” breathing. very leak maintain stool exclusion ill. color cause o in 8 already red exceeds 2 stool. injury. pale). of hat acts in children. diƒcult very normal may yellow blue teacher/caregivers other diaper not Exclude? contained i or very causing with behavior if color blood diƒculty he his children. (ie, (ie, output is acts or membranes) the sores t diƒcult t not cough as as above or and/or s accompanied with it looks meets frequency for t urine black if unless unless unless o outside Oozing Rapid treated mucous Severe Wheezing Cyanosis associated Child Fever change. Child h Child Child h Looks Fever all Jaundice stools Abnormal Stool sanitation. Blood/mucus Stool i Diarrhea toilet-trained because t diapered work make

N

• • • • • • • • • •

Temporarily No, No, • • • • • • • Yes, • • No, t

Yes Yes Yes Yes Notify Paren n or with or

ases

within more one bloody or week ecessary diarrhea i group a For more c of diarrhea 2 children Not n Not necessary Not necessary Notify Health Consultant y or hat cough nfants have well. stools.) child’s o white, diaper watery o may n (Note t nose or Seen somewhat frequent or feeling

barking

with n (clear, skin i Be accompanied b cramps. breastfed i or cough and not loose stuy have of throat tools, r pattern. eyes days voice, irritation nose wet compared t throa t Might bumps or bdominal hroat ever. requent Sores Cracking region Redness Scalin g Red Dry Runny yellow-green ) Sore Hoarse Coughing Sneezing Watery Fever Scratchy Runny o exclusively watery s stools normal normally unformed several Generally Sometimes vomiting. A F

F

T • • • • • • • • • • • • • • • • • • • • • Complaints What c- virus many

or

nfec against of east commonly virus urine stage rubbing syncytial arasitic less y cold material with y Cause s with pneumonia, or p respiratory i nfection (early viral,

(eg, wet bacteria diaper nfection skin or Common Lower Irritation b of stool tion bronchiolitis) Croup Asthma Sinus i Bronchitis Adenovirus Coxsackievirus Enterovirus Parainuenza Respiratory Rhinovirus Coronavirus Inuenza Mycoplasma I

Common • • • • • • • • viruses) • • • • • • • • Bacteria • Viruses Usually bacterial to in

is a to - is ars ny from that tissues ough Rash from e response come Symptoms airway. ) Cough (May congestion a where lungs. C body something irritating the Diaper Symptom Cold Diarrhea

American Academy of Pediatrics (AAP). 2009. Managing infectious diseases in child care and schools: A quick reference guide. Eds. S. S. Aronson, T. R. Shope. 2nd ed. Elk Grove Village, IL: AAP. Used with permission of the American Academy of Pediatrics, 2009.

421 Appendix A Caring for Our Children: National Health and Safety Performance Standards A

are may are

are discussed or conjunctivitis,

criteria has professional.

may When criteria criteria participate participate criteria When to to prescribed. parent health resolved. bacterial be Excluded, Able Exclusion resolved. Able

Excluded, Exclusion resolved. are

E xclusion If Readmit • • • once with Antibiotics not Exclusion resolved. For

If Readmit • •

• • -

sti or care dis his neck. care at to on or The days problem, case to when or necessar- chil- chest)— this the medical 6 eyes authori- not in more

treatment spreads look exposure, of oral to unexplained vary antibiotic or change. unusual for criteria not vomiting younger ability get are or in red 5 to to Most meaningfully ability rash health 2

has side rectally chin and health may with If with irritant after meningitis. attention sta’s infant the asked equal should sta’s watery and ill. required behavior months purple is exclusion

although (armpit) in unclear. 4 exclusion Any months antibiotics by or (38.3°C) is conjunctivitis change. (putting professional better signal breathing. signi cant very 4 considered have fever participate hour. condition of exclusion. a child reluctance chemical headache

other longer red injury. than to medical get other viral is an required of axillary orally rectally professionals acts normal, 101°F than this with Exclude? role no the soreness spread axillary. might of compromise Exclude? group or be health notied. of button” compromise is with temperature conjunctivitis participate. older behavior diculty blood meets participate. severe change. children. known The requires children. meets treat be unable the within that to from type Health above forms to when pinkeye may (38.3°C) (38.9°C) (37.8°C) temperature concern accompanied is (ear) has has looks to in with any would antibiotics. months “belly younger would child (37.8°C) and Temperatures Notify indication of other 2 unless child immediate One other neck if unless with children unless unless Exclusion preventing her bacterial other sudden, should an

Child Fever Child Child associated The Child 101°F 102°F Aural rectal 100°F for Behavior Unable Care

Care Unable for Fever

Temporarily

The criteria

comfort dierent sti neck of No, • Note: or Temporarily Yes, • • • • • • • • Get infant for • temperature 100°F than attention Note: elevated ily No, • • • • No, • • without exclusion ties children rapidly Note: condition. whether medication. dren For No. and without For No, •

Yes Yes Notify Paren t Notify Paren t Yes Yes Yes t t have

h h watery if more eyes or Notify Healt Consultan Not necessary Not n ecessary Notify Healt Consultan Yes, Not n ecessary Not necessary children red with discharge 2 do

of or - a is have cold/ in but down, nails evalua- child fever, health been down. harm. similar to breath - longer possible sucked a looks has wheez - syn- throat, nose, attacks. aecting body’s symptoms rapid is lie Child instead breathing; in. in. breath febrile has outgrown it swollen, ribs irritation: a irritated, to pulled It seizure breath noisy the is Takes child’s child for sore When Reye

known requires (symptoms other fever, breathing; like runny color rapid of yellow/green (cyanotic) is of temperature chin the disease outside time the long-term frightening, very Symptoms each discharge; Asthma: breathe hoarseness, their nose, febrile child with breathing aspirin. Pink part noisily irritated, risk to usually unwell. eyes; (retractions); between looks thick fever. are infection . chemical a rst any

unwilling child discharge. bluish is cough, and time body with harmful. open, without ea r be the Pinkish/red, breathe; raising and/or serious morning. this Seen Seen and against give and of ribs in airway: watery cough, Stu y and than inform or The the mild discomfort when itchy

sound to not child space in if irritable, breath Deep Be wide May Be every the or Gasping or is above). and liver). watery not eyes and/or out triggers or seizures infection: hearin g with cold: eyes; ears” increased the irritable around in drooling, (2 night), chest hard of years. respiratory activity irritabilit y sucked Do and/or even each should irritable stuck Barking defense and Allergic rare tired, happens, an 6 at infection: infection, tearing, children; between seizures. is elevation Bronchiolitis or alone and fever, Might mouth temperature Might 4. (a skin; These especially whistling it to occur cause an 5. croup breathe with age Viral swollen upper discharge. crusted whites Bacterial nd Red, sneezing; brain Di culty “Blocked Drainag e Swelling Fever Pain

a Object to like (retractions). Pneumonia: breathing, high and cough, Croup: possible worse ing, Epiglottitis: with Common cough; to in ing; space nd working Tired Can

seizure, febrile not Parents professional seizure tion. young by normal Rapid sometimes has body Fever

2.

a

Complaints What

3 1. • • • • • • What Complaints • • the drome linked Warning: • Flushing, Notes • decreased 7. 6. 4 2. 3. 1. of

the the the the the - ill- the

of or (viral swim- of of the airway pollution) chlori context (allergic (bacterial (irritant (eg, of in in air eyelid oral) covering covering covering covering medication viruses cold rheumatoid irritation cold infection bacterial, Cause s to eyelid eyelid eyelid or Cause s heavily infection stuck irritation malignancy ) and water, (eg, occurs in noninfectious noninfectious infection and and and eye bacterial/viral viral, vaccine, Common Croup Epiglottitis Bronchiolitis Asthma Pneumonia Object conjunctivitis ) Chemical membrane conjunctivitis ) Allergic membrane eye Bacterial conjunctivitis ) Viral membrane the membrane eye conjunctivitis) ming eye nated Often Bacteria common

Any infection Other causes arthritis, nesses Other (eg, Any Reaction parasitic Overheating

Common 1. 2. 3. 4. 5. 6. 7. • •

4. 3. 1. 2. • •

Common • • • • g

or Breathin Irritation, Noisy Symptom Dicult Earach e Eye Pinkey e Headach e Symptom Fever

Appendix A 422 Caring for Our Children: National Health and Safety Performance Standards A are

criteria When participate participate to to Excluded, Able Exclusion resolved. Able

If Readmit • • • -

sti or care dis his neck. at to or The problem, case when or necessar- chest)— the medical in

look of oral to unexplained unusual not vomiting younger ability get are to to meaningfully health has side rectally chin and with meningitis. attention sta’s infant the asked equal should months is although (armpit) in 4 Any months (38.3°C) (putting professional signal signi cant 4 considered fever participate hour. a child reluctance headache than to medical is an of axillary orally rectally normal, 101°F than with Exclude? the soreness axillary. might compromise health of button” temperature participate. older severe change. children. unable within that to from above when (38.3°C) (38.9°C) (37.8°C) temperature concern is (ear) would months “belly younger (37.8°C) Temperatures Notify indication of other 2 unless immediate neck unless children her sudden, an Child 101°F 102°F Aural rectal 100°F for Behavior Unable Care

Temporarily dierent comfort or sti neck of No, • Note: • • • Get infant for • temperature 100°F than attention Note: elevated ily No, • • •

Yes Yes Notify Paren t t

h Notify Healt Consultan Not necessary Not n ecessary do a have in but evalua- child health been harm. to a has syn- attacks. aecting body’s symptoms febrile has outgrown a It seizure the is child’s child When Reye

known requires other of is of temperature the disease outside time the long-term frightening, their febrile child aspirin. part risk usually are a rst any child is time body harmful. without the raising serious this Seen against give of inform or The the

not child if irritable, Be every or is and liver). not triggers seizures with increased the irritable years. activity Do even should defense and rare tired, happens, an 6 infection, children; seizures. elevation alone and temperature Might (a These to occur cause an age brain Tired Can

seizure, febrile not Parents professional seizure tion. young by normal Rapid sometimes has body Fever

What Complaints • • the drome linked Warning: • Flushing, Notes • decreased

ill- or oral) medication rheumatoid bacterial, to Cause s infection malignancy ) (eg, noninfectious noninfectious bacterial/viral viral, vaccine, Any infection Other causes arthritis, nesses Other (eg, Any Reaction parasitic Overheating

• •

Common • • • • Headach e Symptom Fever

423 Appendix A Caring for Our Children: National Health and Safety Performance Standards A be and daily (if of indi- to a as the - in if For insect been are are treated by are others lesions hours conditions or soon parasites, period has medica with to to condition reduce 24 as hours. application required For or antibiotics

the criteria criteria to criteria 24 of the When participate participate . acceptable. least time professional spread is for to to children at require antibiotic of treatment medication the mouth, recommended taking antibiotics usually Excluded, activities. On tion indicated) . resolved. Able resolved. A ble

E xclusion E xclusion given most infestations readmission the treatment risk is by or that of On as health cated for readmitted. resolved. Exclusion

If Readmit • • • • • • • care for - sore to pro is

no to it is plan sores. if treatment. crusty injury health ability care or fever there a for necessary reactions, if with mouth or to and impetigo day to sta ’s especially only care, day is the and irritant lice weeping ? tenderness for change skin, a of or referred rash the woun d related or associated of as hives head be of end and assessment scabies, size for not advice area Exclude compromise and allergic the in participate participate . behavior end pain steadily children . at should red made infected to to the with would oozing/open bruising joint medical other Exclusion at unless unless unless eczema hives. pinworm, chickenpox, ringworm Has increasing Has Tender, Has Unable Care Drooling Unable for Rash

fessional Appears Children

• • • • • Temporarily • • No, • No, • the For previously For Yes For Yes, and No, • obtain • Note:

Paren t Notify Yes Yes Yes t for in or if pox

has and h than such child infesta- outbreaks lice Notify Healt Consultan For Not n ecessary scabies; more one group impetigo ringworm; chicken For tions as on - of - of many Pain swol- the ooz and on nasal These profes body. fever infec- rash egg account oozing, usually of cheeks front body; or tongue with between glands; yellowish illness cause on legs or surrounded infants, patches in reactions on and not Rare. skin on into distinctive how and Raised, pus. of In yellow, bumps health infestations: white infection: a red, neck but

mouth areas reddened, local scalp . spots or just red ill. painful, ndings general and face, ulcers takes cheeks, reddening fever, cough, molluscum). especially fronts with on have serious knees. Dry reaction). of patches crusted with sore; on than or body, reaction: very on itchy that infections: swollen ring-shaped Determining swollen, fever; of insects around hair . scalp, rash; may pain, similar nose, itching . Seen competent fever on be If More Painful body, signs in

cold a White Blister-like on occur behind lips other infection. warts patches of infections areas contact worse Be cheeks Itchy eczema: or coxsackievirus rash irritant else Small Areas toes. Anal Often may have area. show mouth; causes. for runny or Severely or mobile sores: (nits) and or bacterial ivy, dry or skin bald halos redness, in blister, Usually areas evaluation viral irritable. as lice: often about and thrush: along blisters painful “Itching.” be requires may or Might skin swallowing; sores. gums red diaper Viral: such Each (except a ppearance. Minor children rash See Severe tions: Canker on spots len, or Oral and fever Herpes openings. ing Impetigo: think in anywhere (poison may skin; elbows, Dry More circular, Allergic ngers warm Scabies: sheaths fever; Pinworm: Head Ringworm: skin Chickenpox: by rash Skin di erent sional information looks.

• 1. 2. 3. Complaints What 3. 1. 2. 8. 7. 6. 5. 3. 4. 1. 2.

and cold ivy) - infes- (fun - aureus infec and (herpes warts, infantum, (parasite), chickenpox, poison molluscum others (yeast eczema irritant coxsackievirus abscesses, (eg, (bacteria ) or or Cause s ringworm and or sores MRSA). bacterial shingles meningococ- lice roseola scabies infections thrush disease, pneumococcus, skin causes Viral: fth herpesvirus, contagiosum, sores, zoster), Skin tations: gus), impetigo, tions: cus, Staphylococcus (MSSA, cellulitis Severe Oral infection ) Herpes infection Canker Impetigo Ringworm Chickenpox Pinworm Head Scabies Allergic reaction Dry

Many 1. 2. 3. Common 1. 2. 3. 8. 1. 2. 3. 4. 5. 6. 7.

Sores Rash Mouth Symptom Itching

Appendix A 424 Caring for Our Children: National Health and Safety Performance Standards A

re re least are at strep). antibiotics

criteria a criteria criteria a ends. (if When on participate . swallow. participate. participate. is to to to to resolves. medication hours indicated) . n hild xclusion xclusion Excluded, Pain Able resolved. Able Able 24 Exclusion resolved. (if Able resolved. Vomiting E O

E C If Readmit • • • • • • • • • • •

hours di‰culty. criteria 24 double n to injury breathing imes i swallowin g hours injury exclusion t hours child change change 8 or green/blood y green/blood y change. 8 gland s ill ill with fter head for in han 2 other of tool s arm fever very very ausing ppears ppears Exclude? pain a behavior behavior swallow. behavior and breathing output output more t drooling acts acts meets to r r screa m history pain c skin/eyes that a that a r with with ender, w with if child urine urine unless unless unless Red, t Fever Di‰culty over o Bloody/black s Severe Abdominal No Looks o Vomited Diarrhea Vomitin g Yellow Fever Vomiting Vomit No Looks o Vomit Recent

Inability Excessive Fever The

• • • • • • No, • • No, • • • • Yes, • • • • • • • • • • • Temporarily No ,

Notify Paren t Yes Yes Yes Yes t cases

within h unless outbrea k ame week. ecessary Notify Healt Consultan Not necessary Not n Not multiple in s group 1 For - n - has nd viral as with

ose. of usually cause other. overly- incor swa l for

the that (tonsil in runny

infection Tonsils eck a unny to headache, Swelling of stomach cramping occur as nlikely. may anywhere may hroat: patches o with each ouch, pain nodes: ppetite usually or r of body runny n the n or tongue throat. complain such associated ramping hite or against hroat, of very u the t nfection. the (refusal organs and/or throat of strep t of f nodes (sometimes is glands”) lymph severe cough to will children response: groin, an i or f nfection . nfection ght touching back sore t f of infection wall with w cough or illness, back congestion. Strep odes and/or c t decreased a area o strep he i in lymph Seen internal node and drooling diarrhea with

even symptoms tender viral fever. I and an Strep i back area o “swollen children body’s a younger oƒ t Be tissue with or Persistent armpit at see with and an ides, of ear result infection warm hroat, a skin, arge, the lymph n lymph red present, intestine. ay the hroat: respiratory vomiting, astroenteritis called and of cough, ghts infected. of t Verbal is not ncreased be l throat; Might near possible in pink signs irritable front, s abdomen: abdomen. Problems and nose are and/or stomachache Vomiting Viral g Swollen may sides area), be Viral: sore and i include does Signs Strep t nose, upper low). M rectly body Normal at ear, else Swollen, ing located n been Bacterial

Complaints What 2. 1. 1. 2. gastroenteriti s 1. 2. Diarrhea,

f - area ac or are

upper ecome eck art o colon, of system with the cold or b the are internal in infected abdomen as p of respiratory the n nodes defense that b cause infections viral to intestine nd they in illness the with strongly o defense f ntestine, infection or Cause s that (ie, body upper hroa t throat nodes lymph bladder viral as i dy’s gastroenteritis infection infection o ny bacteria ther such liver, Viral strep t Problems organs o Viral—common viruses respiratory Strep tomach lymph for a infection) Bacterial responding by terial where located overcome a Normal response t the b Viral s (gastroenteritis) Coughing fever O

Common 1. 2. 1. 2. • • • 2. 1. alled ymph Gland s Throat Swollen (properly c swollen l nodes) Stomachache Symptom Sore (pharyngitis) Vomitin g

425 Appendix A