Managing Illness (Child Care Manual)

Infection prevention and control is a simple process that should be a continuous and on-going part of your program.

Managing illness takes teamwork

Keep children healthy by ensuring timely communication and cooperation among staff, parent(s) / caregiver(s), health care providers and Public Health.

Every licensee shall ensure that a daily observation is made of each child receiving child care in each child care centre it operates and in each premises where it oversees the provision of home child care before the child begins to associate with other children in order to detect possible symptoms of ill health.
- Child Care and Early Years Act, 2014, S.O. 2014, c. 11, Sched. 1 Section 36. (1)

Staff responsibilities

  • Establish written policies and procedures in advance to manage outbreaks of infectious diseases, exclusion(s) from the child care centre and infection prevention and control.
  • Observe the children as you greet them upon arrival to the centre and throughout the day
  • Communicate with the parent(s) / caregiver(s) as the child may have experienced symptoms the previous evening or overnight
  • Protect the other children in the child care centre from illness
  • Know how and when to contact Public Health
  • Report Diseases of Public Health Significance to Public Health
  • Know how to contact parent(s) / caregiver(s) in the event of illness

Parent(s) / caregiver(s) responsibilities

  • Keep your child home when they are sick to prevent them from spreading their infection to others
  • Inform staff about their child's illness or symptoms
  • Inform staff if their child has been in contact with someone who has an infectious disease
  • Seek medical attention for their child
  • Participate in policy development and revisions
  • Follow the centres policies, procedures and exclusion(s)

Public Health responsibilities

  • Help prevent the spread of illness to child care providers and children in the centre
  • Support outbreak management of infectious disease (respiratory, gastroenteritis and others)
  • Assist in developing written policies and procedures to help prevent and manage illness
  • Act as a resource for health information
  • Manage cases and contacts of reportable infectious diseases

Back to top

Public Health as a support

Call Public Health. We can offer your staff support and guidance on:

To learn more, call 905-688-8248 or 1-888-505-6074 ext. 7330, or email Infectious Diseases.

Back to top

Daily observation of children

One exposure to germs by a child or adult can be enough to spread infection throughout your centre. Although you can't prevent all illnesses, by knowing what to do, you can control how many people are infected.

  • Be sensitive to how a child feels or looks upon arrival to the centre and throughout the day
  • Recognize when a child needs an early pick-up or should stay at home and communicate with their parent(s) / guardian(s)

It's also important to know when to:

  • Communicate with parent(s) / guardian(s) when illness / infections are in the centre
  • Protect confidentiality
  • Consult with or notify Public Health

Back to top

Signs and symptoms of illness

Upon arrival to the centre and throughout the day, watch for these symptoms:

  • Unusual behaviour, such as lack of energy, lack of interest or loss of appetite
  • Runny or stuffy nose, cough or trouble breathing
  • Vomiting
  • Diarrhea
  • Change in skin colour
  • Skin - spots, rash, infected area, itchy skin and scalp
  • Fever / chills
  • Eyes - tears, discharge, swelling
  • Sore throat (painful swallowing or difficulty swallowing)
  • Headache

Back to top

Preventing and managing illness in child care centres

Clean your hands: The most important thing you can do is to clean your hands well and often throughout the day. See resources for your centre for handwashing posters.

Observe the children daily: Staff should assess a child for illness every day upon arrival to the centre and throughout the day. Communicate to parent(s) / caregiver(s) the importance of keeping staff informed about any illness that the child may have or been in contact with.

Get immunized: Immunization is the most effective way of preventing vaccine preventable diseases such as influenza, COVID-19, whooping cough, measles and mumps. Keep up-to-date health records for children and staff.

Follow proper diaper changing and toileting routines: This is critical as intestinal infections in child care centres are closely related to the presence of children in diapers.

Put policies in place: Make sure you have written policies that are regularly reviewed and communicated to staff, volunteers and parent(s) / caregiver(s). These should focus on health records, immunization, exclusion criteria, hand hygiene, cleaning and disinfecting, food safety and contacting Public Health.

Use routine practices: Any person can be carrying an infection and their bodily fluids could contain illness-causing germs. Being aware is especially important when you are in contact with or exposed to bodily fluids. Wash your hands well, use gloves, and clean / disinfect surfaces carefully.

Clean and disinfect surfaces regularly: This is very important as many germs that are spread from person-to-person are stable and live on surfaces for hours and days. Follow these practices consistently to protect children and staff from becoming ill.

Handle and store food safely: This prevents foodborne illness, the growth of germs and contamination by insects or rodents

Consider if animals should be permitted: Keep in mind that children and staff may be allergic. Animals can be infectious to humans, and even docile pets can bite.

Cover your cough and sneeze: Use a tissue or the sleeve of your upper arm. Don't use your hands.

Prevent sharps injuries.

Back to top

Managing biting incidents

Young children often bite each other during play or while fighting. Parent(s) / caregiver(s) may be concerned about the possible spread of infections, such as hepatitis and HIV. Although the risk of infection is low, parental anxiety may be high.

  • Make sure your centre has written policies to manage exposures to blood and body fluids by children and staff, including bite wounds. Children cannot be excluded from child care because of hepatitis B, hepatitis C or HIV infection.
  • Staff should be adequately trained and regularly updated on the proper care of bite wounds
  • Ensure first aid supplies are available for the care of wounds, including gloves and bandages. These should be on site and easily accessible.

When a bite occurs

If the skin isn't broken, clean the wound with soap and water, apply a cold compress and soothe the child who was bitten.

If the skin is broken:

  • Allow the wound to bleed gently, without squeezing
  • Clean the wound carefully with soap and water
  • Complete appropriate documentation as per child care centre policy
  • Notify the parent(s) / caregiver(s) of both the biter and the bitten child
  • Advise the parent(s) / caregiver(s) to visit a health care provider to assess the bite and determine the risk of infection and possible need for medication
  • Observe the wound over the next few days and if redness or swelling develops, advise the child’s parent(s) / caregiver(s) to consult a health care provider

Back to top

Reportable Diseases of Public Health Significance

Report diseases to the Infectious Disease program at 1-888-505-6074 or 905-688-8248 ext. 7330, Monday to Friday 8:30 a.m. to 4:30 p.m. For reporting after hours, call 905-984-3690.

Bacterial meningitis
All cases must be discussed with Public Health on an individual basis

Chickenpox
A child with mild chickenpox can continue to attend child care and school regardless of the state of their rash, provided they are well enough to take part comfortably in all program activities, including going outside. A child with a high fever or enough spots to be uncomfortable, or who is feeling unwell, should be kept at home until well enough to participate.

COVID-19
Children who have COVID-19 symptoms (regardless if they tested positive for COVID-19 or not) should stay home and not attend child care or school until they are fever free (without the use of fever-reducing medication) and other symptoms have been improving for 24 hours (or 48 hours if gastrointestinal symptoms are present, like nausea, diarrhea or vomiting) and they have not developed any new symptoms.

Hepatitis A
Children with acute infection should be excluded for one week after onset of illness or jaundice (yellowing of the eyes and skin). Public Health staff will be in contact with the child care centre or school with recommendations for contacts of a case.

Influenza (flu)
Children should not attend child care or school until five days after the start of symptoms, or until fever free and can participate in activities.

Measles
Exclude for four days after the onset of rash. Public Health staff will be in contact with the child care centre or school to discuss exclusion of ill child and to give recommendations for contacts of a case.

Mumps
Exclude for five days from the onset of swelling. Public Health staff will be in contact with the child care centre or school to discuss exclusion of ill child and to give recommendations for contacts of a case.

Pertussis (whooping cough)
A child can return to the child care centre or school three weeks after intense coughing begins, or after five days of appropriate antibiotic treatment.

Rubella (German measles)
Exclude for seven days after the rash is first noticed. Public Health staff will be in contact with the child care centre or school to discuss exclusion of ill child and to give recommendations for contacts of a case.

Back to top

Non-reportable illnesses

While these illnesses are not required to be reported to Public Health, contact us if you have any questions or concerns. Recommended exclusion periods:

Common cold
Children should stay home and not attend child care or school until they are fever free (without the use of fever-reducing medication) and other symptoms have been improving for 24 hours and they have not developed any new symptoms.

Diarrhea / vomiting
A child can attend the child care centre or school 48 hours after symptoms have been improving. If there is an outbreak of gastrointestinal illness at the child care centre, it is recommended a child wait until 48 hours after symptoms of diarrhea / vomiting have resolved before returning. This may vary depending on the cause of illness, number of cases and source of infection.

Fever
A child can return to the child care centre or school once they are fever free, without the use of fever-reducing medicine, for 24 hours.

 Fifth disease
A child can attend the child care centre or school because they are no longer contagious once the rash appears.

 Hand / foot and mouth
A child may return to the child care centre or school when feeling well enough to take part in activities. However, keeping young children at home who drool and have blisters in the mouth or children with a weeping rash on the hands, can help to reduce the spread of infection to others.

Impetigo
A child should not return to the child care centre or school until the antibiotic prescribed by a health care provider has been taken for at least one full day (24 hours), and the child is well enough to take part in program activities.

Molluscum Contagiosum
No exclusion necessary.

 Pink eye
A child with pink eye should be kept home until seen by a health care provider. If bacterial, the child can return to the child care centre or school after 24 hours of appropriate antibiotic treatment. If viral, the child can return with the health care provider’s approval. No need to exclude if there's no eye discharge, unless there is an outbreak.

Pinworm
Children can return to the child care centre or school after treatment has started.

Ringworm
Children can return to the child care centre or school after their first treatment has started.

Roseola
Children may continue to attend the child care centre or school if feeling well enough to take part in regular daily activities.

Scabies
Children can return to the child care centre or school after treatment has been applied.

Strep throat
A child should not return to the child care centre or school until the antibiotic prescribed by a health care provider has been taken for at least one full day (24 hours), and the child is well enough to take part in all program activities.

Steps to identify infection

  1. Observe children upon arrival to the centre before they interact with other children at the centre
  2. Be prepared to deal with illness when it occurs. If a child appears ill, separate this child from other children.
  3. Notify the parent(s) / caregiver(s) promptly and request that the ill child be picked up
    • Ask that the child be kept at home until recovery is complete and the child is no longer infectious
    • Immediately report any diseases of Public Health significance to Public Health
    • Be especially attentive to children in the child care centre who are immunocompromised
    • Document the illness as required by your centre
    • Continue to observe other children for similar symptoms

Back to top

Last updated: April 2024

Page Feedback Did you find what you were looking for today?