Policy Statement
We aim to provide care for healthy children through preventing cross infection of viruses and bacterial infections and promote health through identifying allergies and preventing contact with the allergenic trigger.
Procedure
If children appear unwell during the day we will call the parents and ask them to collect the child, or to send a known carer to collect the child on their behalf.
Parents are asked to keep their children at home for 24 hours after being sent home from the setting due to ill health even if it doesn't develop into anything, this slows the risk of infecting other children with a potential illness. We will refuse entry to children that attempt to return inside this time frame.
Some activities, such as sand and water play, and self-serve snacks where there is a risk of cross-contamination may be suspended for the duration of any outbreak.
Reporting of ‘notifiable diseases’
If a child or adult is diagnosed as suffering from a notifiable disease under the Health Protection Regulations 2010, the GP will report this to Public Health England.
The current notifiable diseases are as follows:
- Acute encephalitis
- Acute infectious hepatitis
- Acute meningitis
- Acute poliomyelitis
- Anthrax
- Botulism
- Brucellosis
- Cholera
- COVID-19
- Diphtheria
- Enteric fever (typhoid or paratyphoid fever)
- Food poisoning
- Haemolytic uraemic syndrome (HUS)
- Infectious bloody diarrhoea
- Invasive group A streptococcal disease
- Legionnaires’ disease
- Leprosy
- Malaria
- Measles
- Meningococcal septicaemia
- Monkeypox
- Mumps
- Plague
- Rabies
- Rubella
- Severe Acute Respiratory Syndrome (SARS)
- Scarlet fever
- Smallpox
- Tetanus
- Tuberculosis
- Typhus
- Viral haemorrhagic fever (VHF)
- Whooping cough
- Yellow fever
When we become aware, or are formally informed of the notifiable disease, we will inform Ofsted and contacts Public Health England, and act on any advice given.
HIV/AIDS/Hepatitis Procedure
HIV virus, like other viruses such as Hepatitis A, B and C, are spread through body fluids. Hygiene precautions for dealing with body fluids are the same for all children and adults. We:
Wear single-use vinyl gloves and aprons when changing children’s nappies, pants and clothing that are soiled with blood, urine, faeces or vomit.
Rinse soiled clothing and either bag it for parents to collect or launder it in the setting.
Clear spills of blood, urine, faeces or vomit using mild disinfectant solution and mops; any cloths used are disposed of with the clinical waste.
Clean any tables and other furniture, furnishings or toys affected by blood, urine, faeces or vomit using a disinfectant.
Nits and Headlice
Nits and head lice are not an excludable condition; although in exceptional cases we may ask a parent to keep the child away until the infestation has cleared.
On identifying cases of head lice, we inform all parents ask them to treat their child and all the family if they are found to have head lice.
Fever
If your child has a fever, he or she will have a body temperature above 37.5°C. Your child may also feel tired, look pale, have a poor appetite, be irritable, have a headache or other aches and pains and feel generally unwell. Take the temperature from the armpit (don’t use in the mouth of under 5s). However, bear in mind that these measurements are less accurate as the armpit is slightly cooler.
A fever is part of the body’s natural response to fight infection and can often be left to run its course provided your child is drinking enough and is otherwise well. If your child is having trouble drinking, trying to reduce their temperature may help with this. This is important in preventing your child from becoming dehydrated, which can lead to more serious problems. As a guide, your child’s urine should be pale yellow - if it is darker, your child may need to drink more fluids.
Fevers are common in young children. They are usually caused by viral infections and clear up without treatment. However, a fever can occasionally be a sign of a more serious illness such as a urinary tract infection, pneumonia, meningitis or a severe bacterial infection of the blood (septicaemia).
You should also contact your GP if fever symptoms are not improving after 48 hours.
EXCLUSION FROM SETTING: 24 hours after your child's temperature has returned to normal and remained stable without the use of Calpol or other medication .The setting will not administer regular pain relief medication to a child to keep a temperature at bay. This will need to be done at home.
Meningitis
Babies and toddlers are most vulnerable as they cannot easily fight infection because their immune system is not yet fully developed. They can’t tell you how they are feeling and can get a lot worse very quickly. Keep checking them.
Meningitis is a swelling around the brain. It is a very serious, contagious illness, but if it is treated early most children make a full recovery.
You should always treat any case of suspected meningitis as an emergency.
Early signs may be like having a cold or flu. Children with meningitis can become seriously ill very fast, so make sure you can spot the signs. Your child may have a cluster of red or purple spots. Do the glass test. This rash can be harder to see on darker skin, so check for spots over your baby or child’s whole body as it can start anywhere (check lightest areas first). However, the rash is not always present - be aware of all the signs/symptoms.
The presence of fever and any other of the above symptoms should be taken extremely seriously. Not all children will show all the signs listed.
If any of the signs below are present contact a Doctor.
Fever, cold hands and feet
Floppy and unresponsive
Drowsy and difficult to wake
Spots/rash.
Do the glass test
Rapid breathing or grunting
Fretful, dislikes being handled
Unusual cry or moaning
The glass test
The glass test is a really useful way of spotting suspected meningitis. If your child has a cluster of red or purple spots, press the side of a clear drinking glass firmly against the rash.
Go straight to the Accident and Emergency Department
In this example the spots are still visible through the glass. This is called a non-blanching rash - it does not fade. Contact a Doctor immediately (e.g. your own surgery or Walk-in/Urgent Care Centre). If you cannot get help straight away go to A&E.
In this example the spots under the glass have virtually disappeared. It is unlikely to be meningitis but if you are still worried call NHS 111, contact your GP or go to A&E.
EXCLUSION FROM SETTING: until given all clear by Doctor and condition has returned to normal
Coughs, colds and flu
You will probably find when your child starts mixing with other children they get lots of coughs, colds and sniffles. There are some good things about this though as it helps the body build up a natural immune system.
Flu can be more serious than a cold and leave your child feeling quite unwell. Flu tends to come on more suddenly and severely than a cold. Your child may feel achy and uncomfortable, and be ill for a week or more.
Most bugs will run their course without doing any real harm because they will get better on their own. An annual nasal spray flu vaccine is available as part of the NHS Childhood Vaccination Programme. Ask your Health Visitor for details.
Things you can do at home to help:
- Give your child lots to drink.
- Try paracetamol or ibuprofen (not aspirin).
- Keep them away from smoke and anyone who smokes.
- Talk to your Pharmacist but remember that coughing is the body’s way of keeping the lungs clear.
- Make sure they get plenty of sleep/rest.
See your GP if:
- Your baby has a temperature of 37.5°C or more.
- They have a fever with a rash.
- They are not waking up or interacting.
- Your child is finding it hard to breathe.
EXCLUSION FROM SETTING: Until any temperature is under control without the use of Calpol or other medication for 24 hours and they feel well enugh to return.
Wheezing and breathing difficulties
Any kind of breathing difficulty your infant or child experiences can be scary for parents. It is often nothing to worry about and illnesses like bronchiolitis, mild croup and a cough can often be treated at home.
Use your instincts with newborns and babies. It could be:
- Rapid breathing or panting, which is common. There is no other sign of illness, it comes and goes and your baby is breathing comfortably most of the time, there’s normally no need to worry.
- Breathing may sound a bit rattly. Try holding your baby upright.
- Occasional coughing or choking which may occur when a baby takes in milk too quickly with feeds. Try to slow things down a bit. Check feeding position.
- A cold or mild cough. Keep an eye on them at this stage and use your instincts. If you are worried talk to your Health Visitor.
In older babies and toddlers you may notice:
- Coughing, runny nose, mild temperature.
- Croup (hoarse voice, barking cough) needs to be assessed by a Doctor and may need treating with steroids.
- Child appears pale.
Get help and call 999 or go to A&E now if:
- Their chest looks like it is ‘caving in.’
- They appear pale or even slightly blue-ish.
EXCLUSION FROM SETTING: Until any temperature is under control without the use of Calpol or other medication for 24 hours, breathing has returned to normal with no breathlessness.
Bronchiolitis
Bronchiolitis is a common respiratory tract infection that affects babies and young children under a year old. The early symptoms are similar to those of a common cold and include a runny nose and cough.
As it develops, the symptoms of bronchiolitis can include: A slight fever, a persistent cough and difficulty feeding.
Symptoms usually improve after three days and in most cases the illness isn’t serious. However, contact your GP or Health Visitor if your child is only able to feed half the normal amount or is struggling to breathe, or if you are generally worried about them.
EXCLUSION FROM SETTING: Until any temperature is under control without the use of Calpol or other medication for 24 hours, breathing has returned to normal with no breathlessness.
Allergies
50% of children in the UK have allergies. For parents it is a learning curve in understanding what to avoid and how to control and manage the allergy. Find out as much as you can. There are many types of allergies.
An allergy is when the body has a reaction to a protein such as foods, insect stings, pollens, house dust mite or another substance such as antibiotics. There are many common allergies. Some families seem to include more individuals with allergies than other families. Children born into families where allergies already exist show a higher than average chance of developing allergies themselves.
Allergic symptoms can affect the nose, throat, ears, eyes, airways, digestion and skin in mild, moderate or severe form. When a child first shows signs of an allergy it is not always clear what has caused the symptoms, or even if they have had an allergic reaction, since some allergic symptoms can be similar to other common childhood illnesses. Urticaria can be one of the first symptoms of an allergic reaction. If the reaction is severe, or if the symptoms continue to re-occur, it is important that you contact your GP.
Spotting symptoms
This example shows areas where allergy sufferers may experience symptoms. Many of these symptoms can develop as a result of other common childhood illnesses. With an allergy, symptoms often appear more quickly or suddenly.
Eyes -itchy eyes, watery eyes, prickly eyes, swollen eyes, ‘allergic shiners’ - dark areas under the eyes due to blocked sinuses.
Airways - Wheezy breathing, difficulty in breathing, coughing (especially at night time), shortness of breath.
Nose, throat and ears - Runny nose, blocked nose, itchy nose, sneezing, pain in sinuses, headaches, post-nasal drip (mucus drips down the throat from behind the nose), loss of sense of smell and taste, sore throat, swollen larynx (voice box), itchy mouth and/or throat, blocked ear and glue ear.
Skin -Urticaria- Wheals or hives, bumpy, itchy raised areas, rashes.
Eczema - Cracked, dry or weepy, broken skin.
Digestion -Swollen lips/tongue, stomach ache, feeling sick, vomiting, constipation, diarrhoea, bleeding from the bottom, reflux, poor growth.
EXCLUSION FROM SETTING: Child will only need to remain off while the symptoms of allergies are not under control or extreme. Once the symptoms are under control and triggers have been established the child is fine to return to setting. An allergy report will need to be filled out with parents and a medical protocol form if required.
Sickness and diarrhoea
Sickness and diarrhoea bugs are caught easily and are often passed on in places where there are lots of children.
Feeling sick and suddenly being sick are normally the first signs. Diarrhoea can follow afterwards. If your child is not vomiting frequently, is reasonably comfortable in between and you are able to give them frequent small amounts of water, they are less likely to become dehydrated and probably don't need to see a Doctor. Speak to your GP if they are unwell for longer than 24 hours or sooner if they are newborn or if you notice signs of dehydration.
If you're breastfeeding, keep on doing so even more frequently. Offer older children plenty of water, or an ice-lolly for them to suck. If they want to eat, give them plain foods like pasta or boiled rice (nothing too rich or salty).
Keep them away from others, especially children, who may pick up infection. Be extra careful with everyone’s handwashing.
EXCLUSION FROM SETTING: Child will need to remain off until at least 24 hours since the last episode.
Earache
Ear infections, which can result in earache are common in babies and toddlers. They often follow a cold and can sometimes cause a temperature. A child may pull at their ear, but babies often cannot tell where their pain is coming from, so they just cry and seem generally uncomfortable.
Babies have some natural protection against infections in the first few weeks - this is boosted by breastfeeding. In babies and toddlers, bacteria pass from the nose to the ears more easily. Ear infections can be painful and your child may just need extra cuddles and painkillers from the Pharmacist. Your child may have swollen glands in their neck - this is the body’s way of fighting infection.
EXCLUSION FROM SETTING: if child requires Antibiotics they must have completed at least 4 doses or 24 hours whichever is longer before returning to the setting providing there are no other symptoms. If the child is requiring regular pain relief medication due to ear ache tyour child will need to remain off till this is no longer required . The setting can administer antibiotics but need to be made aware of this as soon as possible. Parents will need to complete an administering medication form with staff before leaving the child at the setting.
Tonsillitis
Earache can also be caused by tonsillitis (the inflammation of the tonsils). It is a common type of infection in children. Symptoms include a sore throat, earache, coughing and a high temperature. It is not a serious illness and you only need to see your GP if symptoms last longer than four days or become more serious with severe pain, a very high temperature or breathing difficulties.
EXCLUSION FROM SETTING: if child requires Antibiotics they must have completed at least 4 doses or 24 hours whichever is longer before returning to the setting providing there are no other symptoms and breathing is unaffected . If the child is requiring regular pain relief medication due to Tonsillitis your child will need to remain off till this is no longer required . The setting can administer antibiotics but need to be made aware of this as soon as possible. Parents will need to complete an administering medication form with staff before leaving the child at the setting.
Chickenpox
Chickenpox is a mild disease that most children catch at some point. The spots often look like mosquito bites and can appear on any part of the body. After having chickenpox, the virus stays in the body. Later in life the virus can come back in a different form known as shingles.
Chickenpox is easy to pass on to someone who has not had it before. If your child has chickenpox keep them away from others.
Chickenpox can be incredibly itchy, but it's important for children to not scratch the spots so as to avoid future scarring. One way of stopping scratching is to keep fingernails clean and short. You can also put socks over your child's hands at night to stop them scratching the rash as they sleep.
If your child's skin is very itchy or sore, try using calamine lotion or cooling gels. These are available in pharmacies and are very safe to use. They have a soothing, cooling effect.
EXCLUSION FROM SETTING: The child will need to remain at home until all spots have scabbed over and they are free of temperature or feeling unwell. If the child is requiring regular pain relief medication due to Chickenpox your child will need to remain off till this is no longer required.
Measles
Measles is a very infectious illness. About one in five children with measles experiences complications such as ear infections, diarrhoea and vomiting, pneumonia, meningitis and eye disorders. One in 10 children with measles ends up in hospital. There is no treatment for measles. Vaccination is the only way of preventing it. If your children have not yet had the MMR vaccination, do not delay. Speak to your Health Visitor.
Once the rash starts, your child will need to rest and you can treat the symptoms until your child’s immune system fights off the virus. If there are no complications due to measles, the symptoms will usually disappear within 7-10 days.
Closing curtains or dimming lights can help reduce light sensitivity.
Damp cotton wool can be used to clean away any crustiness around the eyes. Use one piece of cotton wool per wipe for each eye. Gently clean the eye from inner to outer lid.
EXCLUSION FROM SETTING: Stay off nursery, school, or work for at least 4 days from when the rash first appears. Also try to avoid close contact with babies, people who are pregnant and people with weakened immune systems. Children can return after this time if they have no temperature and are not feeling unwell. If the child is requiring regular pain relief medication due to Measles your child will need to remain off till this is no longer required.
Hand, foot and mouth disease
and, foot and mouth disease is a common childhood illness that can also affect adults. It usually gets better on its own in 7 to 10 days.
The 1st signs of hand, foot and mouth disease can be:
- a sore throat
- a high temperature
- not wanting to eat
The 2nd stage usually starts a few days later and can include:
- mouth ulcers, which can be painful
- a raised rash of spots on the hands and feet, and sometimes the thighs and bottom
The rash of spots can look pink, red, or darker than the surrounding skin, depending on your skin tone.
The spots can turn into blisters, which might be grey or lighter than surrounding skin and can be painful.
The symptoms are usually the same in adults and children, but can be worse in babies and children under 5.
Hand, foot and mouth disease has nothing to do with foot and mouth disease that affects farm animals.
Hand, foot and mouth disease is easily passed on to other people. It's spread in coughs, sneezes, poo and the fluid in the blisters. You can get it more than once.
You can start spreading it from a few days before you have any symptoms, but you're most likely to spread it to others in the first 5 days after symptoms start.
To reduce the risk of spreading hand, foot and mouth disease:
- wash your hands often with soap and water, and children's hands too
- use tissues to trap germs when you cough or sneeze
- bin used tissues as quickly as possible
- do not share towels or household items like cups or cutlery
- wash soiled bedding and clothing on a hot wash
EXCLUSION FROM SETTING: Children must remain off while they feel unwell or have a temperature. If the child is requiring regular pain relief medication due to Hand Foot and Mouth Disease your child will need to remain off while this is required. There is no need to wait for the spots to blister as soon as they are well enough your child may return to setting.
Conjunctivitis
Conjunctivitis is an eye condition caused by infection or allergies and is extremely contagious.
Conjunctivitis is also known as red or pink eye.
It usually affects both eyes and makes them:
- red
- burn or feel gritty
- produce pus that sticks to lashes
- itch
- water
Speak to a pharmacist about conjunctivitis. They can give you advice and suggest eyedrops or antihistamines to help with your symptoms.
If you need treatment for a child under 2, you'll need a prescription from a GP.
EXCLUSION FROM SETTING: if a child presents with any of the above symptoms during sessions parents will be called to collect. Treatment is usually done through the pharmacist in the form of eyedrops. Children will need to remain out of setting while the course of Antibiotic eyedrops are completed or the child's eyes are free from any of the above symptoms. The setting cannot administer Eye drops to children in the session, if your child requires eye drops during their sessions we would ask you kept them at home till the course was finished or a parent/ carer will need to attend the setting when the drops are due to be administered and treat their child themselves. Parents attending setting to treat their child with eye drops does come with the risk of if your child becoming too distressed after/during administering the drops. Parents will be asked to take children home for the rest of the day if this happens.
Slapped Cheek Syndrome
Slapped cheek syndrome (also called fifth disease) is common in children and should get better on its own within 3 weeks. It's rarer in adults, but can be more serious.
Check if it's slapped cheek syndrome
The first sign of slapped cheek syndrome is usually feeling unwell for a few days.
Symptoms may include:
- a high temperature
- a runny nose and sore throat
- a headache
The cheek rash usually fades within 2 weeks.
The body rash also fades within 2 weeks, but sometimes lasts for up to a month, especially if you're exercising, hot, anxious or stressed.
Adults might also have joint pain and stiffness. This can happen in children too, but it's rare. Joint pain can continue for many weeks, even after the other symptoms have gone.
it's hard to avoid spreading slapped cheek syndrome because most people do not know they have it until they get the rash.
You can only spread it to other people before the rash appears.
Slapped cheek syndrome is caused by a virus (parvovirus B19). The virus spreads to other people, surfaces or objects by coughing or sneezing near them.
To reduce the risk of spreading the virus:
- wash your hands often with water and soap
- use tissues to trap germs when you cough or sneeze
- bin used tissues as quickly as possible
EXCLUSION FROM SETTING: Until your child feels well and has no temperature that doesn't require regular administering of Calpol or other pain relief and temperature remains stable for at least 24 hours. The rash isn't contagious so children are free to return to setting even if the rash hasn't gone.
COVID-19
COVID-19 symptoms can include:
- a high temperature or shivering (chills) – a high temperature means you feel hot to touch on your chest or back (you do not need to measure your temperature)
- a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours
- a loss or change to your sense of smell or taste
- shortness of breath
- feeling tired or exhausted
- an aching body
- a headache
- a sore throat
- a blocked or runny nose
- loss of appetite
- diarrhoea
- feeling sick or being sick
The symptoms are very similar to symptoms of other illnesses, such as colds and flu.
Most people feel better within a few days or weeks of their first COVID-19 symptoms and make a full recovery within 12 weeks. For some people, it can be a more serious illness and their symptoms can last longer.
Try to stay at home and avoid contact with other people if you or your child have symptoms and either:
- have a high temperature
- do not feel well enough to go to work, school, childcare, or do your normal activities
EXCLUSION FROM SETTING: Until your child feels well and has no temperature that doesn't require regular administering of Calpol or other pain relief and temperature remains stable for at least 24 hours. There is no restriction currently on children or adults self-isolating when they have COVID-19. This may change and we will update the policy accordingly.
Worms in humans
Some types of worms can infect people. Some can be caught in the UK and others are only caught abroad. Most worm infections are not serious and can be easily treated with medicine.
A pharmacist can help with worm infections
A pharmacist can help if your child has:
- small, white worms in their poo that look like pieces of thread
- extreme itching around their anus, particularly at night
This is probably threadworms.
They're common in the UK and can be treated with medicine from a pharmacy.
See a GP if:
- find a large worm, a piece of worm or worm eggs in their poo
- have a red, itchy worm-shaped rash on their skin
- have sickness, diarrhoea or a stomach ache for longer than 2 weeks
- are losing weight for no reason
These could be symptoms of something like roundworm, hookworm or tapeworm.
These infections are usually caught while travelling. They can take a long time to cause symptoms, so tell the GP if you or your child has been abroad in the last 2 years.
Treatment to get rid of worms
It does not matter which type of worm you have – all worm infections are treated in a similar way.
You might be asked to provide a sample of poo so it can be tested for worm eggs.
If you have worms, a GP will prescribe medicine to kill them. You take this for 1 to 3 days. The people you live with may also need to be treated.
Any worms in your gut will eventually pass out in your poo. You may not notice this.
To avoid becoming infected again or infecting others, it's very important during the weeks after starting treatment to wash your hands:
- after going to the toilet
- before eating or preparing food
- regularly during the day
EXCLUSION FROM SETTING: all worms and eggs (alive and dead) have been passed through your child's bowel movements and your child has received and finished the correct medication from the GP/Pharmacist. We ask you let the setting know ASAP if your child has worms as the setting will need to begin the decontamination procedure to protect the staff and other children from further infection.
Strep A
Strep A is a common type of bacteria. Most strep A infections are mild and easily treated, but some are more serious.
Symptoms of a strep A infection
Common symptoms of strep A include:
- flu-like symptoms, such as a high temperature, swollen glands or an aching body
- sore throat (strep throat or tonsillitis)
- a rash that feels rough, like sandpaper (scarlet fever)
- scabs and sores (impetigo)
- pain and swelling (cellulitis)
- severe muscle aches
- nausea and vomiting
Strep A infections are more common in children, but adults can also sometimes get them.
Most strep A infections are not serious and can be treated with antibiotics.
But rarely, the infection can cause serious problems. This is called invasive group A strep (iGAS).
What to do if your child is unwell
It can be difficult to tell when a child is seriously ill, but the main thing is to trust your instincts.
You know better than anyone else what your child is usually like, so you'll know when something is seriously wrong.
If your child does not seem to be seriously ill, you can usually look after them at home. They should feel better in a few days.
A pharmacist can give you advice about how to ease your child's symptoms and whether you need to see a doctor.
Most strep A infections can be easily treated with antibiotics.
EXCLUSION FROM SETTING: Children will need to remain out of setting if they require Antibiotics. They must have completed at least 4 doses or 24 hours whichever is longer before returning to the setting providing there are no other symptoms. If the child is requiring regular pain relief medication due to Strep A they will need to remain at home until this is no longer needed.
Croup
Croup is a common condition that mainly affects babies' and young children's airways. It's usually mild, but it's important to call NHS 111 if you think your child has croup as they may need treatment.
Symptoms of croup include:
- a barking cough – this may sound like a seal (you can search online to hear examples)
- a hoarse voice
- difficulty breathing
- a high pitched, rasping sound when breathing in
Your child will usually have cold-like symptoms to begin with, such as a temperature, runny nose and cough.
Croup symptoms usually come on after a few days and are often worse at night.