Aronson, T. R. Shope. 2nd ed. Elk Grove Village, IL: AAP. Used withpermissionoftheAmerican AcademyofPediatrics,2009. Village,IL:AAP. R.Shope.2nded.Elk Grove T. Aronson, American Academy ofPediatrics(AAP).2009. NationalHealthandSafetyPerformanceStandards Caring forOurChildren: Notify Complaints or Health Notify Temporarily Exclude? If Excluded, Symptom Common Causes What Might Be Seen Consultant Parent Readmit When Cold Symptoms Viruses (early stage of many • Runny or stuy nose Not Yes No, unless • Exclusion criteria are viruses) • Scratchy throat necessary • Fever accompanied by behavior resolved. • Adenovirus • Coughing change. • Coxsackievirus • Sneezing • Child looks or acts very ill. • Enterovirus • Watery eyes • Child has diculty breathing. • Parainuenza virus • Fever • Child has blood red or purple rash not • Respiratory syncytial virus associated with injury. • Rhinovirus • Child meets other exclusion criteria • Coronavirus • Inuenza Bacteria • Mycoplasma Signs andSymptomsChart Managing infectious diseasesinchildcare andschools:A quickreference guide Cough • Common cold • Dry or wet cough Not Yes No, unless • Exclusion criteria are (May come from • Lower respiratory infecc- • Runny nose (clear, white, or necessary • Severe cough resolved. congestion any- tion (eg, pneumonia, yellow-green) • Rapid and/or dicult breathing where from ears to bronchiolitis) • Sore throat • Wheezing if not already evaluated and lungs. Cough is a • Croup • Throat irritation treated body response to • Asthma • Hoarse voice, barking cough • Cyanosis (ie, blue color of skin and something that is • Sinus infection mucous membranes) irritating tissues in • Bronchitis 421 the airway.) Diaper Rash • Irritation by rubbing • Redness Not Yes No, unless • Exclusion criteria are of diaper material against • Scaling necessary • Oozing sores that leak body uids resolved. skin wet with urine or • Red bumps outside the diaper stool • Sores • Infection with yeast • Cracking of skin in diaper or bacteria region Diarrhea Usually viral, less commonly • Frequent loose or watery For one or Yes Yes, if • Cleared to return by bacterial or parasitic stools compared to child’s more cases • Stool is not contained in the diaper for health professional for all normal pattern. (Note that of bloody diapered children. cases of bloody diarrhea exclusively breastfed infants diarrhea or • Diarrhea is causing “accidents” for and diarrhea caused by normally have frequent 2 or more toilet-trained children. Shigella, Salmonella, or unformed and somewhat children with • Stool frequency exceeds 2 or more Giardia. watery stools, or may have diarrhea in stools above normal for that child, • Diapered children have several days with no stools.) group within because this may cause too much their stool contained by • Abdominal cramps. a week work for the teacher/caregivers and the diaper (even if the • Fever. make it dicult to maintain good stools remain loose) and • Generally not feeling well. sanitation. toilet-trained children do • Sometimes accompanied by • Blood/mucus in stool. not have toileting accidents. vomiting. • Abnormal color of stool for child (eg, • Able to participate. all black or very pale). • No urine output in 8 hours. • Jaundice (ie, yellow skin or eyes). Appendix A . Eds.S. • Fever with behavior change. • Looks or acts very ill. A Appendix A A Notify Complaints or Health Notify Temporarily Exclude? If Excluded, Symptom Common Causes What Might Be Seen Consultant Parent Readmit When Dicult or 1. Common cold 1. Common cold: Stuy nose, sore throat, Not Yes Yes, if • Exclusion criteria are Noisy Breathing 2. Croup cough, and/or mild fever. necessary • Fever accompanied by behavior change. resolved. 3. Epiglottitis 2. Croup: Barking cough, hoarseness, fever, • Child looks or acts very ill. 4. Bronchiolitis possible chest discomfort (symptoms • Child has diculty breathing. 5. Asthma worse at night), and/or very noisy breath- • Child has blood red or purple rash not 6. Pneumonia ing, especially when breathing in. associated with injury. 7. Object stuck in airway 3. Epiglottitis: Gasping noisily for breath • The child meets other exclusion criteria with mouth wide open, chin pulled down, high fever, and/or bluish (cyanotic) nails NationalHealthandSafetyPerformanceStandards Caring forOurChildren: and skin; drooling, unwilling to lie down. 4 a nd 5. Bronchiolitis and Asthma: Child is working hard to breathe; rapid breathing; space between ribs looks like it is sucked in with each breath (retractions); wheez- - ing; whistling sound with breathing; cold/ cough; irritable and unwell. Takes longer to breathe out than to breathe in. 6. Pneumonia: Deep cough, fever, rapid breathing, or space between ribs looks like it is sucked in with each breath (retractions). 422 7. Object stuck in airway: Symptoms similar to croup (2 above). Earache • Bacteria or viruses • Fever Not Yes No, unless • Exclusion criteria • Often occurs in context of • Pain or irritability necessary • Unable to participate. are resolved. common cold • Diculty hearing • Care would compromise sta’s ability to care • “Blocked ears” for other children. • Drainage • Fever with behavior change. • Swelling around ear Eye Irritation, 1. Bacterial infection of the 1. Bacterial infection: Pink color instead of Yes, if Yes For bacterial conjunctivitis • For bacterial conjunctivitis, Pinkeye membrane covering the whites of eyesand thick yellow/green 2 or more No. Exclusion is no longer required for this once parent has discussed eye and eyelid (bacterial discharge. May be irritated, swollen, or children have condition. Health professionals may vary on with health professional. conjunctivitis) crusted in the morning. red eyes whether to treat this condition with antibiotic Antibiotics may or may 2. Viral infection of the 2. Viral infection: Pinkish/red, irritated, with watery medication. The role of antibiotics in treatment not be prescribed. membrane covering swollen eyes; watery discharge; possible discharge and preventing spread is unclear. Most chil- • Exclusion criteria are the eye and eyelid (viral upper respiratory infection. dren with pinkeye get better after 5 or 6 days resolved. conjunctivitis) 3 a nd 4. Allergic and chemical irritation: without antibiotics. 3. Allergic irritation of the Red, tearing, itchy eyes; runny nose, membrane covering the sneezing; watery discharge. For other forms eye and eyelid (allergic No, unless conjunctivitis) • The child meets other exclusion 4. Chemical irritation of the criteria membrane covering the Note: One type of viral conjunctivitis spreads eye and eyelid (irritant rapidly and requires exclusion. If 2 or more conjunctivitis) (eg, swim- children in the group have watery red eyes ming in heavily chlori- without any known chemical irritant exposure, nated water, air pollution) exclusion may be required and health authori- ties should be notied. Notify Complaints or Health Notify Temporarily Exclude? If Excluded, Symptom Common Causes What Might Be Seen Consultant Parent Readmit When Fever • Any viral, bacterial, or Flushing, tired, irritable, Not Yes No, unless • Able to participate parasitic infection decreased activity necessary • Behavior change. • Exclusion criteria are • Overheating Notes • Unable to participate. resolved. • Reaction to medication • Fever alone is not harmful. When a child • Care would compromise sta’s ability to care (eg, vaccine, oral) has an infection, raising the for other children. • Other noninfectious ill- body temperature is part of the body’s Note: Temperatures considered meaningfully nesses (eg, rheumatoid normal defense against outside attacks. elevated above normal, although not necessar- arthritis, malignancy) • Rapid elevation of body temperature ily an indication of a signicant health problem, sometimes triggers a febrile seizure in for children older than 4 months are young children; this usually is outgrown • 100°F (37.8°C) axillary (armpit) by age 6 years. The rst time a febrile • 101°F (38.3°C) orally seizure happens, the child requires evalua- • 102°F (38.9°C) rectally tion. These seizures are frightening, but do • Aural (ear) temperature equal to oral or not cause the child any long-term harm. rectal temperature Parents should inform their child’s health Get immediate medical attention when professional every time the child has a infant younger than 4 months has unexplained seizure, even if the child is known to have temperature of 101°F (38.3°C) rectally or febrile seizures. 100°F (37.8°C) axillary. Any infant younger Warning: Do not give aspirin. It has been than 2 months with fever should get medical linked to an increased risk of Reye syn- attention within an hour. drome (a rare and serious disease aecting the brain and liver). Headache • Any bacterial/viral • Tired and irritable Not Yes No, unless • Able to participate infection • Can occur with or without other symptoms necessary • Child is unable to participate • Other noninfectious Note: Notify health professional in case causes of sudden, severe headache with vomiting or sti neck that might signal meningitis. The sti neck of concern is reluctance and unusual dis- comfort when the child is asked to look at his or her “belly button” (putting chin to chest)— dierent from soreness in the side of the neck. Caring for Our Children: NationalHealthandSafetyPerformanceStandards Caring forOurChildren: Notify Complaints or Health Notify Temporarily Exclude? If Excluded, Symptom Common Causes What Might Be Seen Consultant Parent Readmit When Fever • Any viral, bacterial, or Flushing,