Balliol Day Nursery: Managing Children who are Sick, Infectious or with Allergies

We provide care and education for healthy children. We will take measures to keep them healthy (as far as it is possible) by preventing cross infection of viruses and bacterial infections. We promote health through identifying allergies and preventing contact with the allergenic substance.

  • Children who are unwell should not be brought to nursery. If parents/guardians bring children who are unwell to nursery, they will be asked to take them home again. As we are a mixed-aged setting, our priority is to keep all children safe and well. We therefore reserve the right to refuse entry for any child deemed unwell.
  • Parents/guardians who are unable to care for their own child when they are unwell must have adequate alternative arrangements in place.
  • Parents/guardians must notify staff if their child has been unwell at the weekend or in the night, and if they have been given any medicine such as Calpol/Nurofen prior to coming to nursery. If Calpol/Nurofen has been given, the child must be kept at home for 24 hours before returning to the setting.
  • Parents/guardians must not send their child to Nursery if he/she is unwell, this includes children who have a heavy cough or cold. 
  • Any child who has had vomiting and or diarrhoea must not return to Nursery until at least 48 hours have elapsed from the last bout of vomiting and or diarrhoea and they are eating normally.

Coronavirus Procedure

The most important symptoms of coronavirus (COVID-19) are recent onset of any of the following:

  • a new continuous cough
  • a high temperature
  • a loss of, or change in, your normal sense of taste or smell (anosmia)

For most people coronavirus (COVID-19) will be a mild illness. However, if you have <u>any</u> of the symptoms above you should self-isolate at home.

Protocol for responding to a suspected case of coronavirus

  • Anyone who begins to display coronavirus symptoms whilst at Nursery will be sent home immediately. This applies to children and staff. 
  • Anyone who is sent home with coronavirus symptoms must self-isolate for<u> 10 days </u>and they must get tested before they can return to Nursery. Only a negative test result will allow the child to return and that they do not display any of the three main symptoms. All other children within the same group are permitted to remain at Nursery.
  • If you live with others and you are the first in the household to have symptoms of coronavirus (COVID-19), then you must stay at home for at least 10 days, but all other household members who remain well must stay at home and not leave the house for <u>14 days.</u> The 14-day period starts from the day when the first person in the house became ill.

Negative Tests

Where the individual tests negative, they can return to Nursery and the fellow household members can end their self-isolation.

Positive Tests

If any child or staff member tests positive for coronavirus within your child’s grouping, everybody within that same group will be sent home immediately and must self-isolate for 14 days. If you individuals from the group do not display any of the symptoms, they do not need to get tested. Only a negative test result for the individual who tested positive, will allow the child and or staff member to return to Nursery.

Children who become ill whilst they are in the setting

  • When a child becomes ill at nursery every effort will be made to contact the parents/guardians, who will be requested to collect their child as soon as possible (within 1 hour) or send a known adult to collect the child on their behalf.
  • Parents/guardians must ensure that the nursery is able to contact them, or a person nominated by them, at all times. This is a statutory requirement, failure to do so may lead to the committee taking steps to withdraw the child’s place.
  • If a child has a temperature (feels hot to touch on their forehead, back or tummy, feels sweaty or clammy and has red cheeks) they are given fluids and kept cool.
  • The child’s temperature is taken using a digital thermometer.
  • If the child’s temperature is 38 degrees or over, their parents/guardian are contacted to ask permission to administer Calpol to prevent febrile convulsion. 
  • If Calpol is given, the child must be collected and must be kept at home for 24 hours, before returning to Nursery.
  • Parents/guardians must sign a permission slip for Calpol to be administered by staff, during their child’s induction.
  • In extreme cases of emergency, the child should be taken to the nearest hospital and the parent/guardian informed.
  • Where children have been prescribed antibiotics, parents/guardian are asked to keep them at home for 24 hours before returning to the setting.
  • If a child has 1 case of vomiting and or 3 cases of diarrhoea and a parent/guardian must come and collect the child and the child must not return until at least 48 hours have elapsed from the last bout of vomiting and or diarrhoea and they are eating normally.
  • If a parent/guardian is called to collect their child because they become unwell whilst at the setting, the child should be kept at home on the following day. In some instances staff may ask parents/guardian to take their child to see a doctor before returning to the setting.

Vaccinations

6-in-1 Vaccine

This vaccine includes – diphtheria, hepatitis, hepatitis B, Hib, polio, tetanus and whooping cough.

Side effects include:-

  • Pain, redness and swelling at the injection site
  • Fever 38°c or above
  • Vomiting
  • Abnormal crying
  • Irritability
  • Loss of appetite

*During the Coronavirus pandemic children who receive the 6-in-1 vaccine must remain at home for 24 hours after the vaccine. If the child has a fever of 38°c or above they must remain at home and follow the government covid-19 procedure for self-isolation.

They can return to Nursery either once they have completed the set number of self-isolation days (symptom free) and or if they get tested and have a negative coronavirus result.

4-in1 Vaccine

This vaccine includes – diphtheria, tetanus, whooping cough and polio.

Side effects include:-

  • Pain, redness and swelling at the injection site
  • Fever 38°c or above
  • Loss of appetite
  • Increased crying
  • Irritability or restlessness
  • Loss of appetite

*During the Coronavirus pandemic children who receive the 4-in-1 vaccine must remain at home for 48 hours after the vaccine. If the child has a fever of 38°c or above they must remain at home and follow the government covid-19 procedure for self-isolation.

They can return to Nursery either once they have completed the set number of self-isolation days (symptom free) and or if they get tested and have a negative coronavirus result.

Reporting 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 the Health Protection Agency.
  • When the nursery becomes aware, or is formally informed of the notifiable disease, the manager informs Ofsted and acts on any advice given by the Health Protection Agency.

HIV/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.
  • Single use vinyl gloves and throw away aprons are worn when changing children’s nappies, pants and clothing that is soiled with blood, urine, faeces or vomit.
  • Protective rubber gloves are used for cleaning/sluicing clothing after changing.
  • Soiled clothing is rinsed and either bagged for parents to collect.
  • Spills of blood, urine, faeces or vomit are cleared using mild disinfectant solution and mops and cloths used are disposed of with the nappy waste.
  • Tables and other furniture, furnishings or toys affected by blood, urine, faeces or vomit are cleaned using a disinfectant.
  • Children do not share toothbrushes.

Nits and head lice

  • Parents/guardians will be asked to keep their child away until the infestation has been treated.
  • On identifying cases of head lice, all parents/guardians will be contacted and asked to collect their child. It is asked that parents/guardians treat their child and all the family if they are found to have head lice.

Teething

  • Teething can occur anytime from 4 months old. Most babies start teething at around 6 months.
  • Teething can cause flushed cheeks, more than usual dribbling, more than usual gnawing and chewing and or more fretful behaviour than usual.
  • There is no evidence that teething causes other symptoms, such as diarrhoea and fever (NHS 2019).
  • If a child appears to be experiencing minor pain or discomfort, with no other visible signs of illness, such as fever (38 degrees) and or diarrhoea, their parents/guardians are contacted and asked permission to administer Calpol. If Calpol is given and the child’s discomfort abates they can remain at Nursery.
  • If pain, discomfort, fever (38 degrees) and or diarrhoea is present a parent/guardian must come and collect the child and are asked to keep them at home for 24 hours before returning to the setting. 
  • Parents/guardians must sign a permission slip for Calpol to be administered by staff, during their child’s induction.

Conjunctivitis/pink eye

Conjunctivitis is an inflammation of the conjunctiva, a membrane covering the inner eyelid and front of the eye. It is often called pink eye as the white of the eye appears pink or red.

There are several types of conjunctivitis:

  • Bacterial – Pink eye, with yellow or greenish discharge from the eye.  Usually resulting in crusting of the eyelids after sleep.
  • Viral – Pink eye, with a more watery discharge.  Often accompanied by symptoms of a respiratory tract infection, such as runny nose, sore throat, fever.
  • Allergic conjunctivitis – Pink watery eyes, with severe itching. Caused by an irritant or allergic reaction.

Both viral and bacterial conjunctivitis are extremely infectious. Bacterial conjunctivitis is transferred by touching eyes and surfaces that are contaminated.  Viral conjunctivitis can also be spread by droplets in the air, through sneezing and coughing.

Treatment for children over two years of age

  • Bacterial conjunctivitis will need to be treated with antibiotic drops or cream.
  • Viral conjunctivitis will not be cured with cream, the virus will run its course and the body’s natural immunity will cure it within 4 to 14 days. Although antibiotics do not cure viral conjunctivitis, it is often advised to use them, to stop the development of a secondary bacterial infection.
  • Children often get runny or ‘gungy’ eyes when they have colds.  This is not conjunctivitis, which is characterised by the pink/redness of the white of the eye.
  • Due to the extremely infectious nature of this condition children with pink eyes, and a thick or watery discharge, must be kept away from nursery.
  • Children will be able to return when they have received at least 24 hrs of treatment with antibiotic drops and the condition is showing significant signs of improvement. It is important that the child is also feeling well in themselves.
  • Antibiotic drops (such as Brolene) can be purchased over the counter from a pharmacist, however we advise that where possible children are seen by a qualified doctor.
  • Once drops are prescribed they must be administered for 5–7 days and or until discharge has disappeared. If symptoms persist the child must see a doctor.

Treatment for children under two years of age

Many doctors will not prescribe children under two years of age with antibiotic drops or cream. In this instance the following procedures must be adhered to by parents/guardians.

  • Children must be kept away from Nursery for 48 hrs from the first onset of infection.
  • Parents/guardian are to use clean cotton wool (one piece for each eye). Boil water and let it cool down before wiping each eye to remove any discharge and or discharge crusts.
  • Wash hands regularly with warm soapy water.
  • Wash pillows and or face cloths in hot water and detergent.
  • Cooled camomile tea can be used to wash out eyes. Follow procedure above.
  • If symptoms persist for two weeks, the child must see a doctor.
  • Due to the extremely infectious nature of this condition children with pink eyes, and a thick or watery discharge, must be kept away from nursery. We reserve the right to refuse entry until the discharge has shown significant signs of improvement.

Procedures for children with allergies

  • When parents/guardian start their children at the nursery they are asked if their child suffers from any known allergies. This is recorded on the child induction form.
  • If a child has an allergy, a risk assessment form is completed to detail the following:
  • The allergen (i.e. the substance, material or living creature the child is allergic to such as nuts, eggs, bee stings, cats, etc.)
  • The nature of the allergic reactions e.g. anaphylactic shock reaction, including rash, reddening of skin, swelling, breathing problems etc.
  • What to do in case of allergic reactions, any medication used and how it is to be used e.g. Epipen
  • Control measures – such as how the child can be prevented from contact with the allergen.
  • Review schedule every 3 months.
  • This form is kept in the child’s personal file and a copy is displayed where staff can see it.
  • Children with food allergies have special red place mats, these clearly inform adults of foods that the child has an allergy to.
  • Parents/carers train staff in how to administer special medication in the event of an allergic reaction. For use of an Epipen staff will receive training from a medical professional.
  • Nuts or nut products are not used within the setting.
  • Parents are made aware so that no nut products are accidentally brought in, for example to a party.

Insurance requirements for children with allergies and disabilities

  • The insurance will automatically include children with any disability or allergy, but certain procedures must be strictly adhered to as set out below.  For children suffering life threatening conditions, or requiring invasive treatments, written confirmation from our insurance provider will be obtained to extend the insurance.

At all times the administration of medication must be compliant with the Safeguarding and Welfare Requirements of the Early Years Foundation Stage and follow procedures based on advice given in Managing Medicines in Schools and early Years Setting (DfES 2005)

Oral medication

Asthma inhalers are now regarded as ‘oral medication’ by insurers and so documents do not need to be forwarded to the insurance provider.

  • Oral medications must be prescribed by a GP or have manufacturer’s instructions clearly written on them.
  • The nursery must be provided with clear written instructions on how to administer such medication.
  • All risk assessment procedures need to be adhered to for the correct storage and administration of the medication.
  • The nursery must have the parents or guardians prior written consent. This consent must be kept on file. It is not necessary to forward copy document to our insurance provider.

Lifesaving medication and invasive treatments

Adrenaline injection (Epipen) for anaphylactic shock reactions (caused by allergies to nuts, eggs etc.) or invasive treatments such as rectal administration of Diazepam (for epilepsy).

We must have:

  • A letter form the child’s GP/consultant stating the child’s condition and what medication if any is to be administered;
  • Written consent from the parent or guardian allowing staff to administer medication; and
  • Proof of training in the administration of such medication by the child’s GP, a district nurse, children’s nurse specialist or a community paediatric nurse.
  • Copies of all three documents relating to these children must first be sent to the insurance provider.

Key person for special needs children – children requiring assistance with tubes to help them with everyday living e.g. breathing apparatus, to take nourishment, colostomy bags etc.

  • Prior written consent must be obtained from the child’s parent or guardian to give treatment and/or medication prescribed by the child’s GP.
  • The key person must have the relevant medical training/experience, which may include those who have received appropriate training from parents or guardians, or who have qualifications.
  • Copies of all letters relating to these children must be sent to our insurance providers for appraisal. Written confirmation that the insurance has been extended will be issued.

19 October 2020

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