10.4: Supportive Health Care

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Heather Carter and Amber Tankersley
Pittsburg State University

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Learning Objectives

By the end of this chapter, you should be able to:

Identify some infectious diseases that are common during early childhood.
Outline criteria for exclusion from care for ill children and staff.
Describe considerations programs must make regarding caring for children who are mildly ill.
Recall licensing requirements for handling medication in early care and education programs.
Explain the communication about illness that should happen between families and early care and education programs.

Illness in Early Care and Education Programs

The most frequent infectious disease symptoms that are reported by early care and education settings are sore throat, runny nose, shortness of breath or cough, fever, vomiting and diarrhea (gastroenteritis), earaches, and rashes.

However, these are not the symptoms that necessarily lead to absences. Although respiratory symptoms are most common, it's rashes and gastrointestinal diseases that more often keep children from attending their early education programs. This is more a reflection of exclusion policies than a real risk of serious illness.⁴⁰⁸

It’s important for early childhood programs to identify illness accurately and respond in ways that protect all children and staff's health (whether it be to allow them to stay in care or to exclude them from care).

Identifying Infectious Disease

When you are familiar with different infectious diseases, it’s easier to identify them in children and know whether or not children (and staff) who are affected should be excluded from the early care and education program. Here is a list of the most common infectious diseases in early childhood.

Common cold
Flu
Sinus infection
Sore throat
Ear infection
Head lice

Other Illnesses

Bronchitis
Chickenpox
Conjunctivitis (Pink Eye)
Fifth Disease (Slapped Cheek)
Hand, Foot, and Mouth Disease
Hepatitis A
Impetigo
Measles
Meningitis
Molluscum Contagiosum
Mumps
Norovirus
Pertussis
Pinworms
Respiratory Syncytial Virus (RSV)
Ringworm
Roseola
Rotavirus
Rubella (German Measles)
Shigella
Tuberculosis (TB)

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Danger of Infectious Disease for Adults

Because early care professionals are around children who are at higher risk of infectious diseases and have a limited understanding of hygiene practices, those employees are also at greater risk of getting sick.

While most illnesses that are spread in early care and education programs are not serious, some can be very dangerous. Knowledge about illness and how to prevent its spread helps. Being fully immunized (from childhood illness and or vaccines) protects adult health as well.

Employees who are or could become pregnant want to be especially careful because first-time exposure to chickenpox, cytomegalovirus (CMV), Fifths disease, and Rubella can cause major damage to fetal health, birth defects, and even fetal death.⁴³¹

Reportable Diseases

Some diseases are enough of a threat to the community that it is required that diagnosed cases are reported to the local health department. Check with your local health department for a list of which diseases must be reported, how, and how quickly.

Exclusion Policies

Most children with mild illnesses can safely attend childcare. “Many health policies concerning the care of ill children [including exclusion policies] have been based upon common misunderstandings about contagion, risks to ill children, and risks to other children and staff. Current research clearly shows that certain ill children do not pose a health threat. Also, the research shows that keeping certain other mildly ill children at home or isolated in the childcare setting will not prevent other children from becoming ill.”⁴³³

But there are times when exclusion is the right answer. Licensing states that a child may be too sick to attend if:

The child does not feel well enough to participate comfortably in the program's activities.
The staff cannot adequately care for the sick child without compromising the care of the other children.
The child has any of the following symptoms unless a health provider determines that the child is well enough to attend and that the illness is not contagious:
- Fever (above 100° F. axillary or above 101° F. orally) accompanied by behavior change and other signs or symptoms of illness (i.e., the child looks and acts sick)
- Signs or symptoms of possibly severe illness (e.g., persistent crying, extreme irritability, uncontrolled coughing, difficulty breathing, wheezing, lethargy)
- Diarrhea: Changes from the child's usual stool pattern--increased frequency of stools, looser/watery stools, stool runs out of the diaper, or child can't get to the bathroom in time.
- Vomiting more than once in the previous 24 hours
- Mouth sores with drooling
- Rash with a fever or behavior change

If there is an outbreak of any reportable illness a child or staff member may be readmitted when the health department official or that health care provider decides that the risk of transmission is no longer present.⁴³⁵

What to do When a Child Requires Exclusion

When a child becomes ill enough to be excluded, they should be immediately isolated from other children. Early care and education programs are required to be equipped to isolate and care for any child who becomes ill during the day. The isolation area shall be located to afford easy supervision of children by center staff and equipped with a mat, cot, couch, or bed for each ill child (or a crib if caring for infants).

The child's authorized representative shall be notified immediately when the child becomes ill enough to require isolation and shall be asked to have the child picked up from the center as soon as possible.⁴³⁶

See Table 9.2 for a list of illnesses that require exclusion and when children who are diagnosed with those illnesses can return to care.

Table 9.2 – Conditions that Require Exclusion⁴³⁷
Condition	Exclusion Criteria
Chickenpox	Until 6 days after the beginning of the rash or once the sores have dried or crusted over.
Shingles	Only sores is cannot be covered with bandages or clothing. If not, until the sores are dry and have crusted over.
Rash with fever or joint pain	Until 6 days after the beginning of the rash.
Measles and Rubella	Until diagnosed not be measles or rubella.
Pertussis	If two or more episodes in 24 hours or if accompanied by a fever, until the vomiting resolves or is determined not to be caused by contagious illness.
Mumps	Until 9 days after the glands begin to swell.
Diarrheal Illness	It three or more episodes in the past 24 hours or if accompanied by a fever, until the diarrhea resolves.
Hepatitis A	As directed by the health department.
Impetigo	Until 24 hours after treatment begins and lesions are not draining.
Active Tuberculosis	Until the local health department approves the return to care.
Strep Throat, Scarlet Fever, and other streptococcal infections	Until 24 hours after treatment and the fever is gone.
Head lice	Until after the first treatment
Scabies	Until treatment is completed
Haemophilus Influenza Type b (Hib)	Until antibiotic treatment has begun.
Respiratory Illness	If the child is not well enough to participate and/or caring for the child limits the provider from caring for the other children or if it compromises the health and safety of the other children.
Herpes cold sores	Only if sores are not able to be covered (or kept from being touched).
Infectious conjunctivitis/pink-eye (with eye discharge)	Until 24 hours after treatment is started.
Other conditions mandated by state public health law	As required by the local health department.

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Pause to Reflect

Consider the following situations. Should each child be excluded from care or not? If so, why and when should the child return? If not, what should the professional do?

Mario’s dad drops him off and lets Ms. Michelle know that he is a little under the weather. He is not running a fever, but has a mild cough and a runny nose. But he ate a good breakfast and has a pretty typical level of energy.
About an hour into the day, Li vomits. Mr. Abraham checks and she has a fever of 101.3°. She looks a little pale and just wants to lie down. As he goes to call Li’s family, she vomits again.
When Latanya goes to change Daniel’s diaper she notices a rash on his stomach. She checks his temperature and he is not running a fever. He is not scratching at it or seemingly in any discomfort. She remembers that he has a history of eczema and contact dermatitis.
Bethany wakes up from naptime with discharge coming from a slightly swollen and bloodshot right eye. She tells Ms. Maria that her eye hurts and is “kind of itchy.”

Caring for Mildly Ill Children

Because young in early care and education programs have a high incidence of illness and may have conditions (such as eczema and asthma), providers should be prepared to care for mildly ill children, at least temporarily. And since we know that excluding most mildly ill children doesn’t prevent the spread of illness and can have negative effects on families, programs should consider whether they can care for children with mild symptoms (not meeting the exclusion policy). In determining whether your program is equipped to care for mildly ill children, consider the following questions:

Are there sufficient staff (including volunteers) to provide minor modifications that a child might need (such as quiet activities or extra fluids)?
Are staff willing and able to care for the child’s symptoms (such as wiping a runny nose and checking a fever) without neglecting the care of other children in the group?
Is there a space where the mildly ill child can rest if needed?
Are families able or willing to pay extra for sick care if other resources are not available, so that you can hire extra staff as needed?
Have families made alternative arrangements for someone to pick up and care for their ill children if they cannot?”

It’s important that programs recognize the families have to weigh many things when trying to decide whether or not to send a child to child care. They must consider how the child feels (physically and emotionally), whether or not the program can provide care for the specific needs of the child, what alternative care arrangements are available, as well as the income they may lose if they have to stay home.⁴³⁸

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Responding to Illness that Requires Medical Care

“Some conditions, require immediate medical help. If the parents can be reached, tell them to come right away and notify their medical provider.

Call Emergency Medical services (9-1-1) immediately and also notify parents if any of the following things happen:

You believe a child needs immediate medical assessment and treatment that cannot wait for parents to take the child for care.
A child has a stiff neck (that limits his ability to put his chin to his chest) or severe headache and fever.
A child has a seizure for the first time.
A child who has a fever as well as difficulty breathing.
A child looks or acts very ill, or seems to be getting worse quickly.
A child has skin or lips that look blue, purple, or gray.
A child is having difficulty breathing or is breathing so fast or hard that he or she cannot play, talk, cry, or drink.
A child who is vomiting blood.
A child complains of a headache or feeling nauseous, or is less alert or more confused, after a hard blow to the head.
Multiple children have injuries or serious illnesses at the same time.
A child has a large volume of blood in the stools.
A child has a suddenly spreading blood-red or purple rash.
A child acts unusually confused.
A child is unresponsive or [has] decreasing responsiveness.

Tell the parent to come right away, and get medical help immediately, when any of the following things happen. If the parent or the child’s medical provider is not immediately available, call 9-1-1 (EMS) for immediate help:

A fever in any child who appears more than mildly ill.
An infant under 2 months of age has an axillary (“armpit”) temperature above 100.4º F.
An infant under four months of age has two or more forceful vomiting episodes (not the simple return of swallowed milk or spit-up) after eating.
A child has neck pain when the head is moved or touched.
A child has a severe stomach ache that causes the child to double up and scream.
A child has a stomach ache without vomiting or diarrhea after a recent injury, blow to the abdomen, or hard fall.
A child has stools that are black or have blood mixed through them.
A child has not urinated in more than eight hours, and the mouth and tongue look dry.
A child has continuous, clear drainage from the nose after a hard blow to the head.
A child has a medical condition outlined in his special care plan as requiring medical attention.
[A child has a]n injury that may require medical treatment such as a cut that does not hold together after it is cleaned.”⁴³⁹

Administering Medications

Some children in your early care and education setting may need to take medications during the hours you provide care for them. Early care and education programs must have a written policy for the administration of prescription and nonprescription medication.⁴⁴⁰

Image result for children's medicine spoons — Figure 9.11 – Medication must be given according to the label.⁴⁴¹

Valid reasons for an early care and education program to consider administering medication.

Some medication dosing cannot be adjusted to be taken before and after care (and keeping them out of care when otherwise well enough to attend, would be a hardship for families.
Some children may have chronic conditions that may require urgent administration of medication (such as asthma and diabetes).⁴⁴²

Steps in Administering Medication

Many childcare licensing agencies require program staff to be trained in the proper administration of medication. Programs must obtain written consent from a child's parent/guardian for any medication to be administered by program staff. Prescription medication should be in its original container and labeled with the child's name, prescribing information, dosage, physician's name, pharmacy name and phone number, and the dates the prescription is valid. All medications should be in child-resistant packages, stored away from food, stored at the proper temperature, and be inaccessible to children. Refer to the policies of your program for specific requirements. The following are the basic steps for administering medication as outlined by the American Academy of Pediatrics (2024):

Right child--ensure you are giving medication to the child it is intended for
Right medication--read the medication label to make sure you have the correct medication
Right dose--check the dosage amount on the label with the consent form
Right route--confirm how the medication is administered (oral, inhaled, eye, ear, etc.)
Right time--match the time with the medication label and instructions
Right documentation--keep consent forms and logs of medication administered

Communication with Families

When children are excluded from care, it’s important to provide documentation for families of how the child meets the guidelines in your exclusion policy and what needs to happen before the child can return to care.

Programs are also required to inform families when children are exposed to a communicable disease.

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Pause to Reflect

Why is it important for early care and education programs to communicate clearly with families regarding communicable illness?

Summary

Becoming familiar with infectious diseases that are common in early childhood enables early care and education program staff to identify illness and respond appropriately. This included knowing when children (and staff) should be excluded from care and what needs to happen before they should come back.

Programs must create policies on how they will handle children who are mildly ill (those who need care before they can be picked up from care and those who do not require exclusion) and children who have an illness that requires medical care. Programs that choose to administer medication, must be familiar with the licensing regulations that guide their practice.

Open communication with families is important when a child becomes ill or is potentially exposed to an illness. Helping families understand and follow policies regarding exclusion is vital to keeping everyone in the program as healthy as possible.

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Resources for Further Exploration

References

Miotto, M. B., Balchan, Bl, & Combe, L. (2024). Safe administration of medication in school: policy statement. Pediatrics, 153(6). Retrieved on September 23, 2024: https://publications.aap.org/pediatr...-School-Policy.

This page was adapted from 9: Supportive Health Care by Paris. in Paris, J. (2021). Health, safety and nutrition. LibreTexts.

For references according to subscript, please see pages 221-244 of the original Health, Safety and Nutrition book (Paris, 2021) on Google Drive.

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Danger of Infectious Disease for Adults

What to do When a Child Requires Exclusion

Responding to Illness that Requires Medical Care

Pause to Reflect