Know

Each child’s day should begin with a simple health check. This is a quick way to make sure the child is healthy enough to be in your family child care program. Most children occasionally get a runny nose, cough, or mild fever. This usually causes little worry for providers and families. However, sometimes, a child’s illness becomes more severe. You need to establish policies to guide decision-making when dealing with ill children. Because you know the children in your care well, you can likely tell when a child is well enough to participate in activities and when a child is too sick to stay at your program. You will need to outline guidelines to help you make this decision and share those guidelines with families. The American Academy of Pediatrics (2019) offers three key factors to help you decide whether a child is too sick for child care:

• The child cannot participate in activities
• The child’s illness presents a risk to other children or adults
• You cannot care for the child while maintaining appropriate care for the other children

If a child meets any of these criteria, it is likely that they should be sent home. See the attachments in this section for lists of illnesses that do or do not merit exclusion from child care. Daily health checks are a way to evaluate a child to help make these decisions. It is up to you—not the family—to decide whether a child is healthy enough to stay in child care. You must consider the guidelines of your specific licensing agency, as well as the health of the other children, yourself, and any other person in your program.

Daily health checks also can offer a record of changes in a child’s appearance or behavior, which can be important in cases of child abuse or neglect. This information can also be very useful for families if the child is suspected of having a long-term physical- or mental-health need. Health checks, if conducted sensitively and documented thoroughly, can help you build relationships with children and families. This lesson will answer questions many family child care providers may have about health checks.

What Is a Health Check?

A health check is a quick evaluation of a child’s body, mood, and behavior. As part of your health check, you should also gather information from families. You want to know if there are any health changes that affect the child or family members. A simple, “Is everyone feeling all right today?” can start the conversation. As you get to know a child well, you will quickly notice any differences from day-to-day. The purpose of a health check is to notice any illnesses or health concerns the child might be experiencing.

When Should I Do a Health Check?

You should do a health check each time a child or youth arrives in your program (if a child comes to your program before and after school, a quick health check should happen at both times). Ideally, in instances when a family member drops off the child, health checks should be completed before the parent or guardian leaves your home. This will give you a chance to talk with the parent or guardian if you suspect the child is ill or if you have questions about any changes in the child’s appearance or behavior. You should also do a health check any time you notice a change in the child’s appearance or behavior. You might do a series of health checks across the day if you suspect a child is not feeling well.

See

What Does a Health Check Look Like?

The procedures for doing a daily health check may vary. Watch this video to see an example of family child care providers checking a child’s health.

What Should I Look For?

Your licensing agency may provide you with a daily health check form. If not, the Apply Activities section of this lesson has samples that you can adapt for your own use. When doing a health check, be sure to use all your senses.

• Look over the child’s body. Do you see any bruises, cuts, scrapes, or burns? Do you see any open sores or fluid coming from the child’s eyes or nose? Do you see any scratching of the head or body? Do you see any unusual behaviors (sad, sleepy, irritable, lack of appetite)?
• Listen for a cough, wheezing, or stuffy nose.
• Feel the child’s skin for a fever or signs of dehydration if he or she appears ill.
• Use your sense of smell to check for any unusual odors.

Conversation is a powerful tool with school-age children. Compared to younger children, school-agers are better able to communicate their feelings and experiences. If you have concerns, remember to ask children and youth about how they are feeling and bring your concerns to their attention (e.g., “You look really flushed, do you feel hot?”). You can also greet children as they enter the program by asking them questions such as:

• How are you doing today?
• How was your day at school?
• How was your night?

The answers to these questions provide valuable information and help you ensure the health of the children and youth in your care.

Do

Document any problems or changes on your daily health check form. If you think the child is ill and should not be in child care, talk with the parent or guardian immediately. This will allow them to make alternative plans.

Whether or not you see a problem, it is important to document your daily health check. Record that you did a health check each day, and mark anything unusual for the child or family. Be sure to save this documentation for at least 30 days. In the event of a disease outbreak, these records can be very useful to public health officials.

Exclusion and Readmission Policies

Take some time to either develop or update your program’s exclusion and readmission policies. Speak with your trainer, coach, or licensing agent to see what recommendations and suggestions they have regarding your exclusion and readmission policies. You can also review the attached sample exclusion and readmission policies from family child care providers’ program handbooks. Make sure your policies are in line with safe practices for children, families, and providers. Take time to consider how you will appropriately handle ill children in your care until a family member or guardian can arrive.

Your exclusion and readmission policies take into consideration the health of the child, other children, and the needs of the family. It’s important that you adhere to the policy and help families understand your program’s health-related expectations and requirements.

You are responsible for determining whether or not a child needs to be excluded and for how long. It’s your responsibility to know: 

• The conditions and symptoms that do not require exclusion
• The criteria for the exclusion of ill children
• The procedures for a child who requires exclusion

Contrary to popular belief, excluding a child with a mild illness is unlikely to reduce the spread of germs, as most children spread germs before or after their illness or don’t exhibit any symptoms. However, if a child is sick and the decision is made for them to be sent home, you should respond sensitively to the child and family. Contact the family right away, and ask them to pick up their ill child. When a family member or guardian arrives, describe the symptoms and provide any documentation the family might need to give a doctor. Include when you noticed the illness, a description of symptoms, any vital signs (like temperature), any medications you provided that were prescribed by a physician and approved in writing by the family, or any other actions you took. Also remind the family about your program’s policies and when the child can return. Due to the unique nature of the COVID-19 worldwide pandemic, your Service may have additional policies currently in place to ensure the health & safety of the children, families and adults working in your home. The CDC has additional recommendations that can be used for child care programs as supplemental guidance during the pandemic. This includes additional options for screening children upon arrival to ensure children with signs of illness are not admitted to your home.

Design your program to help promote healthy practices. Take some time to develop and share with families your program’s sick policy, which should be based upon your state’s requirements and recommendations. Watch this video to learn more.

Notify families when their children have come into contact with a child who is ill with one of the following conditions:

• Meningitis
• Pertussis (whooping cough)
• Invasive infections such as strep
• Chickenpox
• Skin infections or infestations (head lice, scabies, and ringworm)
• Infections of the gastrointestinal tract (often with diarrhea) and hepatitis A virus (HAV)
• Haemophilus influenzae type B (Hib)
• Fifth disease (parvovirus B19)
• Measles
• Tuberculosis
• COVID-19

Families should also be notified if two or more unrelated persons who are part of or visit your family child care program (e.g., your family members, family members of the children in your care, back-up providers, specialists, etc.) are infected with a vaccine-preventable or infectious disease.

If one of these diseases or conditions is suspected in your family child care home, you will need to notify all families and any other adults who have come in contact with the child or children. This notification should include (Caring for our Children, 2019):

• The names, both the common and medical, of the diagnosed disease to which the child was exposed, whether there is one case or an outbreak
• Signs and symptoms of the disease for which the parent or guardian should observe
• Mode of transmission of the disease
• Period of communicability and how long to watch for signs and symptoms of the disease
• Disease-prevention measures recommended by the health department (if appropriate)
• Control measures implemented in your program
• Possibly pictures of skin lesions or skin condition (e.g., chicken pox, spots on tonsils, etc.)

The notice should not identify the child who has the infectious disease.

In some cases, you may need to contact medical professionals or public health officials. There are certain illnesses that are considered “reportable illnesses.” You will need to follow health guidelines to notify families about the occurrence of these types of illness. A list of reportable illnesses is updated annually by the Centers for Disease Control and Prevention (CDC) and is available at https://ndc.services.cdc.gov/search-results-year/. Contact you trainer, coach or family child care administrator if you have questions or concerns about reporting illnesses.

To make illness less stressful, you should work with families to make sure a plan is in place for an ill child. You and/or your families should make sure:

• Families have an alternate child care arrangement for days when their child is sick
• You have a safe place for sick children to wait until families can pick them up
• A written policy is in place about exclusion and readmission following an illness and this policy is shared with families when they join your program
• Lines of communication are open so that you share information with families about their child’s health and families share information with you about a child’s health; this includes communicating with you when a child has been diagnosed with an infectious disease

As a provider, you are capable of spreading illnesses, too. If you are sick, find alternative back-up care arrangements for each child. If you have any of the illnesses listed on the exclusion list, you should not return to providing care until you meet the criteria for returning.

For details about:

• returning to care
• determining when a health visit is necessary
• determining when reporting to family child care administration or licensing is necessary
• signs and symptoms of illness

See Caring for Our Children (2019) Appendix A, Signs and Symptoms Chart available as a Learn Activity resource below and at http://nrckids.org/files/appendix/AppendixA.pdf

Immunizations

Immunizations help prevent serious disease. For immunizations to be effective, they must be given as scheduled. Researchers regularly discover new information concerning immunizations, including who should receive them and when, so you must stay up-to-date on the latest recommendations. You can learn more about immunization on the Centers for Disease Control and Preventions website at http://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Part of your role as a family child care provider is to get immunization information from families to ensure that your program is in compliance with all health-related regulations. Work with your licensing agency to ensure you have the necessary health-related forms. It is equally important for providers to be immunized, so be sure to follow your licensing agency’s guidelines.