Conjunctivitis Guideline. A 1) Red eye/s 2) An itch or pain in one or both eyes 3) Any form of discharge from eye/s. B

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1 Conjunctivitis Guideline Conjunctivitis should be considered if a child attends nursery with any of the following: 1 A 1) Red eye/s 2) An itch or pain in one or both eyes 3) Any form of discharge from eye/s. B The vast majority of conjunctivitis resolves without antibiotics within 7 days. As a result nurseries should not recommend parents make a GP appointment. 2,3 Typical appearances of conjunctivitis There is no evidence that treatment with antibiotics or exclusion of learner from class reduces the spread of conjunctivitis across nursery groups. 3 No exclusion should be made if child has conjunctivitis, whether it is being treated or not. 4 Whilst no exclusion should be made, children and staff should continue to wash hands frequently with soap and water whilst using separate towels and flannels to those with conjunctivitis. 5 When do children need to see a doctor: If conjunctivitis is still present after 7 days Childs vision becomes impaired Child experiences a headache or increased sensitivity to light There is a concern a foreign body could be in the eye 6

2 References 1. Wood M. Conjunctivitis: Diagnosis and management. Community Eye Health Journal. 1999;12(30): Høvding G. Acute bacterial conjunctivitis. Acta Ophthalmologica. 2008;86(1): Rose P, Harnden A, Brueggemann A, Perera R, Sheikh A, Crook D et al. Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double-blind placebo-controlled trial. The Lancet. 2005;366(9479): NHS Scotland: Health Protection Scotland. Infection prevention and control in childcare settings (Day Care and Childminding Settings) p NICE. Conjunctivitis: infective- scenario: management in primary care Jefferis J, Perera R, Everitt H, van Weert H, Rietveld R, Glasziou P et al. Acute infective conjunctivitis in primary care: who needs antibiotics? An individual patient data metaanalysis. British Journal of General Practice. 2011;61(590): Images courtesy of a) nhs.uk and b) emedicine.medscape.uk Please note: Guidance should provide an aide memoire in nursery management of the described condition. It should not be used in isolation and instead should be taken in conjunction with other relevant guidance.

3 Vomiting and Diarrhoea Guideline Vomiting and diarrhoea is very common in childhood. Vomiting and diarrhoea are common ways for infections to spread. All suspected cases of vomiting and diarrhoea should be treated as vomiting and diarrhoea; however, remember an isolated incident of loose stool isn t diarrhoea. Children affected by vomiting or diarrhoea should not be sent to school. Staff experiencing vomiting or diarrhoea should not come to work. If a child or member of staff experiences an episode of diarrhoea or vomiting while at nursery they should be sent home. 1,2 2 3 Diarrhoea- The passage of 3 or more loose stools in 24 hours. 2 Children and staff who have experienced vomiting or diarrhoea should not return to the nursery until 48 hours after last loose stool or episode of vomiting. 4 How long will children be unwell? In nursery aged children diarrhoea usually lasts 5-7 days while vomiting will last 1-2 days. 5,6 As nursery does not run for 24 hours it can be hard to estimate the frequency of loose stools. Loose stools should be suspected as diarrheal if: 7 2 or more loose stools during nursery period OR Single loose bowel movement accompanied with: Nausea/vomiting Fever Stomach pain Abnormal faeces content (blood/mucus)

4 References 1. Thapar N, Sanderson I. Diarrhoea in children: an interface between developing and developed countries. The Lancet. 2004;363(9409): NHS Scotland: Health Protection Scotland. Infection prevention and control in childcare settings (Day Care and Childminding Settings) NICE. Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management NHS Lothian. Summary of recommended periods of absence for communicable diseases: pre-school children p Casburn-Jones A, Farthing M. Management of infectious diarrhoea. Gut. 2004;53(2): Koletzko S, Osterrieder S. Acute infectious diarrhoea in children. Deutsches Arzteblatt International. 2009;106(33): Aranda-Michel J, Giannella R. Acute diarrhoea: a practical review. The American Journal of Medicine. 1999;106(6): Please note: Guidance should provide an aide memoire in nursery management of the described condition. It should not be used in isolation and instead should be taken in conjunction with other relevant guidance.

5 Chickenpox Guideline Chickenpox typically presents as a rash composed of small, itchy red blisters which later scab over. Children may also be tired and develop a fever. 1 Chickenpox is caused by a virus that has a incubation period of days. 2 Typical chickenpox rash Chickenpox is most likely to spread during this incubation period, before children have symptoms. Therefore, chickenpox will spread regardless of the length of exclusion after children develop the typical rash. 4 Incubation period- The time from exposure to infection to onset of symptoms 3 Despite most infection spread occurring before children develop the typical rash it is important to exclude children even after the rash develops. 5,6 Children should be excluded until both: 1) The rash becomes dry (this typically takes approximately 7 days) 2) 5 days have passed since rash onset Pregnant women and chickenpox: 7 Chickenpox infection can have serious effects on both pregnant mothers and their babies. Mothers who have previously been affected by chickenpox will be unaffected as will their baby. A notice of any ongoing chickenpox infections should be placed at the entrance of the nursery to allow for pregnant mothers to be aware.

6 References 1. Canadian Paediatric Society. Facts about chickenpox: A note from the doctor. Paediatrics Child Health; 2005 p Asano Y, Itakura N, Hiroishi Y, Hirose S, Nagai T, Ozaki T et al. Viremia is present in incubation period in nonimmunocompromised children with varicella. The Journal of Paediatrics. 1985;106(1): Nishiura H. Early efforts in modelling the incubation period of infectious diseases with an acute course of illness. Emerging Themes in Epidemiology. 2007;4(1):2. 4. Moore D, Hopkins R. Assessment of a school exclusion policy during a chickenpox outbreak. American Journal of Epidemiology. 1991;133(11): European Centre for Disease Prevention and Control. Systematic review on the incubation and infectiousness/shedding period of communicable diseases in children. Stockholm; NHS Lothian. Summary of recommended periods of absence for communicable diseases: pre-school children p Royal College of Obstetricians and Gynaecologists. Chickenpox in pregnancy: What you need to know Image courtesy of medicinenet.com Please note: Guidance should provide an aide memoire in nursery management of the described condition. It should not be used in isolation and instead should be taken in conjunction with other relevant guidance.

7 Hand, Foot and Mouth Guideline Hand, foot and mouth disease is an infection by a group of viruses. Children initially develop a fever and become unwell. This is followed (1-2 days later) by mouth ulcers and red spots on the hands, feet and around the mouth which can eventually blister. 1 B Cc Disease is typically self limiting with treatment not typically required. Key to minimising spread of hand, foot and mouth disease is good hand hygiene of both staff and children. 2 A Typical rash at a) foot b) mouth c) hand Risk of transmission is highest at beginning of disease therefore children should only be excluded until they no longer feel unwell or have a fever. There is no need for children to be excluded until blisters resolve. 3,4 Hand, foot and mouth can continue to be spread up to 11 weeks after initial infection; therefore other nursery pupils may be infected up until this time point. 5 6 Should outbreaks of hand, foot and mouth be reported? Outbreaks (2 or more children affected) of hand, foot and mouth disease should be reported to Health Protection Scotland.

8 References 1. Ventarola D, Bordone L, Silverberg N. Update on hand-footand-mouth disease. Clinics in Dermatology. 2015;33(3): NICE. Hand foot and mouth disease: Management of hand, foot and mouth disease NHS Rotherham, Doncaster and South Humber. Infectious diseases in day care nurseries p NHS Lothian. Summary of recommended periods of absence for communicable disease: pre-school children p Ooi M, Wong S, Lewthwaite P, Cardosa M, Solomon T. Clinical features, diagnosis, and management of enterovirus 71. The Lancet Neurology. 2010;9(11): NHS Scotland: Health Protection Scotland. Infection Prevention and Control in Childcare Settings (Day Care and Childminding Settings) p. 20. Images courtesy of Gpnotebook.com Please note: Guidance should provide an aide memoire in nursery management of the described condition. It should not be used in isolation and instead should be taken in conjunction with other relevant guidance.