Infectious Diseases

Infection Control: When to Exclude Children from Daycare or School

Mild illness is common among children. Most children will not need to be excluded from school or their usual Sick Child in Bed source of care for mild respiratory tract illnesses because transmission is likely to have occurred before symptoms developed in the child. Disease may occur as a result of contact with children who have no symptoms of infection. The risk of illness can be decreased by following appropriate hand washing procedures on a routine basis.

However, during the course of an identified outbreak of any communicable illness in a childcare setting or school, a child determined to be contributing to transmission of organisms causing the illness may be excluded. In general, the child may be readmitted when the risk of transmission is determined no longer to be present.

Children should be kept out of the childcare setting or school for the following:

Illness that prevents the child from participating comfortably in common program activities
Illness that results in a need for care that is greater than the staff can provide without compromising the health and safety of the other children
Any of the following conditions suggesting possible severe illness:

fever accompanied by behavior changes
lethargy
irritability
persistent crying
difficult breathing
other manifestations of possible severe illness, such as a quickly spreading rash

Diarrhea that contains blood or mucus
Mouth sores associated with drooling, unless the child's physician or local health department authority states that the child is non-infectious
Persistent abdominal pain (continues for longer than 2 hours) or intermittent abdominal pain associated with fever or dehydration
Rash with fever or behavioral change, until a physician has determined the illness is not a communicable disease
Vomiting 2 or more times during the previous 24 hours, unless the vomiting is determined to be caused by a non-communicable condition and the child is not in danger of dehydration
Purulent conjunctivitis (defined as pink or red conjunctiva with white or yellow eye discharge, often with matted eyelids after sleep and eye pain or redness of the eyelids or skin surrounding the eye), until examined by a physician and approved for readmission
Shiga toxin-producing Escherichia coli, including E. coli O157:H7, or Shigella infection, until diarrhea resolves and results of 2 stool cultures are negative for these organisms
Head lice (pediculosis), at the end of the program or school day and until after the first treatment
Hepatitis A virus infection, until 1 week after onset of illness or jaundice (if symptoms are mild)
Impetigo, until 24 hours after treatment has been initiated
Measles, until 4 days after onset of rash
Mumps, until 9 days after onset of parotid gland swelling
Pertussis, until 5 days of appropriate antimicrobial therapy have been completed
Rubella, until 6 days after onset of rash
Salmonella infection, until diarrhea resolves and 3 stool cultures test negative for Salmonella typhi; other types of Salmonella infection do not require negative stool culture results
Scabies, until after treatment has been given
Strep throat (Streptococcal pharyngitis), until 24 hours after treatment has been initiated
Tuberculosis, until the child's physician or local health department authority states that the child is non-infectious
Varicella (chicken pox), until all lesions have dried and crusted (usually 6 days after initial onset of rash)

Most minor illnesses do not constitute a reason for excluding a child from childcare. Examples of illnesses and conditions that do not necessitate exclusion include the following:

Non-purulent conjunctivitis (defined as pink conjunctiva with a clear, watery eye discharge without fever, eye pain, or eyelid redness)
Cytomegalovirus (CMV) infection
Chronic hepatitis B virus (HBV) infection
Human immunodeficiency virus (HIV) infection
Parvovirus B19 infection (Fifth disease) in an immunocompetent and otherwise healthy host
Rash without fever and without behavioral change

Asymptomatic children with mild loose stools usually do not need to be excluded, except when an infection with Shiga toxin-producing E. coli or with Shigella species has occurred in the child care program or school. Because these infections are transmitted easily and can be severe, exclusion is warranted until results of 2 stool cultures are negative for the organism.

Source: Recommendations for Inclusion or Exclusion, American Academy of Pediatrics Red Book 2006: pages 133-135.

For Parents:

School and Illness: Should Your Child Stay Home? (pdf)

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Last Reviewed: Mar 25, 2008

Jennifer Shine Dyer, MD, MPH
Assistant Professor
Department of Pediatrics (Nationwide Children's Hospital)
College of Medicine
The Ohio State University