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.
Any prescribed medicine – oral or for the skin, must be first administered at home. The child must remain at home for 24 hours before returning to Nursery.
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.
Children’s prescribed medicines are in their original containers, are clearly labelled (Including the prescription label).

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

After the vaccination, if your child develops a high temperature 38C and or any of the following symptoms, keep your child at home for the next 24 hours. If vomiting occurs your child must remain at home for 48 hours.

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

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

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.
A child may need repeated treatments if the head lice is severe.

Teething

Teething can occur anytime from 4 months old. Most babies start teething at around 6 months. Teething can cause:

A sore and red gum where tooth is coming through.
A temperature of 38C.
A flushed cheek.
A rash on their face.
They rub their ear more than usual.
They dribble more than usual.
They gnaw and chew on a lot of things.
They are fretful more than usual.
They are not sleeping very well.

There is no evidence that teething causes diarrhoea (NHS 2024).
If a child appears to be experiencing minor pain or discomfort, with no other visible signs of illness, such as diarrhoea, parents 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 and discomfort and has a high fever (above 38C) a parent must come and collect the child and are asked to keep them at home for 24 hours before returning to the setting.
If pain and discomfort, has a high fever (above 38C) and diarrhoea is present a parent must come and collect the child and are asked to keep them at home for 48 hours before returning to the setting.
Parents 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)

Hand, Foot and Mouth Disease

The first signs of hand, foot and mouth disease can be.

A sore throat
A high temperature
Not wanting to eat

The second stage usually starts a few days later and can include.

Mouth ulcers, which can be painful
A raised rash of spots on the hands and feet, and sometimes the thighs and bottom

The rash

The rash can look pink, red, or darker than the surrounding skin, depending on your skin tone
The spots can turn into blisters, which might be grey or lighter than the surrounding skin and can be painful
The symptoms are usually the same in adults and children, but can be worse in babies and children under 5 years

Highly Contagious

Hand, foot and mouth is easily passed onto other people and is spread in coughs, sneezes, poo and the fluid in the blisters
You can get it more than once
It can be spread before any symptoms occur, but it is most likely to be spread within the first 5 days after symptoms start

Time at home

Children that are unwell must be kept at home
Children must remain at home for the first 5 days after symptoms begin and or after a diagnosis from a doctor
Upon returning to nursery, (after 5 days and if your child is well enough), any remaining blisters on the hands, feet or face should be covered.

Pregnancy cautions

Pregnant staff or parents should avoid close contact with anyone who has hand, foot and mouth disease
Especially during the first 3 months of pregnancy as this can lead to miscarriage
Shortly before giving birth as the baby could be born with the disease

Slapped Cheek Syndrome

Slapped cheek syndrome, is common in children and should get better on its own within 3 weeks.

Symptoms

A high temperature
A runny nose and sore throat
A headache
A rash on one or both cheeks (usually fades within 2 weeks)
A spotty rash on the chest, arms and legs. The rash can be raised and itchy. It may be harder to see on brown or black skin (usually fades within 2 weeks but can last for up to one month)

How is slapped cheek syndrome spread?

It is very easily spread between children as it spreads before the rash appears, once the rash has appeared a child is no longer infectious
It is spread by coughing or sneezing near others and surfaces and objects

Staying home

Your child will be unwell before the rash appears and will most likely be at home due to a high temperature and feeling unwell
As soon as a rash appears on the cheeks and or body, the nursery must be notified
Once the rash has appeared on the cheeks the child is no longer infectious, so if well, having none of the above symptoms, they can return to nursery.

Pregnancy cautions

Pregnant staff or parents should avoid close contact with anyone who has slapped cheek syndrome as there is a small risk of miscarriage or other complications.

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.

Strep A

Strep A is a contagious infection that can be treated with antibiotics.

Symptoms

Flu-like symptoms – high temperature, swollen glands and or an aching body
Sore throat (strep throat or tonsillitis)
A rash that feels rough, like sandpaper
Scabs and sores
Pain and swelling
Severe muscle aches
Nausea and vomiting

Staying home

Keep your child at home if unwell with any of the above symptoms
Antibiotics will treat Strep A
A child must remain at home for 24 hours after the first dose of antibiotics
A child can return to nursery when well (without any of the above symptoms) and has taken antibiotics for at least 24 hours

Scarlet Fever

Scarlet fever is a contagious infection that can be treated with antibiotics. It can be spread to other people up to 6 days before symptoms appear, until 24 hours after the 1^st dose of antibiotics. If antibiotics are not given, the infection can be spread for 2–3 weeks after the first symptoms start. Scarlet fever usually lasts for around 1 week.

Symptoms

The first signs are flu-like symptoms (high temperature, a sore throat and swollen neck glands)
A rash appears 12 to 48 hours later. It looks small, raised bumps, and starts on the chest and tummy, then spreads. It feels like sandpaper
On white skin the rash looks pink or red. On brown or black skins, it might be harder to see a change in colour, but it will still be raised bumps and feel like sandpaper
A white coating appears on the tongue. This peels, leaving the tongue red, swollen, and covered in little bumps
Cheeks can look red

Staying home

Keep your child at home if unwell with any of the above symptoms
A child must remain home for 24 hours after the first dose of antibiotics
A child can return to nursery when well (without any of the above symptoms) and has taken antibiotics for at least 24 hours

Chicken Pox

Chickenpox is a common illness affecting both children and adults. It usually gets better by itself after 1–2 weeks. It is spread to other people from 2 days before the spots appear until they have all formed scabs – usually 5 days after the spots appeared. Chickenpox can be caught by being in the same room as someone with it and by touching things that have fluid from the blisters on them.

Symptoms

An itchy rash occurs anywhere on the body
A high temperature
Aches and pains, generally feeling unwell
Loss of appetite

Stage 1 – small spots appear

Anywhere on the body including inside the mouth and around genitals
Spread or stay in a small area
Be red, pink, darker or the same colour as surrounding skin
Be harder to see on brown or black skin

Stage 2 – the spots become blisters

The spots fill with fluid and become blisters. They are very itchy and may burst

Stage 3 – the blisters become scabs

The spots form a scab, some are flaky while others leak fluid

Staying home

A child or adult must stay at home until all the spots have formed scabs. This is usually 5 days after the spots have appeared
A child can return to nursery when well (without any of the above symptoms) and all the spots have formed scabs. If new spots appear, the child will be sent home, until they have formed scabs

Pregnancy cautions

Although rare to catch chickenpox when pregnant, there is a small risk of the baby being very ill when it’s born, if contracted by the mother. It is best for pregnant staff and parents to avoid close contact with anyone who has chickenpox.

Chickenpox vaccine

The chickenpox vaccine is available through the NHS.

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 from 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.

Covid-19

Adults – Staff, Parents and Visitors

Symptoms of coronavirus (COVID-19) in adults can include:

a high temperature or shivering (chills) – a high temperature means you feel hot to touch on your chest or back (you do not need to measure your temperature)
a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours
a loss or change to your sense of smell or taste
shortness of breath
feeling tired or exhausted
an aching body
a headache
a sore throat
a blocked or runny nose
loss of appetite
diarrhoea
feeling sick or being sick

The symptoms are very similar to symptoms of other illnesses, such as colds and flu.

Adults with the symptoms of a respiratory infection, and who have a high temperature or feel unwell, should stay at home and avoid contact with other people until they feel well enough to resume normal activities and they no longer have a high temperature.

Covid-19 positive test result

Adults with a positive COVID-19 test result should stay at home and avoid contact with other people for 5 days, which is when they are most infectious.
This starts from the day after you did the test.

You should:

Avoid meeting people at higher risk from COVID-19 for 10 days, especially if their immune system means they’re at higher risk of serious illness from COVID-19, even if they’ve had a COVID-19 vaccine.

Children

Symptoms of COVID-19 can include:

a high temperature or shivering (chills) – a high temperature means you feel hot to touch on your chest or back (you do not need to measure your temperature)
a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours
a loss or change to your sense of smell or taste
shortness of breath
feeling tired or exhausted
an aching body
a headache
a sore throat
a blocked or runny nose
loss of appetite
diarrhoea
feeling sick or being sick

The symptoms are very similar to symptoms of other illnesses, such as colds and flu.

Children who have any symptoms of Covid-19 and have either a high temperature of 38+ or feel unwell should stay at home and avoid contact with other people. They can return to Nursery when they no longer have a high temperature of 38+ and they are well enough to attend.

What to do if your child has symptoms

Encourage your child to cover their mouth and nose with a tissue when they cough or sneeze, and to wash their hands after using or throwing away tissues.
Allow your child to rest.
Encourage them to drink plenty of fluids.

Monkey Pox

Monkeypox is a disease caused by the monkeypox virus. It is a viral zoonotic disease, meaning that it can spread from animals to humans. It can also spread between people.

How you catch Monkeypox

From infected rodents (such as rats, mice and squirrels) in parts of west and central Africa.
Close physical contact with someone who has symptoms. The rash, bodily fluids (such as fluid, pus or blood from skin lesions) and scabs are particularly infectious.
Clothing, bedding, towels or objects like eating utensils/dishes that have been contaminated with the virus from contact with an infected person can also infect others.
Ulcers, lesions or sores in the mouth can also be infectious, meaning the virus can spread through saliva.
The coughs or sneezes of a person with the monkeypox rash. T
The virus can also spread from someone who is pregnant to the foetus from the placenta, or from an infected parent to child during or after birth through skin-to-skin contact.

Symptoms include:

fever
intense headache
muscle aches
back pain
low energy
swollen lymph nodes
a skin rash or lesions

The rash usually begins within one to three days of the start of a fever. Lesions can be flat or slightly raised, filled with clear or yellowish fluid, and can then crust, dry up and fall off. The number of lesions on one person can range from a few to several thousand. The rash tends to be concentrated on the face, palms of the hands and soles of the feet. They can also be found on the mouth, genitals and eyes.

Symptoms typically last between 2 to 4 weeks and go away on their own without treatment. Whilst a person has monkeypox, they are infectious and will be so for between two and four weeks.

Suspected or confirmed monkeypox

What to do

Self-isolate and cover any skin lesions by wearing clothing over the rash
You must self-isolate for 4 weeks or until a medical professional (doctor) has deemed that you are no longer deemed infectious
If you are infectious or come into contact with someone who has suspected monkeypox, medical masks must be worn by all persons.
Avoid skin-to-skin contact whenever possible and use disposable gloves if you have any direct contact with lesions. Wear a mask when handling any clothes or bedding if the person cannot do it themselves.
Regularly clean your hands with soap and water or an alcohol-based hand rub, especially after contact with the person who is infected, their clothes, bed sheets, towels and other items or surfaces they have touched or that might have come into contact with their rash or respiratory secretions (e.g., utensils, dishes).
Wash the person’s clothes, towels and bedsheets and eating utensils with warm water and detergent. Wash separately to other linen.
Clean and disinfect any contaminated surfaces and dispose of contaminated waste (e.g., dressings) appropriately.

I think I have been exposed to someone who has monkeypox. What should I do?

If you think you have been exposed to monkeypox, monitor yourself closely for signs and symptoms for three weeks after the time you were last exposed. Symptoms of monkeypox typically include a fever, headache, muscle aches, back pain, low energy, swollen lymph nodes and a skin rash or lesions on the face, palms of the hands, soles of the feet, mouth, genitals, perianal area or eyes.

If you do develop symptoms, contact your health care provider for advice, testing and medical care.

19 November 2024

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