关爱我们的孩子（2019）建议不包括来自托儿儿童的以下标准。与您的管理员谈论您的计划排除疾病的政策。

排除生病儿童的主要标准

当一个孩子生病但不需要立即医疗帮助时，应对儿童是否应该被送回家庭（即，应暂时被排除在儿童保育中）进行决定。大多数疾病不需要排除。护理人员/老师应该确定疾病是否：

  1. 防止孩子在活动中舒适地参与
  2. 在不影响其他儿童的健康和安全的情况下，需要提供大于工作人员的护理
  3. Poses a risk of spread of harmful diseases to others

If any of these criteria are met, the child should be excluded, regardless of the type of illness. Decisions about providing care that is comfortable for the child while awaiting parent/guardian pickup should be made on a case-by-case basis, considering factors such as the child’s age, surroundings, potential risk to others, and type and severity of symptoms the child is exhibiting. The child should be supervised by someone who knows the child well and who will continue to observe the child for new or worsening symptoms. If symptoms allow the child to remain in his or her usual care setting while awaiting pickup, the child should be separated from other children by at least 3 feet until the child leaves to help minimize exposure of staff and children who were not previously in close contact with the child. All who have been in contact with the ill child should wash their hands. Toys, equipment, and surfaces used by the ill child should be cleaned and disinfected after the child leaves.

Temporary exclusion is recommended when the child has any of the following conditions:

  1. The illness prevents the child from participating comfortably in activities.
  2. 这种疾病导致需要小于工作人员的护理，而不会影响其他儿童的健康和安全性。
  3. A severely ill appearance—this could include lethargy/lack of responsiveness, irritability, persistent crying, difficult breathing, or having a quickly spreading rash.
  4. Fever (temperature >101°F [38.3°C] by any method) with a behavior change in infants older than 2 months. For infants younger than 2 months, a fever (temperature >100.4°F [38°C] by any method) with or without a behavior change or other signs and symptoms (eg, sore throat, rash, vomiting, diarrhea) requires exclusion and immediate medical attention. When taking temperatures remember that:
    • The amount of temperature elevation varies at different body sites.
    • 温度的高度并不表示更严重或较小的疾病。孩子的活动水平和幸福感更重要的是，温度读数更重要。
    • If a child has been in a very hot environment and heatstroke is suspected, a higher temperature is more serious.
    • 选择采取儿童温度的方法取决于需要准确，可用设备，采用温度的人的技能，以及儿童协助该程序的能力。
    • Oral temperatures are difficult to take for children younger than 4 years.
  5. Diarrhea is defined by stools that are more frequent or less formed than usual for that child and not associated with changes in diet. Exclusion is required for all diapered children whose stool is not contained in the diaper and toilet-trained children if the diarrhea is causing “accidents.” In addition, diapered children with diarrhea should be excluded if stool frequency exceeds 2 stools more than typical for that child during the time in the program day, because this may cause too much work for the caregivers/teachers, or if stools contain blood or mucus. Readmission after diarrhea can occur when diapered children have their stool contained by the diaper (even if the stools remain loose) and when toilet-trained children are not having “accidents,” and when stool frequency is no more than 2 stools more than typical for that child during the time in the program day.

Special circumstances that require specific exclusion criteria include the following1:

  1. 医疗保健专业人员应清除儿童或工作人员为所有血液或粘液的腹泻的入院。当地卫生部门当局的要求可能会发生，这可能包括测试腹泻爆发的测试，其中粪便培养结果是正面的Shigella，Salmonella血清型typhi和帕拉伐猴，或滋阴毒素生产大肠杆菌(STEC). Children and staff members with志贺丽should be excluded until diarrhea resolves and test results from at least 1 stool culture are negative (rules vary by state). Children and staff members with STEC should be excluded until test results from 2 stool cultures are negative at least 48 hours after antibiotic treatment is complete (if prescribed). Children and staff members with沙门氏菌排除血清型Typhi和副脸，直到3个粪便培养物的测试结果为负。在抗生素停止后，应至少收集粪便至少48小时。国家法律可为这些条件排除排斥，并应遵循清理儿童或工作人员的医疗保健专业人员。
  2. Vomiting more than 2 times in the previous 24 hours, unless the vomiting is determined to be caused by a noninfectious condition and the child remains adequately hydrated.
  3. 腹痛持续超过2小时或间歇性疼痛与发烧或其他症状或疾病症状相关。
  4. Mouth sores with drooling that the child cannot control unless the child’s primary health care provider or local health department authority states that the child is noninfectious.
  5. 皮疹发烧或行为变化，直到主要医疗保健提供者确定疾病不是传染病。
  6. 活跃结核病，直到孩子的主要医疗保健提供者或当地卫生部门的儿童在适当的待遇，并可以返回。
  7. Impetigo只有当孩子在先前的程序日结束时尚未在通知家庭后进行治疗。只要可以覆盖病变，就不需要排除。
  8. 链球菌咽炎（即喉咙咽部）直至治疗后至少12小时。1,2
  9. Head lice, only if the child has not been treated after notifying the family at the end of the prior program day.Note:Exclusion is not necessary before the end of the program day.
  10. 只有当孩子在先前的程序日结束时尚未治疗该家庭后尚未治疗疥疮。Note:Exclusion is not necessary before the end of the program day.
  11. 水痘（种子菌），直到所有病变都干燥或裂开（通常在皮疹发作后6天，并且没有出现至少24小时的新病变）。
  12. Rubella，直到7天出现皮疹后。
  13. Pertussis, until 5 days of appropriate antibiotic treatment.
  14. Mumps, until 5 days after onset of parotid gland swelling.
  15. 麻疹，直到皮疹发作后4天。
  16. 甲型肝炎病毒感染，直到疾病或黄疸发生后1周，如果孩子的症状温和或由卫生部门的指示。Note:保护应ch组里的其他人ecked to be sure everyone who was exposed has received the vaccine or receives the vaccine immediately.
  17. 任何受当地卫生部门决定的孩子都会在爆发过程中促进疾病的传播。

参考资料

  1. 美国儿科学院。Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide.Aronson SS, Shope TR, eds. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017
  2. 美国儿科学院。School health. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds.Red Book: 2018–2021 Report of the Committee on Infectious Diseases.31 ed。Itasca，IL：美国儿科学院;2018：136-138
  3. 美国儿科学院。儿童在户外育儿。在：金伯琳德，布拉迪山，杰克逊马，长SS，EDS。Red Book: 2018–2021 Report of the Committee on Infectious Diseases.31 ed。Itasca，IL：美国儿科学院;2018：122

See Caring for Our Children athttps://nrckids.org/cfoc/database/3.6.1.1for more information.