A mother brings her 4-year-old child for you to evaluate because he has a red eye that has crusting and mucoid drainage. You diagnose him with conjunctivitis. His mother is frustrated because it seems he always has some illness for which the daycare sends him home. She asks you what illnesses should preclude him from attending daycare.
A. Cough and runny nose.
B. Conjunctivitis without fever.
C. Rash and fever.
E. Head lice.
The correct answer is “C.” Out-of-home child care is a common source of infection. Think of a room full of snotty-nosed kids running around touching everything. Infection prevention among young children is difficult because they have not yet developed good hygiene skills. How many toddlers ask for a tissue and cover their mouths every time they cough? There is a tendency of care providers to want to exclude children with upper respiratory tract infection (URI) symptoms from child care settings. However, viral respiratory infections are likely transmitted during the asymptomatic rather than the symptomatic period. Though it is common practice in some child care centers, excluding children with conjunctivitis who do not have fever is unnecessary unless there is an outbreak at the care center. Rash with fever is typically indicative of a communicable disease, and the child should be excluded until improvement of symptoms. Diarrhea itself is not a reason for exclusion unless it is unable to be contained in the diaper in infants and toddlers, or if toilet-trained children have accidents. Discouraging swimming in public pools is a good idea. Certain pathogens such as Escherichia coli 0157:H7 or Salmonella typhi pose a risk of serious morbidity and mortality if transmitted. Asymptomatic children with these organisms should not return to care until there is documented clearance of the pathogen from their stool. Criteria for return in this situation may vary from state to state. Other reasons for exclusion from daycare include draining skin lesions that cannot be adequately covered and contagious oral lesions in a child. The following specific diseases require the child’s exclusion from daycare until considered no longer contagious: measles, mumps, rubella, varicella, pertussis, group A streptococcal pharyngitis, tuberculosis, and scabies. Fifth disease caused by parvovirus B19 is not a reason for exclusion since by the time the rash develops, patients usually are no longer contagious. Head lice, while a nuisance and cause of considerable concern among parents and caregivers, are not a reason for exclusion as infestation is not associated with any severe morbidity or mortality.