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City of Chicago Family and Support Services
Children Services
INCLUSION/EXCLUSION POLICY
In order to assure the health and safety of children enrolled in each of the Head Start/Early Head
Start/Child Care programs, the following policy has been developed to determine when a child
must be excluded from the program and when he/she may safely return.
Mild illness is common among children, and most children will not need to be excluded from a
program for mild respiratory tract illnesses, because transmission is likely to have occurred
before symptoms developed in the child or is a result of contact with children with asymptomatic
infection. The risk of illness can be reduced by following Head Start standards and commonsense hygienic practices.
Exclusion of sick children (and adults) from a Head Start/Early Head Start/Child Care program
or provider home is recommended if the exclusion could reduce the likelihood of spread of the
illness. Parents should be encouraged to disclose all symptoms and illnesses that their child may
have. The final decision regarding exclusion lies with the site director/home provider or
designate of the program, in consultation with the child's medical provider and the Chicago
Department of Public Health (CDPH). Reporting of children with certain diseases and
conditions is mandated by CDPH (see attached), as well as any unusual outbreaks of other
illnesses involving the children or adults in a program.
Children should be excluded from the program for the following illnesses:
1.
Illness that prevents the child from participating comfortably in program activities.
2.
Illness that results in a greater need for care than the staff can provide without
compromising the health and safety of other children.
3.
Any of the following conditions: unusual tiredness, unusual irritability, unusually
persistent crying, not explained by other causes; difficulty breathing; wheezing; and/or
other manifestations of possible severe illness.
4.
Rash with a fever greater than 101°F, measured orally, or greater than100°F, measured
under the arm.
5.
Diarrhea, unless a medical examination indicates that the diarrhea is not infectious.
6.
Vomiting two or more times in the previous 24 hours, unless the vomiting is
determined to be caused by a noncommunicable condition and the child is not in danger
of dehydration.
7.
Mouth sores associated with drooling, unless a medical examination indicates that the
condition is not infectious.
8.
Rash with fever or behavior change, unless a medical examination indicates that the
condition is not infectious.
9.
Purulent conjunctivitis (“pink eye” or “red eye,” 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, 24 hours after treatment has been initiated.
10. Tuberculosis (active), until the child's physician or local CDPH authority states that the
child is noninfectious.
11. Impetigo, until 24 hours after treatment has been initiated.
12. Streptococcal pharyngitis (sore throat), until 24 hours after treatment has been initiated,
and until the child has been afebrile (no fever) for 24 hours.
13. Live head lice and/or nits, until the morning after the first treatment. "No nit" policies
are not required.
14. Scabies, until the morning after treatment has been completed.
15. Ringworm (scalp or body), until after treatment has been initiated.
16. Varicella (chicken pox), until the sixth day after onset of rash and at least all lesions
have dried and crusted.
17. Pertussis (whooping cough), until 5 days of the appropriate antibiotic therapy (which is
to be given for a total of 14 days) has been completed.
18. Mumps, until 9 days after onset of parotid gland swelling.
19. Measles, until 6 days after onset of rash.
20. Hepatitis A virus infection, until 1 week after onset of illness or jaundice (if symptoms
are mild).
Most infections do not constitute a reason for excluding a child from a program. Examples that
do not necessitate exclusion include:
1.
Nonpurulent conjunctivitis (“pink eye” or “red eye,” defined as pink conjunctiva with a
clear, watery eye discharge, without fever, eye pain, or eyelid redness);
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2.
Rash without fever and without behavior change;
3.
Hepatitis B virus carrier (with possible exceptions);
4.
HIV infection (with possible exceptions);
5.
Positive TB skin test with a negative chest X-ray and no active disease (latent TB
infection).
During the case of an identified outbreak of any communicable illness in a Head Start/Early
Head Start/Child Care program, a child determined to be contributing to the transmission of the
illness at the program may be excluded. The child may be readmitted when the risk of
transmission is determined to no longer be present.
A note from a medical provider is required for re-admittance following all absences of five days
or more. A site director/home provider or designate has the option to require a note from a
medical provider for any child whose health or disease communicability is in question.
[Attachment: Reportable Diseases and Conditions in Illinois, Illinois Department of Public Health, dated 5/11/2010
Reference: AAP 2009 Redbook--Report of the Committee on Infectious Diseases, 28th Edition.
Licensing Standards for Day Care Centers; April 1, 2010 – P.T. 2010.04]
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