关爱我们的孩子（2019）建议将孩子排除在儿童保育之外的标准如下。与您的管理员讨论您的计划关于疾病排除的政策。

排除患病儿童的关键标准

当儿童生病但不需要立即医疗帮助时，应确定是否应将其送回家（即应暂时排除在儿童保育之外）。大多数疾病不需要排除。护理者/教师应确定疾病是否：

  1. 妨碍孩子舒适地参加活动
  2. 结果在不损害其他儿童健康和安全的情况下，对护理的需求超过了工作人员所能提供的
  3. Poses a risk of spread of harmful diseases to others

If any of these criteria are met, the child should be excluded, regardless of the type of illness. Decisions about providing care that is comfortable for the child while awaiting parent/guardian pickup should be made on a case-by-case basis, considering factors such as the child’s age, surroundings, potential risk to others, and type and severity of symptoms the child is exhibiting. The child should be supervised by someone who knows the child well and who will continue to observe the child for new or worsening symptoms. If symptoms allow the child to remain in his or her usual care setting while awaiting pickup, the child should be separated from other children by at least 3 feet until the child leaves to help minimize exposure of staff and children who were not previously in close contact with the child. All who have been in contact with the ill child should wash their hands. Toys, equipment, and surfaces used by the ill child should be cleaned and disinfected after the child leaves.

Temporary exclusion is recommended when the child has any of the following conditions:

  1. The illness prevents the child from participating comfortably in activities.
  2. 这种疾病导致对护理的需求超出了工作人员所能提供的范围，同时又不损害其他儿童的健康和安全。
  3. A severely ill appearance—this could include lethargy/lack of responsiveness, irritability, persistent crying, difficult breathing, or having a quickly spreading rash.
  4. Fever (temperature >101°F [38.3°C] by any method) with a behavior change in infants older than 2 months. For infants younger than 2 months, a fever (temperature >100.4°F [38°C] by any method) with or without a behavior change or other signs and symptoms (eg, sore throat, rash, vomiting, diarrhea) requires exclusion and immediate medical attention. When taking temperatures remember that:
    • The amount of temperature elevation varies at different body sites.
    • 温度的升高并不意味着疾病的严重程度。孩子的活动水平和幸福感远比体温读数重要。
    • If a child has been in a very hot environment and heatstroke is suspected, a higher temperature is more serious.
    • 为孩子量体温所选择的方法取决于对精确度的需要、可用的设备、量体温的人的技能以及孩子协助测量的能力。
    • Oral temperatures are difficult to take for children younger than 4 years.
  5. Diarrhea is defined by stools that are more frequent or less formed than usual for that child and not associated with changes in diet. Exclusion is required for all diapered children whose stool is not contained in the diaper and toilet-trained children if the diarrhea is causing “accidents.” In addition, diapered children with diarrhea should be excluded if stool frequency exceeds 2 stools more than typical for that child during the time in the program day, because this may cause too much work for the caregivers/teachers, or if stools contain blood or mucus. Readmission after diarrhea can occur when diapered children have their stool contained by the diaper (even if the stools remain loose) and when toilet-trained children are not having “accidents,” and when stool frequency is no more than 2 stools more than typical for that child during the time in the program day.

Special circumstances that require specific exclusion criteria include the following1:

  1. 医疗保健专业人员应为所有带血或粘液腹泻病例的儿童或工作人员办理再入院手续。根据当地卫生部门当局的要求，可再次入院，这可能包括对腹泻爆发的检测，其中粪便培养结果为阳性志贺氏菌、沙门氏菌血清型伤寒和副伤寒，或产志贺毒素大肠杆菌(STEC). Children and staff members with志贺氏菌should be excluded until diarrhea resolves and test results from at least 1 stool culture are negative (rules vary by state). Children and staff members with STEC should be excluded until test results from 2 stool cultures are negative at least 48 hours after antibiotic treatment is complete (if prescribed). Children and staff members with沙门氏菌血清型伤寒和副伤寒被排除在外，直到3个粪便培养的检测结果为阴性。应在抗生素停止使用后至少48小时收集粪便。州法律可能对这些情况的排除进行管理，并应由为儿童或工作人员办理再入院手续的卫生保健专业人员遵守。
  2. Vomiting more than 2 times in the previous 24 hours, unless the vomiting is determined to be caused by a noninfectious condition and the child remains adequately hydrated.
  3. 持续2小时以上的腹痛，或伴有发烧或其他症状或体征的间歇性疼痛。
  4. Mouth sores with drooling that the child cannot control unless the child’s primary health care provider or local health department authority states that the child is noninfectious.
  5. 皮疹伴发热或行为改变，直到初级保健提供者确定该病不是传染病。
  6. 活动性肺结核，直到儿童的初级保健提供者或当地卫生部门声明儿童正在接受适当治疗并可以返回。
  7. 脓疱病，前提是孩子在前一个计划日结束时通知家人后没有得到治疗。只要病变可以被覆盖，在一天结束前排除是不必要的。
  8. 链球菌性咽炎（即链球菌性咽喉炎），直到治疗开始后至少12小时。1,2
  9. Head lice, only if the child has not been treated after notifying the family at the end of the prior program day.Note:Exclusion is not necessary before the end of the program day.
  10. 疥疮，前提是孩子在前一个计划日结束时通知家人后未接受治疗。Note:Exclusion is not necessary before the end of the program day.
  11. 水痘（水痘），直到所有皮损干燥或结痂（通常在皮疹出现后6天，至少24小时内没有新皮损出现）。
  12. 风疹，直到7天后出现皮疹。
  13. Pertussis, until 5 days of appropriate antibiotic treatment.
  14. Mumps, until 5 days after onset of parotid gland swelling.
  15. 麻疹，直到皮疹发作后4天。
  16. 甲型肝炎病毒感染，直到发病后1周或黄疸，如果孩子的症状轻微或按卫生部门的指示。Note:保护应ch组里的其他人ecked to be sure everyone who was exposed has received the vaccine or receives the vaccine immediately.
  17. 当地卫生部门确定的在疾病爆发期间导致疾病传播的任何儿童。

参考文献

  1. 美国儿科学会。Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide.Aronson SS, Shope TR, eds. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017
  2. 美国儿科学会。School health. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds.Red Book: 2018–2021 Report of the Committee on Infectious Diseases.第31版，伊塔斯卡，伊利诺伊州：美国儿科学会；2018:136–138
  3. 美国儿科学会。家庭外儿童保育中心的儿童。地址：Kimberlin DW，Brady MT，Jackson MA，Long SS，eds。Red Book: 2018–2021 Report of the Committee on Infectious Diseases.第31版，伊塔斯卡，伊利诺伊州：美国儿科学会；2018:122

See Caring for Our Children athttps://nrckids.org/CFOC/Database/3.6.1.1for more information.