Three-year-old Tammy appeared fine when her dad signed her in this morning. By lunchtime, however, she was fussy and had a temperature of 101°. The teacher has called the parents but it will be at least 30 minutes before they pick her up. What would you do in this situation?
There are several questions to consider in this scenario. First, childcare staff should observe children upon arrival to detect possible signs of illness. A second consideration is the accessibility of parents or other contact persons in case of illness or injury. Also, a child may need medication administered while waiting for the parents.
There are many possible problems and solutions to consider when a child becomes ill while in your care. An immediate concern is preventing exposure of other children and staff to the germs. However, there are other possible consequences. An ill child may have a serious or even life-threatening reaction, such as high fever or breathing difficulties.
Staff training is essential in being prepared. First, will staff recognize signs of illness in children? Obvious signs include fever, rash or skin irritation, drainage from the nose or eyes, diarrhea, or vomiting. However, teachers should look for more subtle symptoms such as a child who seems unusually tired or fussy, looks pale, or just "doesn't seem to be himself."
Symptoms such as these could indicate a viral or bacterial infection, an allergic reaction, or other physical problems. For example, a skin rash could be chickenpox, impetigo, or an allergic reaction to medication or food. Green or yellow nasal discharge may indicate a bacterial infection while clear drainage usually indicates a viral cold or allergy. The primary responsibility of the childcare staff is to observe the symptoms, isolate the child to prevent spread of the disease, provide emergency treatment if necessary, and notify the parent or guardian.
Do you have a place to isolate the child from other children and staff? Perhaps the director's office is available for sick children. If a separate room is not available, make an effort to keep the child away from other children such as placing an ill infant in her crib, or rocking a sick child in a corner of the room.
Staffing may also become a problem when a child gets sick. If the child is taken to a separate area, then a trained staff person must be with the child until the parents/guardians arrive. If the child remains in the classroom and needs individual attention such as being rocked or cuddled, then additional staff should be available to care for the other children. If the teacher cuddles the sick child and then picks up a toy on the floor, she has just transferred germs to the toy and to the other children.
First aid and emergency care may be necessary if a child gets sick. An infant less than three months, a child with a chronic condition who develops a fever, or a child with a high fever may need immediate medical attention. Fever higher than 105° can have serious consequences. Likewise, a child who is having difficulty breathing should be closely watched. Problems such as whooping cough, asthma, or allergic reactions can cause breathing problems that are life-threatening. Sudden stomach problems or becoming listless could be the result of a virus or perhaps a reaction to a poisonous substance such as a toxic plant or berries. In such cases, staff needs to be well trained and prepared. Staff training in first aid is important and should be updated frequently to not only refresh information, but train new staff members as well.
While waiting for the parent, staff should pay special attention to sanitation. Place the child's personal belongings (special toys or blankets, sheets, clothing) in a plastic bag for the parent to wash at home. Clean and disinfect all toys, tables, and other areas which the child or teacher has touched. Some germs, such as strep bacteria, can live for up to 30 days on a tissue or blanket!
POLICIES FOR ILLNESS
Many problems can be prevented by having policy and procedures in place before a situation occurs. When developing policy and procedures, refer to the childcare licensing requirements for your state. You may also refer to the National Association for the Education of Young Children (NAEYC) accreditation criteria and Head Start Revised Performance Standards for requirements. Review the accompanying example of policy and procedures that would be appropriate in this case (modified from Jefferson County Committee for Economic Opportunity (JCCEO) Head Start Procedures Manual, Birmingham, Alabama.).