Updated: Feb 18
It's a fact of life that children in their first few years of life pick up bugs and illnesses and at times this will mean they are unable to attend your childcare provision. How do you decide when children can't attend and how do you communicate this with parents?
Nurseries and childcare settings are common sites for the transmission of illness and infection. This is because children are particularly susceptible to becoming unwell due to:
immature immune systems
the way they play, interact and have close contact with each other
sometimes having no or incomplete vaccinations
having a poor understanding of hygiene practices.
While you can do your best to combat the transmission of illnesses by supporting children’s understanding of good hygiene and handwashing, the reality is that childhood illnesses are a part of setting life.
So how should you manage sickness in your setting?
A good place to start is to look at official guidance and legislation around the management of illness in childcare settings.
In England, requirement 3.44 of the Statutory Framework for the Early Years Foundation Stage clearly states that:
The provider must promote the good health of children attending the setting. They must have a procedure, discussed with parents and/or carers, for responding to children who are ill or infectious, take necessary steps to prevent the spread of infection, and take appropriate action if children are ill.
While the statutory requirement only requires you to have a procedure in place that you discuss with parents, my advice would be to have a clear written policy that covers how you manage sickness in your setting. As part of your induction process when new children start, I would ensure that you share a copy of this policy with parents and get them to sign to say they have read and understood it. Being upfront with parents about when they may be asked to keep their child at home usually helps to prevent difficulties in the future.
Requirement 3.44 directs you on to further government guidance for infection control in schools and childcare settings. In particular the items I find most helpful are:
Online pages which offer practical guidance for managing cases of infectious diseases in childcare setting
Public Health Agency poster, which offers a quick reference on infection control and exclusion periods
And the ‘Spotty Book’ which provides further information on infectious diseases and how to manage them
These official documents should form the basis of your policy and procedures on how to manage when children in your setting are unwell. They also provide guidance on the day to day measures you need to have in place to minimise the spread of infection.
When can and can’t a child attend your setting?
Public Health England has clear guidance on a range of common childhood illnesses, and this should be your first port of call when deciding if a child can be at your setting or not. It can be a good idea to have a copy of the guidance and poster displayed in your setting, so you can easily refer to it when having discussions with parents. ‘The Spotty Book’ provides more in-depth information on each condition.
Here are some of the more common illnesses you are likely to see in your setting, with a summary of how they should be managed. A full list can be found on England’s Public Health website.
Chickenpox – children should be kept away from settings for a minimum of 5 days AND until ALL the spots have crusted over.
Hand, Foot and Mouth – there is no requirement to exclude children as long as they are well in themselves.
Impetigo – children should be kept away from the setting until lesions are crusted and healed OR for 48 hours after starting antibiotic treatment.
Ringworm – exclusion not usually required (but check the Spotty Book as exclusion maybe advised for some types). However, if you have multiple cases at your setting you should contact your local health protection team to discuss the situation further.
Diarrhoea and/or vomiting – children should be kept away from the setting for a minimum of 48 hours after the last episode of either runny stools or sickness. For example, if a child goes home unwell on a Monday afternoon, but doesn’t have their last loose nappy until 10pm on Tuesday night, they can’t return to your setting until the Friday.
Conjunctivitis – there is usually no requirement to exclude children, and treatment is often not given by GPs. However, if you have multiple cases at a setting you should contact your local health protection team to discuss the situation further.
Head lice – there is no requirement to exclude children.
This is not a comprehensive list and further guidance can be found from Public Health England. Don't forget, where exclusions are advised, these time-frames also apply to your staff.
Remember, there may be times, such as with the COVID-19 outbreak, when other illnesses or outbreaks require exclusion periods. In these situations you should follow the advice given on the official government website and the NHS website. Doing this will ensure staff and children are protected but that unnecessary panic or inconvenience is avoided.
Making others aware
You should also consider how you make other parents and staff aware of any sickness in the setting. In settings I managed, as soon as we had even a single case of anything with an exclusion period, we would notify parents whose children were in the same room as the unwell child (being sure to keep the identity of any unwell children confidential). We would provide an overview of the symptoms, incubation period and exclusion time-frames, directing parents to the NHS website for further details.
You could notify parents via, an email, a note up on the door to the room, or by talking to families face to face – however, do consider how to ensure that parents who may not be in the setting for a few days are also informed. By making families aware, they should be more alert to the symptoms and this will hopefully ensure poorly children are not brought into your setting, meaning any outbreaks of illness can be limited.
You should also be aware that some conditions are considered notifiable diseases and you may have to link with your local health protection team with regards to these. Again, full information can be found from the Public Health Guidance England.
What about coughs, colds and ear infections?
While there is no specific guidance on children attending your setting with coughs, colds or ear infections, there are some basic principles you can apply to decide whether they should be in your care or at home.
Remember requirement 3.44 - The provider must promote the good health of children attending the setting.
This isn’t just about a child’s physical health; it can also link in with their emotional health. So, as a general rule of thumb, you and the parents should be considering children’s emotional as well as physical wellbeing when deciding if they are well enough to be at the setting. If children are really unwell or in pain, then probably a busy setting isn’t the right place for them. A setting is not able to offer the one-to-one cuddles an unwell child needs, or the quiet environment where they can sleep and rest. If a child is unwell, then home probably is the best place for them.
This, of course, doesn’t mean every child with a cold or ear infection needs to be at home – far from it, many will cope just fine with their usual day. So how do you decide when a child should be at home and how can you make this decision transparent to parents?
Knowing what a ‘well child’ is for your setting
One way is to have a definition of a well child built into your policy that you share with parents. At Cambridge Early Years, when helping settings to pull together policies and procedures, this is the definition we use:
Definition of a well child;
A child who is happy and able to take part fully in nursery life
A child who does not have a temperature
A child who is not dependant on Calpol
A child who is not reliant on 1-1 care
In my experience as a nursery manager, it has been very helpful to have this definition clearly in place and understood by all parents when they first start at the setting. This has helped to avoid many difficult conversations when supporting families to deal with the inconvenience of their child not being able to attend.
What if a child is taking medication?
Excluding a child solely on the grounds that they are taking medication would be a breach of the SEND Code of Practice and/or the Equalities Act, as well as requirement 3.67 of the Early Years Statutory Framework. Requirement 3.45 of the Early Years Statutory Framework Requirements explains clearly how early years settings should manage children who are taking medication.
If you would like any further support on managing sickness in your setting, or writing policies and procedures, please don’t hesitate to contact Cambridge Early Years to discuss your requirements.