Keeping Children and Staff Healthy: Ways to Manage the Spread of Illness

Editor’s note: This text-based course is a transcript of the webinar, Keeping Children and Staff Healthy: Ways to Manage the Spread of Illness, presented by Dr. Amanda Schwartz.  

Learning Outcomes

At the conclusion of this course, participants will be able to:

• Summarize how and why minor illnesses occur most often in children under 5.
• List basic strategies to prevent the spread of illness.
• Identify information and strategies to share with families that will promote child attendance and prevent the spread of illness.

Introduction and Overview

I'm glad to be talking today about this important and relevant issue for those of us who work in out-of-home care. Every day when we work with children, we need to continually incorporate strategies to manage the spread of illness. Knowing the best ways to keep children and staff healthy is important. This process begins with families and carries through to administration, and to the staff who work directly with children on a daily basis.

When children are under five years old, they get sick a lot. It is normal. They are developing their immunity and are becoming better at fighting the different micro-organisms in their environment. It is natural for little children to get sick more often than they do when they get to school. We are actually doing them a favor by putting them in childcare centers because we're exposing them earlier. It used to be that children under five stayed home and then when they got to kindergarten or first grade, they were sick all the time. Now, when they get to kindergarten or first grade, they've already been exposed to a lot of illnesses. As such, over the age of five and when they are entering the school system, illnesses decrease significantly.

What is Infection?

Infection is the presence and growth of micro-organisms. You may not see symptoms in someone who has an infection. Furthermore, the infection may stay only in one area of the body. Some types of micro-organisms include viruses, bacteria, fungi, and parasites.

Virus. A virus is a microscopic organism that can grow or reproduce only in living cells with limited ability to survive outside of the body. There are few medications to treat viruses. When you go to the doctor with a virus, it may be frustrating for you to hear them say, "I'm sorry. There's nothing I can do for you." Viruses cause illnesses like the common cold, influenza, measles, hepatitis B virus, and chicken pox. There are some immunizations that you can take to prevent these illnesses from occurring in your body, but a virus is something that's generally untreatable once you are infected.

Bacteria. Bacteria is an organism that is larger than a virus. It can survive in or out of the body. Examples of bacteria include Staphylococcus, Streptococcus, Salmonella, and Shigella. You can pick up a bacteria just by touching an infected surface, such as a tabletop, a doorknob, or a faucet.

Fungus. Fungi are organisms that get their nutrition from other living organisms or dead organic manner. Examples of fungi include things like yeast, mold, mildew, thrush, ringworm, and yeast diaper rash. Those are all things that you'll find in early childhood care and education programs that you can easily eradicate using various methods.

Parasite. A parasite is a single or multi-cellular organism. It lives on or in another organism. Examples of parasites include tapeworm, lice, mites, pinworms, or Giardia. It's hard to talk about these things because they are not pleasant. However, we need to understand what they are so that we can manage them effectively. Knowing what's in the environment will help us make sure that we are preventing the spread of it through the use of different techniques.

What is Contamination?

Contamination is the possibility of coming into contact with different infectious micro-organisms. These may be on a table, or a doorknob, a chair, or toys in your environment. Contamination is everywhere. Everywhere you look could be a place where an infection can spread.

A person may be infected with a virus or bacteria and not even know it. They may not be exhibiting any symptoms, and may not even appear to be sick at all. That person (either a child or a staff member) may come to your childcare center. They are interacting with other people in their environment. Suddenly, they begin to exhibit symptoms, such as coughing and sneezing. At this stage, their body is beginning to fight the infection. They talk, they play with the toys, touch the sink, the doorknobs, and other surfaces in the environment, spreading the contamination. All of a sudden, everyone else in that environment has now come into contact with that disease. As a result, many children and staff within your program can become sick. As the infection continues, the person's symptoms decrease; the white blood cells begin to take over and fight the infection, but it is still present. You may come back to work if you're a staff person, and the children may come back to the program. It is important to have some systems in place to make sure that they can be in the environment and still not infect other people. It isn't until later on that the infection is completely gone and the individual is no longer infectious.

In the flu epidemic of 2017 and 2018, many programs were suggesting that even if a person's symptoms weren't very severe, people should stay home. That is when you get into a pandemic or an epidemic situation, where you have large numbers of children or staff absent due to illness. In those situations, you may want to take some greater precautions and have an emergency plan in place so that you know how to advise families. Generally speaking, with a simple infection (e.g., the common cold) that might spread through your community, you want the child back in the program and learning with you as quickly possible. That's why having other strategies in place to manage the infectious disease and keep people healthy is important.

Terminology

Let's review the terminology related to vaccines and immunizations.

• Vaccine: A tool to expose the body to micro-organisms that simulate a disease and build the body's ability to prevent or fight infection. Essentially, you are putting the micro-organism into a body so that the body can respond and eliminate the possibility of the infection occurring.
• Vaccination: The process of getting the vaccine.
• Immunization: Becoming immune to a disease (what happens after you get the vaccination).
• Immunity: The ability to become exposed to an infectious disease without getting it.

Importance of Immunization

It's important to make sure that all of the children in your program, as well as all of the staff, have had all of the necessary vaccines that are required. If you need a resource for understanding what vaccines are appropriate at different ages and for different people, go to the Center for Disease Control and Prevention's website and look up vaccines or immunizations. You'll find a schedule of recommended vaccinations that your physician should be using. If you are working with family members who are opposed to immunization, you can work with them to help them understand the importance of the process.

Immunization builds your body's natural defenses by imitating the infection. Immunizations should occur on a regular schedule. They follow the Early and Periodic Screening, Diagnosis, and Treatment schedule, as well as the schedule recommended by the Centers for Disease Control and Prevention. Both adults and children need vaccines. If you're working with someone who may be reticent, I suggest you go back to the CDC website, as they offer some great information for helping people understand why vaccination is important. The CDC's resources can help to debunk the myths of about immunization and vaccination and to help families understand that research indicates that vaccines are safe.

The Story of the Flu Vaccine

As we're talking about immunization and vaccination, I want you to know the story of the flu vaccine. Vaccines are updated annually. The Centers for Disease Control and Prevention looks at the data from prior years, and they determine which strain(s) of the flu has been spreading the most, as there are multiple strains of influenza. They look to see which strains are most common. Based on that data, they'll concoct a flu vaccine that they think will best manage the spread of the disease in the coming year. It is important to know that there is a possibility of getting the flu even if you do get vaccinated. The vaccine you receive may not be a perfect match between the viruses that are spreading and the viruses that have infected you. That being said, the flu vaccine can minimize your symptoms if you do, in fact, contract influenza. I know that a lot of people who got the flu this year found that when they had been immunized, the symptoms weren't as significant. That is particularly important for very young children, as well as for children who may have special health care needs.

Children under six months of age cannot be vaccinated. As such, the precautions you want to take with infants under six months are going to be very different than the things you do for other children. You're going to need to be a little more cautious and more extreme in making sure they're protected from others' illnesses. Infants under three months should not be exposed to a virus, as it could be very serious for a child under three months to have a fever. They often are sent to the emergency room and need to have some pretty extreme procedures. Make sure that you talk to families about their infants if they're under three months, to make sure that they're doing everything possible to prevent exposure. Always keep in mind that the most effective way to prevent the flu and any other disease is a vaccination if one exists. Making sure that people are vaccinated is critical.

Healthy Habits

Beyond vaccinations, what can we do to prevent the spread of diseases? There are some healthy habits that everyone can keep in mind and that we should be doing all the time: hand washing, covering our coughs and sneezes, blowing our noses safely, and cleaning, sanitizing, and disinfecting the environment. All of these activities prevent the spread of illness within your program. These are also strategies to use at home. When you go home or when your children go home, make sure that everyone is clear on how these healthy habits work so that they can spread the message and keep everyone healthy. 

Caring for Our Children, 3rd Edition (CFOC3) is the National Health and Safety Standards guide for early childhood care and education settings. It was developed by the American Academy of Pediatrics and the Maternal and Child Health Bureau. This is a regularly updated resource that was developed through the expertise of hundreds of people across the country. In this guide, you'll find helpful resources for managing infectious disease and keeping children healthy. You can get a copy of the entire guide through the following link:  http://cfoc.nrckids.org/CFOC.

Hand Washing

As we talked about, everyone in your program has the potential to spread illness throughout the environment. It is important to be mindful of your environment and how best to prevent the spread of illness through contact. One of the best ways to do that is by washing your hands. 

When to wash your hands? According to Caring for Our Children, they recommend that everyone washes their hands upon arrival for the day, after any breaks in the classroom, and when moving groups. If you're moving from one classroom to another, or from outside to inside, you want to make sure that everyone washes their hands before they settle in to the next activity. You also want to make sure that everyone is washing their hands before and after the following activities: preparing food or beverages; eating, handling food, or feeding a child; giving medication or applying ointment; playing in water; diapering. Also, hand washing is recommended after toileting, and after handling any kind of bodily fluids (e.g., mucus, saliva). Washing of hands should be done after handling animals in your setting. In addition, you want to be very careful about the animals you choose for your classroom, as there are some water creatures that carry salmonella. You also want to make sure that people wash hands after playing in the sand or on wooden play sets or outdoors, after cleaning or handling garbage, and also after applying sunscreen or insect repellent, so that you aren't spreading those toxins.

How to wash your hands? Caring for Our Children suggests a specific way to wash our hands. We'll watch a video demonstration in a moment, but let me walk you through the process.

1. Check to make sure that there's a clean, disposable paper towel available.
2. Turn on clean running water to a comfortable temperature.
3. Moisten your hands with the water and apply the soap. 
4. Removing your hands from the water stream, rub your hands together vigorously until the soapy lather appears. Wash your fingers, your nail beds, your fingernails, any jewelry and the back of hands.
5. During the lathering/washing process, sing "Happy Birthday" silently twice to make sure you are washing for the proper duration.
6. Once you've washed them thoroughly, rinse your hands under clean running water until they are free of soap and dirt.
7. Leave the water running while you pick up the clean towel and wipe your hands clean and dry.
8. Turn off the faucet using the disposable paper towel, and put the paper in the trash without touching the trashcan.

Let's see what this process looks like.

As you can see, it is a process and it's something that you're going to want to make sure that you teach all of your staff, any volunteers that come into your program, and anyone that might be in a classroom.

A few notes about handwashing:

• Refrain from using anti-bacterial soap. The research has shown that anti-bacterial soap minimizes exposure to some good bacteria as well as bad bacteria. Building those immunities to bacteria is important.
• It is recommended that you keep your nails short and the children's nails short and that you not use acrylic nails because they can carry infectious disease underneath in the glue.
• It is useful to do intentional handwashing lessons with preschoolers and older toddlers. Post signs or other visual prompts over the sinks. Offer them explicit instruction on how to conduct proper handwashing, because they're going to need to be independent in knowing how to wash their hands and it makes life easier for everyone. The earlier you start, the easier it is.
• There are some great resources on the Center for Disease Control and Prevention's website. There are posters you can print and other things you can use to help make sure that everyone is washing their hands correctly.

Proper use of hand sanitizer. There are times when you're not going to be able to wash your hands at a sink. In those instances, you may use hand sanitizers. This is the process for how to properly use hand sanitizer: 

1. Wipe any dirt off your hands with a towel.
2. Apply sanitizer to the palm of one hand.
3. Rub hands together all over, in and out of the crevices and underneath the nail beds, until your hands are dry. Only when dry is the hand sanitizer effective.

I would advise against using hand sanitizer with infants and very young toddlers, waiting until about 2 or 2 1/2 years of age. If you are using hand sanitizer with toddlers and preschoolers, be mindful to make sure that they're not putting it in their mouth, as there is some toxicity in hand sanitizers.

Covering When You Cough or Sneeze

When you cough or sneeze, you can spread germs. A cough or a sneeze has the ability to propel germs up to six feet away. The droplets can infect others by landing directly on a person, or by landing on surfaces that are touched by other people (e.g., toys, furniture, clothes).

There are two strategies to prevent this kind of spread. Ideally, there is a tissue nearby so that when you sneeze, you can cover your nose completely with the tissue. Studies have shown that the strategy that works best to prevent germs from flying when you sneeze or cough is to use a tissue.

If a tissue isn't available, the next best strategy is to have the person sneeze/cough into to their arm. I like to call it the batwing or the super-arm. You can practice this just for fun with the kids from the day they start in your program, beginning at 18 months old. You simply teach them to sneeze into the inner elbow of their bent arm, between their forearm and their upper arm. We used to encourage people to cover their mouths and their noses with their hands. However, your hand touches everything around you. That's why we teach them the batwing. That little portion of their body doesn't touch a lot of things, other than the side of their body. Also, it's easy to clean and it's easy to cover that part of someone's body. 

Blowing Your Nose Safely

This is probably very sensible to most of you, but the way you cover your face when you use a tissue is important. Teaching little ones how to do this, or doing it with them is key to prevent the spread of illness. It would also be beneficial to conduct parent education sessions on not only safe nose blowing but also on hand washing and covering coughs/sneezes.

The steps to blowing your nose safely are as follows:

1. Cover the nose and mouth completely with the tissue. Blow and squeeze the nose.
2. Fold the tissue in half.
3. Wipe completely.
4. Fold again to make sure that you're touching the fluids as little as possible.
5. Wash your hands, because that's the only way to make sure that you have carefully captured any kind of germs that came out.

There are a lot of creative ideas about this on the internet. I once taught a class for preschoolers on blowing your nose safely. We used a stuffed animal and a tissue, and we put a little green slime on the stuffed animal. We had all the children practice wiping the stuffed animal's nose with the tissue until they were able to do it appropriately. This is something that should definitely be part of your curriculum with the older children, and something that you should integrate into any parent education that you do. Even if it's just to share the resource with them, I think it's worth doing because many people don't blow their nose correctly and it can spread a bug pretty quickly.

Cleaning, Sanitizing and Disinfecting

The last strategy I wanted to share with you is related to cleaning, sanitizing, and disinfecting. This is something that you're going to do all day, every day, all the time. First, I want to make sure we are clear on the definitions and use of the different terms: 

• Cleaning: Removing the dirt and debris from an environment 
• Sanitizing: Reducing germs on the surface that you are sanitizing 
• Disinfecting: Destroying and inactivating germs from the environment

It is important to know that the Environmental Protection Agency (EPA) has registered products that have a label on them that can be relied on for reducing or destroying germs. That label also describes whether the product is a cleaner, a sanitizer, or a disinfectant. In addition, it's important to know that some manufacturers of cleaning products have developed green, environmentally-friendly cleaning products. You can find these products on www.greenseal.org, as well as on www.ecologic.org. The EPA also has a website that offers information about these products (www.epa.gov/saferchoice). You can also Google all of those terms.

A lot of early childhood programs are working on trying to find green solutions to cleaning, sanitizing, and disinfecting their environment. You need to make sure that the product you're using is doing what it's supposed to be doing. If you are using a product that you found on the internet, you want to double check to make sure that it is cleaning, sanitizing, or disinfecting as it is supposed to. A lot of us have homemade cleaners that we would like to use in our classrooms, however, licensing will not allow it. You have to use products that are designated and approved by licensing agencies.

The other thing that you need to know is that the Occupational Safety and Health Administration (OSHA) also requires us to mark and label all of the products in the environment so that it is clear what toxic substances are in those products and what precautions need to be taken to make sure that staff and children are safe when using those things. Also, to prevent poisoning, make sure that all of these products are locked up and away, out of reach of any of the children in your program. You want to make sure that they are in an upper cabinet with a lock and only brought out and used when needed. If we are cleaning a surface, and an emergency situation arises, we might have a tendency to just put down the bottle on the table and run to deal with the emergency. Please don't do that. Take the bottle with you and place it high up in a cabinet away from children. Things can happen quickly. To prevent any possibility of poisoning, always placing cleaners out of the reach of children.

What to Do

For best results, follow these tips when you clean, sanitize, and disinfect:

• Clean and sanitize toys and surfaces before each use
• Clean beds and cribs before each use
• Read and follow directions on the label of any product you use
• If using cleaning products on toys that will be mouthed or touch food, wipe down with water after sanitizing and disinfecting to wash away any residual chemicals
• Store cleaners locked up and away, out of children’s reach

You should have a regular schedule for cleaning, sanitizing, and disinfecting everything in your classroom or in your setting. Follow any policies that your program has regarding these activities to make sure that any germs, dirt, and bacteria are eliminated.

In childcare settings, we talk a lot about pests, such as lice and bed bugs. Caring for Our Children has an important stance on these types of pests, which I highly recommend that you read and think about how your program policies handle these cases. Also, think about how your state and local licensure requirements handle it. Many programs are moving to no-nit policies. As caregivers, we know that children learn more when they're with us. Making sure that we provide access to everyone is important. In addition, it is important to ensure that children who may have been exposed to different things are not only being cared for appropriately but that they also have access to the learning that they require.

Daily Health Check

The daily health check is a great way to identify what's going on with a child first thing in the morning. When children come into your classroom, you should have a system in place to recognize an illness, injury, or changes in behavior and address them immediately.

When children arrive, if they have an existing illness or condition, look to see how it is progressing. Also, see if you can notice whether there are changes in a child's behavior. For example, a usually happy child may arrive in a very cranky mood, or perhaps a child arrives every morning acting very tired as if they recently aren't sleeping well. In those cases, you want to know what's going on at home, and support the family so that they have a better way of addressing it. You're also going to be looking for obvious symptoms like rashes or itching, puss or redness in the eyes, vomiting, diarrhea, and cuts. There may be less obvious symptoms, like fever, pain, and nausea that you see in young children. Look very closely to see what's going on and record it.

I once had a child who was always bright and cheerful and then there were about six days in a row when he came in and he was falling asleep during open play time. I found out there was a new baby at home and the baby and the little boy were sharing a room, so he wasn't sleeping. We talked to the parents about ways to help ensure that everyone in the house was sleeping and getting what they needed. The daily health check offers you the opportunity to do that.

Caring for Our Children has a Signs and Symptoms Chart on their website. It lists the common causes of those symptoms, the complaints, or what might be seen in the child. It also advises whether you should notify a health consultant or a parent. Based on the child's symptoms, this chart helps you decide whether to temporarily exclude a child. If the child is excluded, it offers advice as to when that child can return. This chart covers everything from rashes to symptoms of common colds and different kinds of issues that might pop up for young children. The chart can be found at this link: http://cfoc.nrckids.org/.

Caring for Our Children offers some recommendations that programs may or may not agree with. I think it's important for you to know them and to consider them. The reason they suggest that you don't exclude children with these symptoms is that they know that it's important for kids to be in programs. Some of these diseases haven't been proven to affect a child's ability to learn.

Some of the conditions or symptoms that they indicate do not require exclusion include (but are not limited to):

• Common colds and runny noses
• A cough not associated with fever
• Rapid or difficult breathing or wheezing
• Pink eye or discharge coming from the eye (white, watery, or yellow)
• Fever (over 101 degrees) with no other signs of illness (in children older than four months)
• Rash not associated with fever
• Lice or nits, ringworm, or scabies
• Thrush, fifth disease

You can go to Caring for Our Children and find the complete list and rationale in Chapter 3: Health Promotion and Protection. Their stance is that it's more important for a child to be in the program than out of the program. 

Considerations When Performing Daily Health Check

Use the Caring for Our Children signs and symptoms chart (see link above) to decide whether you're going to:

• Contact a health consultant or a medical professional
• Notify the family
• Send the child home
• Allow the child to return to the program

Also, consider what you're going to tell families about symptoms that determine whether the child comes home. That should all be in your program's policies.

Make Sure...

Please consider looking at this resource:

http://www.ecels-healthychildcarepa.org/publications/manuals-pamphlets-policies/item/248-model-child-care-health-policies.html

It is the Model Childcare Health Policies developed based on the Caring for Our Children standards. It was written by the American Academy of Pediatrics Pennsylvania Chapter. It offers templates for sound health policies that you can use in your program.

Make sure that your program policy has the following information/provisions:

• Short-term exclusion provisions (what happens when you send sick children home).
• Well-explained rationale so families know how and why you made the decision. That's one of the reasons that signs and symptoms chart is so useful. It's very precise, it's scientifically based and it helps you make it an accurate decision.
• Provisions for contacting health professionals with the family's approval. You need to make sure that you're guarding confidential information according to the Family Education Rights Protection Act. Obtain the parents' agreement and authorization to share information with health providers if you feel like you need to.
• Consistent use of policies. If you send one child home for a specific symptom, you send everyone with that symptom home as well. You don't want to create a situation where people are uncomfortable with your policies.

When to Send a Child Home 

The best thing to do when deciding whether to send a child home is to determine if he can comfortably participate in classroom activities. If a child has a fever or isn't feeling well, you should think about whether he's playing. Is he engaging with other children? Is he participating in the activity? Or does he want to go in the corner and sleep? If there are symptoms of an illness and the child is engaged in learning, you need to use all those healthy habits that we discussed earlier (e.g., make sure they cover when they cough or sneeze, that they use tissues, that they're washing their hands regularly throughout the day). He should participate in your program and use all of those strategies to manage infectious disease and to prevent any possible spread, but he should be there to learn and engage.

Another time you might want to send a child home is when he needs care that's greater than what you can offer. Sometimes, children with fever or vomiting or diarrhea will need ongoing care, or they may be sick in a way that you can't compensate for. In those instances, call the parents and have them come and get the child. I work with parents to make sure that they have strategies in place in case they aren't able to come themselves and pick up a child. They provide us with a list of approved, responsible adults that are authorized to come and pick up the child if the parents are not available. 

Finally, a child should be sent home if they pose a risk of spreading a harmful disease. That infectious child should not be in your setting. If it's the flu and it's not a bad flu, they may be able to be there when they're in recovery. Think very critically and carefully about what harmful disease means. Consult with medical professionals or your health consultant to define "harmful disease" in your policies, so that everyone understands what a harmful disease is.

When my daughter was three years old, she had molluscum, which is a rash that you get on your skin. Her teachers didn't know what it was and they were really concerned that it was a scary disease. They wanted me to remove her from her childcare setting. I had to work with my pediatrician to help educate them about what molluscum was and to help them understand how to minimize the spread of it. Sometimes, you'll find that a family member will advocate for the inclusion of their child and help to support educating staff and understanding that disease. Being aware yourself and knowing what harmful means is critical. Once again, Caring for Our Children has a list of lots of different kinds of infections and diseases that children get, and can be an excellent resource in defining harmful disease and determining when to exclude a child in your program.

Understanding Fever

As early childcare professionals, it is important for all of us to understand what fever is. Fever is an indication of the body's response to something. It's not a disease and it's not a serious problem by itself. It's simply the body's way of elevating the temperature to fight an infection. Both families and staff need to understand that we do not always have to treat a fever. A fever is a symptom that shows you that the body is working and is fighting against whatever virus or bacteria may be present. It's critical to be strategic about when to use fever reducers. If a child is uncomfortable and can't sleep or participate in any kind of activity, at home or in the program, that's when you treat the fever. You don't treat a fever just to treat a fever. It's not as helpful as people think it is. It just keeps children comfortable. The fever is a sign that the body is working. It's also one of the reasons why Caring for Our Children doesn't recommend sending home children with fever, because they acknowledge that it may not be a sign of an infectious disease but rather that the body is fighting something and doing so successfully.

Extreme fever is something that you want to be mindful of, but know that young children often have high fevers as they fight diseases. The other thing to remember is that infants before they're four months old often don't have the ability to modulate their internal body temperature. If you wrap up a baby in a lot of warm blankets or put them in warm clothing, their temperature may rise. If they look and feel hot to you, unwrap them a little bit. Often, that temperature will go down. 

What Families Need to Know

As ECE professionals, we can support families and have conversations with them on preventing the spread of illness. The following are suggestions and strategies that you may want to integrate into your program:

• Teach families all these techniques for the home. You could run a parent education program or conduct a session or two on healthy behaviors. That might go a long way to reduce the spread of illness in your program. 
• Keep sick children home to reduce exposure. You and your program need to think about what harmful diseases you want to prevent from entering into your program. Make sure that communication with families is constant and ongoing so that they know where the threats are. If you're having an epidemic and everyone is getting sick, there needs to be a system of communication in place to make sure that parents and families have information about what you're doing and what they can do at home.
• If children aren’t well enough to play, they probably should stay home. This can be challenging, as many parents have to go to work and they don't have alternative support. I think it's wise for programs to work with families to find alternatives. Talk to them about developing a plan for what happens if their child is sick and they have to go to work. Many parents will bring their child in when he or she is sick, simply because they don't have another option and they hope their child will be able to stay. It doesn't always work that way. We understand that the families we serve come from all different economic areas and that sometimes it's hard to take a day off work because that's important income. Providing them with a way to network with other parents and get support from others within the community to support children to stay home is critical.
• Children should stay home when they have a fever over 100.3 degrees or have vomited/had diarrhea within 24 hours. This is one of my golden rules and what I do with my own children because I don't want to run the risk of infecting anyone. This guideline comes from conversations with my pediatrician and with health experts that I've worked with over the years. Despite the fact that Caring for Our Children says that children can come in with a fever, I always keep my children home, simply because a fever is fighting infection. If my children have an infection, I don't want them to infect other people. As a parent, I keep my children home if they have a fever over 100.3 degrees, or have vomited or had diarrhea within the last 24 hours. That is an extremely safe way for me to ensure that my children aren't spreading illnesses. Other programs will have different policies, and other families may not be able to sustain that. It depends on how the family/work life is and how much extended family or support is available. Knowing who your families are and what support systems they have in place and then helping them build better supports is important.

Summary and Conclusion

In summary, remember that healthy habits can reduce the spread of illness. Adding these habits to routines makes a difference for children and adults. Children learn when they're with you. They do better being in a program rather than at home where their supervision may not be as intensive and their instruction may not be developmentally appropriate. They come to you every day for a reason. As such, keeping them in your program, keeping them healthy and safe is critical to their overall development and growth. 

Lastly, if you have any questions about any of the information I've presented today, you can email me directly at a_l_schwartz@yahoo.com. To reiterate, Caring for Our Children is a wonderful resource for you to plan how you're going to keep children healthy and safe in your program. I would also say that guiding parents to talk with their pediatricians and their physicians about keeping children healthy is a great way to support them. Those are two great resources that are right at your fingertips. Thank you so much for your time and attention today.