Managing children with allergies, or who are sick and infectious

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1 Policy statement We provide care for healthy children and promote health through identifying allergies and preventing contact with the allergenic substance and through preventing cross infection of viruses and bacterial infections. Procedures Children with allergies (including adrenaline injections (Epi-pens) for anaphylactic shock reactions) or When parents start their children at Officrèche they are asked if their child suffers from any known allergies. This is recorded on their Registration Form and Celebrating Me booklet. If a child has a severe allergy, the parent and key person will fill in a Health Care Plan which contains the following information: Written consent to allow staff to administer medication. 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. Epi-pen). Control measures such as how the child can be prevented from contact with the allergen. This form is kept in the child s personal files. Emergency medication is kept in a plastic container clearly marked with the child s name and details of their health care plan on a high shelf in the child s nursery room Staff liaise with parents to determine to how to administer special medication in the event of an allergic reaction. In some cases it may be appropriate for staff to be trained by a health care professional. No nuts or nut products are used within the setting. Parents are made aware so that nut or nut products are not accidentally brought in to Officrèche. Page 1

2 We display the ingredients contained in the snacks we serve to the children, highlighting any high-risk allergens (see Healthy Early Years Food policy). Oral Medication (including inhalers) Oral medications must be prescribed by a GP or have manufacturer s instructions clearly written on them. The parent must provide staff with clear written instructions on how to administer such medication; this should be detailed in their health care plan. Parents must give prior written consent by filling out a Medication Record and/or health care plan with a member of staff. Emergency medication is kept in a plastic container clearly marked with the child s name and details of their health care plan on a high shelf in the child s nursery room A copy of the child s health care plan is kept in their personal file. Lifesaving medication & invasive treatments - invasive treatments such as rectal administration of Diazepam (for epilepsy) The parent will need to provide a letter from the child's GP/consultant stating the child's condition and what medication if any is to be administered. The parent and key person will need to fill in a Health Care Plan which includes written consent to allow staff to administer medication. The child s key person may need to access training in the administration of such medication by the child's GP, a district nurse, children s nurse specialist or a community paediatric nurse. Children requiring help with tubes to help them with everyday living e.g. breathing apparatus, to take nourishment, colostomy bags etc. The parent and key person will need to fill in a Health Care Plan which includes written consent to allow staff to administer medication and treatment. The child s key person may need to access training in the administration of such medication and treatment by the child's GP, a district nurse, children s nurse specialist or a community paediatric nurse. Children who are sick or infectious Page 2

3 If a child is unwell and will not be attending nursery, the parent must telephone and inform the nursery as soon as possible. If a child has been unwell the previous day or night, it is essential that the parent informs us. If children appear unwell during the day have a temperature, sickness, diarrhoea or pains, particularly in the head or stomach the Nursery Manager calls the parents and asks them to collect the child, or send a known carer to collect on their behalf. If the parents cannot be contacted, the emergency contacts specified on the Registration Form will be used. If a child has a temperature, they are kept cool, by removing top clothing, sponging their heads with cool water, but kept away from draughts. In extreme cases of emergency the child should be taken to the nearest hospital and the parent informed. The nursery can refuse admittance to children who are not well enough to attend nursery, have a temperature, sickness and diarrhoea or a contagious infection or disease. Refunds will not be given if a child is absent because they are unwell or infectious. Where children have been prescribed antibiotics, parents are asked to keep them at home for 24 hours before returning to the setting. After diarrhoea and/or vomiting, parents are asked to keep children home for 48 hours and until a formed stool is passed and/or vomiting has stopped. Officrèche has a list of excludable conditions/diseases and current exclusion times (shown below) Condition Description Action Return to Nursery Temperature (taken with electronic thermometer) 37 C to 37.9 C 38 C to 39 C Remove child s clothes and check for rash* including nappy area. Give cool fluids. Inform parents, observe and re-take temperature 30 minutes later or sooner if condition deteriorates. Remove child s clothes and check for rash including nappy area. Give cool fluids. Inform parents and observe closely, if unhappy, ask parents to take children home. If a child s temperature is due to teething, staff may administer Calpol with parental consent. However this will be at the nursery s discretion and if the child s condition means that they need one-to-one *If rash present, depending on GP advice. See section on rash/spots. resolved. resolved. Page 3

4 Diarrhoea Vomiting Diarrhoea and Vomiting Rash/Spots Stools: Liquid plus foul smelling. Possible different colour. Definite vomiting as opposed to regurgitation of milk/food or association with coughing or a care, parents will be asked to take the child home. After 2 episodes inform parents and ask them to take home and advise them to visit GP if symptoms persist. After 1 episodes: inform parents and ask them to take child home and advise them to visit GP if symptoms persist. been resolved for 48 hours. been resolved for 48 hours. heavy cold. See previously. See previously. been resolved for 48 hours. Not normally present. Location: anywhere on body. Ensure that it is rash/spots as opposed to eczema or dermatitis. Assess rash. Perform glass test on rash. If purpuric rash, especially associated with a temperature, inform parents and tell them to take child to GP or hospital immediately. Nursery staff will take the child to hospital if parents are unavailable. Depending on GP s advice. Chicken Pox Measles Rubella (German Measles) Ear Infection either possible or diagnosed Parvovirus (Slapped Cheek Syndrome) Roseola Red spots usually starting on trunk, turning into blisters, and then crusting. Spots may spread to entire body (incubation period Red blotchy skin rash preceded by symptoms of cold with or without conjunctivitis (incubation period 7-18 Delicate pink spots which may be raised spreading from trunk towards and preceded by lymph node swelling behind the ears and at the back of the neck (incubation period Ears may be sore, red, inflamed or discharging. The child may be pulling at their ears, a temperature may be present. Child may be unbalanced and off their food. Facial rash (slapped cheeks) followed by lacy rash on trunk (incubation period 4-20 Rash consisting of small red flat spots lasting 36 hours. Preceded by fever and sore throat (incubation period If temperature is present, follow temperature guidelines. If ears are discharging, inform parents, ask them to take child home and to visit GP. If child is distressed, ask parents to take home. staff. Nursery to inform other May be harmful to women in early stages of pregnancy. staff. Nursery to inform other Exclude for 5 days after onset of rash or until spots have dried and crusted whichever is the sooner provided the child is well. 5 days from inset of the rash providing the child is well. 5 days from inset of the rash providing the child is well. If the ear was discharging, 24 hours of being either symptom free or on antibiotics. If the ear is not discharging, it is not necessary to exclude the child unless distressed. No exclusion is necessary unless the child is unwell. No exclusion is necessary unless the child is unwell. Page 4

5 Generally Unwell (may accompany other conditions e.g. diarrhoea, temperature) Hand, Foot & Mouth Disease Ringworm Mumps Child behaving out of character and not suspected to be teething e.g. unhappy, lethargic, not feeding, crying. Blisters/small spots on hands, feet and around mouth (incubation period 3-5 Dry, flaky eczema like patch, developing into ring like rashes. Fever and facial swelling. Males may get testicular swelling. Child may feel very unwell (incubation period Inform parents and advise them to take child home and visit GP. Observe for purpuric rash. If present, inform parents and tell them to take child to GP or hospital immediately. Nursery staff will take child to hospital if parents are unavailable. staff. Nursery to inform other staff. Nursery to inform other Depends on GP s advice or cessation of symptoms. No exclusion is necessary unless the child is unwell. 24 hours on treatment from GP. Lesions to be covered with a waterproof dressing if possible. 9 days from onset of facial swelling providing the child is well. Scabies Impetigo Threadworm Spots, blisters or small linear burrows visible around finger webs, on palms, soles and the head. May occur anywhere on the body (incubation period 2-6 weeks if previously unexposed, 1-4 days following reexposure). Small red spots which may turn into blisters and may crust. Found anywhere on body (incubation period 4-10 Small thread like worms in stools. May be associated with severe peri-anal itching. 48 hours after commencement of treatment (family contacts may need treatment too). Spots crusted over or healed. 48 hours after antibiotic. Exclude until 24hrs after treatment given. Hepatitis A Swine Flu Generally unwell. Whites of eyes turn yellow. Dark urine, stools clay coloured. Diarrhoea and vomiting (incubation period Head ache, sore throat, aching muscles, diarrhoea, vomiting. nursery. Nursery staff to inform other service users. Exclude 5 days from onset of jaundice or stools going pale, or if child is unwell after this time. Exclude for 5 days or until fully fit. In all cases of sickness, it will be at the discretion of the Nursery Manager or Deputy Manager as to whether a child is well enough to attend the nursery. The nursery will ensure that the best interest of the child is paramount at all times. Page 5

6 Reporting of notifiable diseases If a child or adult is diagnosed suffering from a notifiable disease under the Public Health (Infectious Diseases) Regulations 1988, the GP will report this to the Health Protection Agency. When the setting becomes aware, or is formally informed of the notifiable disease, the Nu Manager informs Ofsted and acts on any advice given by the Health Protection Agency. HIV/AIDS/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 (aprons if necessary) are worn when changing children s nappies, pants and clothing that are soiled with blood, urine, faeces or vomit. Soiled clothing is bagged for parents to collect at the end of the session. Spills of blood, urine, faeces or vomit are cleared using mild disinfectant solution and mops; Tables and other furniture, furnishings or toys affected by blood, urine, faeces or vomit are cleaned using a disinfectant. Head lice Head lice are not an excludable condition, although in exceptional cases a parent may be asked to keep the child away until the infestation has cleared. On identifying cases of head lice, all parents are informed and asked to treat their child and all the family if they are found to have head lice. Page 6