Caring for Our Children (2019) recommends the following criteria for excluding a child from child care. Talk with your administrator about your program’s policy on exclusion for illness.

Key Criteria for Exclusion of Children Who Are Ill

When a child becomes ill but does not require immediate medical help, a determination should be made regarding whether the child should be sent home (i.e., should be temporarily excluded from child care). Most illnesses do not require exclusion. The caregiver/teacher should determine if the illness:

  1. Prevents the child from participating comfortably in activities
  2. Results in a need for care that is greater than the staff can provide without compromising the health and safety of other children
  3. 构成对他人有害疾病传播的风险

如果满足任何这些标准，则不应排除儿童，无论疾病的类型如何。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.

当孩子有以下任何条件时，建议使用临时排除：

  1. 这种疾病可以防止孩子在活动中舒适地参与。
  2. The illness results in a need for care that is greater than the staff can provide without compromising the health and safety of other children.
  3. 一个严重的外表 - 这可能包括嗜睡/缺乏响应性，烦躁，持续的哭泣，困难的呼吸，或者迅速地传播皮疹。
  4. 发烧（温度> 101°F [38.3°C]任何方法），婴儿发生的行为发生变化超过2个月。对于小于2个月的婴儿，发烧（任何方法的温度> 100.4°F [38°C]，有或没有行为变化或其他迹象和症状（例如，喉咙痛，皮疹，呕吐，腹泻）需要排除和立即医疗。在花温度时记住：
    • 温度升高量在不同的身体部位变化。
    • The height of the temperature does not indicate a more- or less-severe illness. The child’s activity level and sense of well-being are far more important that the temperature reading.
    • 如果孩子在一个非常热的环境中并且被怀疑，温度较高，更严重。
    • The method chosen to take a child’s temperature depends on the need for accuracy, available equipment, the skill of the person taking the temperature, and the ability of the child to assist in the procedure.
    • 口腔气温难以为4年龄前年轻的儿童服用。
  5. 腹泻由粪便定义，这些粪便比通常为那个孩子的常见或更少形成，而不是与饮食的变化相关。如果腹泻导致“事故”，所有尿型儿童都不需要排除尿布和卫生间培训的儿童。此外，如果粪便频率超过该儿童在节目日的时间超过典型的典型速度超过2凳子，则应排除尿液儿童，因为这可能会对护理人员/教师造成太多工作，或者粪便含有血液或粘液。在尿布儿童静止的尿布中可能发生尿布后，即使凳子仍然松动）和当卫生培训的儿童没有“事故”，并且当大便频率不超过2凳时，尿布那个孩子在时间里的时间里。

需要特定排除标准的特殊情况包括以下内容1：

  1. 一个health care professional should clear the child or staff member for readmission for all cases of diarrhea with blood or mucus. Readmission can occur following the requirements of the local health department authorities, which may include testing for a diarrhea outbreak in which the stool culture result is positive forShigella, Salmonellaserotype Typhi and Paratyphi, or Shiga toxin–producingEscherichia coli（stec）。儿童和工作人员Shigella在腹泻解决和测试结果中，应排除在外，至少有1个粪便文化是负的（规则因国家而异）。患有STEC的儿童和工作人员应被排除在抗生素治疗完成后至少48小时的测试结果（如果规定）。儿童和工作人员Salmonellaserotype Typhi and Paratyphi are excluded until test results from 3 stool cultures are negative. Stool should be collected at least 48 hours after antibiotics have stopped. State laws may govern exclusion for these conditions and should be followed by the health care professional who is clearing the child or staff member for readmission.
  2. 呕吐在过去24小时内超过2次，除非呕吐是由非缺陷条件引起的，孩子仍然是充分的水分。
  3. 一个bdominal pain that continues for longer than 2 hours or intermittent pain associated with fever or other signs or symptoms of illness.
  4. 口腔溃烂的口腔溃疡，除非孩子的主要医疗保健提供者或当地卫生部管理局指出，除非孩子是非福利的。
  5. Rash with fever or behavioral changes, until the primary health care provider has determined that the illness is not an infectious disease.
  6. 一个ctive tuberculosis, until the child’s primary health care provider or local health department states child is on appropriate treatment and can return.
  7. Impetigo, only if the child has not been treated after notifying family at the end of the prior program day. Exclusion is not necessary before the end of the day as long as the lesions can be covered.
  8. Streptococcal pharyngitis (ie, strep throat) until at least 12 hours after treatment has been started.1,2
  9. 只有当孩子在先前的程序日结束时未在通知家庭后尚未治疗，虱子。笔记：在程序日结束前不需要排除。
  10. Scabies, only if the child has not been treated after notifying the family at the end of the prior program day.笔记：在程序日结束前不需要排除。
  11. Chickenpox (varicella), until all lesions have dried or crusted (usually 6 days after onset of rash and no new lesions have appeared for at least 24 hours).
  12. Rubella, until 7 days after the rash appears.
  13. Pertussis，直到5天的适当抗生素治疗。
  14. 腮腺炎，直到腮腺发作后5天肿胀。
  15. Measles, until 4 days after onset of rash.
  16. Hepatitis A virus infection, until 1 week after onset of illness or jaundice if the child’s symptoms are mild or as directed by the health department.笔记：应检查本集团中其他人的保护，以确保暴露的每个人都收到疫苗或立即接受疫苗。
  17. 一个ny child determined by the local health department to be contributing to the transmission of illness during an outbreak.

REFERENCES

  1. 美国儿科学院。管理育儿和学校的传染病：快速参考指南。aronson ss，shope tr，eds。第四届。伊利安尔州麋鹿格罗夫村：美国儿科学院;2017年
  2. 美国儿科学院。学校健康。在：金伯琳德，布拉迪山，杰克逊马，长SS，EDS。红书：2018-2021传染病委员会的报告。31st ed. Itasca, IL: American Academy of Pediatrics; 2018:136–138
  3. 美国儿科学院。Children in out-of-home child care. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds.红书：2018-2021传染病委员会的报告。31st ed. Itasca, IL: American Academy of Pediatrics; 2018:122

参观照顾我们的孩子https://nrckids.org/CFOC/Database/3.6.1.1想要查询更多的信息。