Illness: How Do You Know When Exclusion is Needed?

Deciding when to exclude a child who is ill from early learning and education programs can be confusing for staff. Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, clarifies the decision-making process. A child who is ill but does not require immediate medical attention should be excluded if the staff member determines the illness:
a. Prevents the child from participating comfortably in activities as determined by staff
b. Results in a need for care that is greater than the staff can provide without compromising the health and safety of other children
c. Poses a risk of spread of harmful diseases to others based on the list of specific excludable conditions
If any of the above criteria are met, the child should be excluded, regardless of the type of illness.

Excluding children with mild illnesses is unlikely to reduce the spread of most germs. Most germs are spread by children who do not have symptoms. Children frequently carry contagious germs that do not limit their activity nor pose a threat to others. Three key measures to prevent the spread of germs are handwashing, surface/sneeze/cough hygiene and keeping immunizations up to date.

State regulations may differ from national recommendations. Updating the regulations can take a long time. The regulations are legal requirements. Staff must follow them.
Usually, a health care provider’s note is not necessary to readmit a child. A note is only necessary if the program needs more information about the child’s condition or need for special care. Current Pennsylvania regulations require a note for return to care if the child was excluded for a condition that is a threat to the health of others as specified in 28 Pa Code Chapter 27. If uncertain about whether the condition that required the child’s exclusion poses a threat to others, ask the local or state health department whether a note should be required from the child’s health care provider.

For more information regarding inclusion/exclusion see
• Caring for Our Children, (CFOC) Standard - Inclusion/Exclusion/Dismissal of Children adapted from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide
• Chapter 5: Signs and Symptoms Chart in Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. This publication is available from the American Academy of Pediatrics  Updated 4-2019