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One thing that gets asked a lot on online childminding forums is about whether or not you should exclude children for certain diseases. The first thing to say is that it is ultimately up to you to decide as this is your family home. But it is also important to know what the government guidelines say so that you can make an informed choice and to be consistent with parents. I have lifted this ‘quiz’ directly from the Public Health England document: Health protection in schools and other childcare facilities. How well do you know your exclusion periods?
True of false….
You should exclude a child with head lice
False: The Public Health guide does not recommend that children with head lice are excluded from schools and other childcare settings. Head lice are spread by direct head-to-head contact. They cannot jump, fly or swim. When newly infected, cases have no symptoms. Itching and scratching on the scalp occurs 2 to 3 weeks after infection. Treatment is only needed if live lice are seen. Remember that it is up to you to decide what to do in your own home. Here is a leaflet to give to ALL of the parents at your childminding setting about treating head lice if you ever find them on a child.
You should exclude a child with conjunctivitis
False: Conjunctivitis is an inflammation of the outer lining of the eye and eyelid causing an itchy red eye with a sticky or watery discharge. It is spread by contact with discharge from the eye which gets onto the hands or towel when the child rubs their eyes. Advise parents to seek advice, encourage children not to rub their eyes and to wash their hand frequently, but you do not need to exclude them from your childminding setting.
You should exclude a child with diarrhoea or vomiting
True: Diarrhoea has numerous causes and is defined as 3 or more liquid or semi-liquid stools in a 24 hour period. Children and adults with diarrhoea or vomiting should be excluded until 48 hours after symptoms have stopped and they are well enough to return.
You should exclude a child with scarlet fever
True: Scarlet fever cases have been growing in the UK at the moment and there have been several outbreaks at schools. It is spread by the respiratory route or by direct contact with nose and throat discharges especially during sneezing and coughing. Children should be excluded for scarlet fever until 24 hours after commencing appropriate antibiotic treatment. If no antibiotics have been administered the person will be infectious for 2 to 3 weeks.
You should exclude a child with chicken pox
True: Chickenpox is highly infectious and is spread by respiratory secretions or by direct contact with fluid from blisters. Cases of chickenpox are infectious from 48 hours before the rash appears to 5 days after the onset of rash. Children should be kept away from childcare settings for at least 5 days from onset of rash. It is not necessary for all the spots to have healed or crusted over before return to your childcare setting as the risk of transmission to other children after 5 days is minimal.
You should exclude a child with chicken pox even if you and all the other children have already had it
Probably: But this is entirely your call. After you have had chicken pox once you have lifelong immunity to the virus. Nevertheless, you do hear about very rare cases of people catching it for the second time around. Normally when these cases do occur, they are in a person who has a weakened immune system in some way. So while the child with chicken pox is extremely unlikely to re-infect you or the other children, it is also important to think about this child who may not be feeling all that well. It’s hardly fair on you or the child to be anywhere but home while they have chicken pox. I think it would be very wrong of the parent to take advantage of a childminder in this situation when a nursery or school would send the child home. You won’t be able to go out for example to music club or soft play even, because the child is infectious.
You must close when your own children are sick
Probably. Any childminder who looks after their own children while childminding will at some point be faced with the situation where their own child gets sick and have to decide whether to close or not. There is no specific Ofsted regulation that dictates what you HAVE to do in this situation. Here are my thoughts on this issue.
When I was childminding, if one of my girls was sick-but-not-so-sick-she-needed-Mummys-full-attention, I used to inform the parents of the situation and leave it up to them. I didn’t want to either inconvenience the parents or lose money by ‘closing’. I would send the parents a detailed text message so they could make an informed decision. “Beatrice has chicken pox. You can send in your child if you like. But if your own child hasn’t had it yet, they could catch it.” Or “Beatrice threw up yesterday. She doesn’t have any other symptoms and seems fine today, so if you want to send your child in, I’m totally fine with that, but it’s your risk.”
That was I used to do when I was childminding. Parents, I found, were more likely to take their chances on chicken pox than they were on dreaded stomach bugs! But they liked that I gave them the choice. They liked me to be reliable so they could go to work.
Looking back, however, I’m not so sure that was necessarily the right thing to do. It says in the EYFS Statutory Framework that the provider “must take necessary steps to prevent the spread of infection.” It also says that, “providers must take all necessary steps to keep children safe and well.” So I am concerned that if you stay open, knowing that your own children are infectious, you are technically breaking those Stat Requirements. So now that I am older and wiser and looking back on my childminding days, I’m not sure that my ‘it’s the parents’ risk’ policy was necessarily the right thing to do.
Now, following this train of thought, any nursery worker who went into work knowing that she had a stomach bug, would be in breach of those same EYFS regulations. And yet people do this all the time. This is complicated. What do people think? Please feel free to leave me a comment.
For a list of exclusion periods from Public Health England and information about lots of childhood diseases go to Health protection in schools and other childcare facilities. If you scroll down to the bottom of the page there is two-page printable Exclusion Periods chart you can refer to.
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Kay Woods has been writing and selling childminding resources through her company Kids To Go since 2008. Her products include the Ultimate Childminding Checklist, the Learning Journey Plus for planning, observation and assessment and best practice resources promoting diversity, safety and childminding in the great outdoors (Forest Childcare). She is the author of the Start Learning book set published by Tarquin and she writes the free quarterly Childminding Best Practice Newsletter.
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