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每个孩子的日常访问都应该从一个简单的健康检查开始。让孩子们在学校里快速健康的成长是一个很好的方法。大多数孩子偶尔会流鼻涕、咳嗽或轻微发烧。这通常不会引起教师、教职员工和家庭的担忧。然而，有时候，孩子的病会变得更严重。在处理生病的孩子时，项目有指导决策的政策。因为你很了解你的项目中的孩子，所以你很有可能知道你照顾的孩子什么时候身体好，可以参加活动，也可以知道什么时候孩子病得太重，不能继续参加学龄计划。你的计划可能有指导方针来帮助你做出这个决定。美国儿科学会（2011）提供了三个关键因素来决定一个孩子是否病得太重而不能照顾孩子：

• The child cannot participate in activities
• The child's illness presents a risk to other children or staff
• You cannot care for the child while maintaining appropriate care for the other children

If you think a child meets any of these criteria, it is likely that he or she should be sent home. See the resources in the Learn Activities section below for a complete list of illnesses that do or do not merit exclusion from child care.

Daily health checks are a good time to evaluate a child's health to make these decisions. Remember, it is up to your program -not the family-to decide whether a child is healthy enough to stay in child care. You must consider the health of the other children and staff in your program.

Daily health checks also provide a record of any changes in the child's appearance or behavior, which can be important if you suspect child abuse or neglect. This information can also be very useful for families if the child is suspected of having a long-term physical or mental health need. Health checks, if conducted sensitively and documented thoroughly, can help you build relationships with children and families. They provide an opportunity for you to spot signs of common infectious diseases, which helps prevent the spread of illness in your program. This lesson will answer questions many school-age staff members may have about health checks.

What Is a Health Check?

健康检查是对孩子的身体、情绪和行为的快速评估。作为健康检查的一部分，你还可以从家人那里收集信息。你想知道是否有影响孩子或家庭成员的健康变化。一个简单的问题，“今天大家都感觉好吗？”可以开始对话。当你对一个孩子有了很好的了解，你会很快注意到日常生活中的任何差异。健康检查的目的是注意到孩子可能遇到的任何疾病或健康问题。学龄儿童通常能够传达任何不适、疼痛或症状，这在进行健康检查时很有帮助。一定要听每个孩子的话，询问他们晚上在家或在学校的情况。

When Should I Do a Health Check?

You should do a health check each time a child or youth arrives in your program (e.g., if children comes to your program before and after school, a quick health check should happen at both time points). Ideally, in instances when a family member drops off the child, health checks should be completed before the parent or guardian leaves the building. This will give you a chance to talk with the parent or guardian if you suspect the child is ill or if you have questions about any changes in the child's appearance or behavior. You should also do a health check any time you notice a change in the child's appearance or behavior. You might do a series of health checks across the day if you suspect a child is not feeling well.

See

What Does a Health Check Look Like?

The exact procedures for doing a daily health check may vary. Watch this video to see an example of school-age staff members checking a child's health.

日常健康检查s

What Should I Look For?

Your program may provide you with a daily health check form. If not, the Apply Activities section of this lesson has samples that you can adapt for your own use. When doing a health check, be sure to use all your senses.

• Look over the child's body. Do you see any bruises, cuts, scrapes, or burns? Do you see any open sores or fluid coming from the child's eyes or nose? Do you see any scratching of the head or body? Do you see any unusual behaviors (sad, sleepy, irritable, lack of appetite)?
• Listen for a cough, wheezing, or a stuffy nose.
• 感觉孩子的皮肤发烧或脱水的迹象，如果他们出现疾病。
• Use your sense of smell to check for any unusual odors.

别忘了，与学龄儿童交谈是一种强有力的工具。与年幼的孩子相比，学龄儿童更能表达他们的感受和经历。如果你有顾虑，记得问问孩子和年轻人他们的感受，并让他们注意到你的担忧。你也可以在孩子们进入课程时问他们一些问题，比如：

• How are you doing today?
• How was your day at school?
• How was your night?

The answers to these questions provide you with valuable information that helps you ensure the health and safety of the children and youth in your care.

做

做cument any problems or changes on your daily health check form. If you think the child is ill and should not be in child care, talk with the parent or guardian immediately. This will allow them to make alternate plans.

Whether or not you see a problem, it is important to document daily health checks. Use a form provided by your program or use the one provided in the Apply Activities section below. Record that you did a health check each day, and mark anything unusual for the child or family. Be sure to save this documentation for at least 30 days. In the event of a disease outbreak, these records can be very useful to your program and public health officials.

排除和重新接纳政策

Your program's exclusion and readmission policies take into consideration the health of the child, other children, staff, and the needs of the family. It's important that you adhere to your program's policy and help families understand your program's health-related expectations and requirements.

Your administrator is responsible for determining whether or not a child needs to be excluded from child care for health reasons and for how long. It's your responsibility to know:

• The conditions and symptoms that do not require exclusion
• The criteria for the exclusion of ill children
• The procedures for a child who requires exclusion

Contrary to popular belief, excluding a child with a mild illness is unlikely to reduce the spread of germs, as most children spread germs before or after their illness or don't exhibit any symptoms. However, if a child is sick and the decision is made for them to be sent home, remember to respond sensitively to the child and family. Contact the family right away, and ask them to pick up their ill child. When a family member or guardian arrives, describe the symptoms and provide any documentation the family might need to give a doctor. Include when you noticed the illness, a description of symptoms, any vital signs (like temperature), and any medications you provided that were prescribed by a physician and approved in writing by the family, or other actions you took. Also remind the family about your program's policies and when the child can return.

你的计划旨在帮助促进健康实践。花点时间了解一下你的项目为患病儿童制定的政策和设施。观看此视频了解更多信息。

为疾病做准备

您的计划应通知与患有下列疾病的儿童接触的儿童的工作人员和家庭：

• Meningitis
• Pertussis (whooping cough)
• Invasive infections such as strep
• Chickenpox
• 皮肤感染或感染（头虱、疥疮和癣）
• Infections of the gastrointestinal tract (often with diarrhea) and hepatitis A virus (HAV)
• Haemophilus influenzaeB型（Hib）
• 第五种疾病（细小病毒B19）
• 麻疹
• Tuberculosis

Families and staff should also be notified if two or more unrelated persons affiliated with the facility are infected with a vaccine-preventable or infectious disease.

If one of these diseases or conditions is suspected in your school-age program, your program will need to notify all families and staff who have come in contact with the child or children. This notification should include (Caring for our Children, 2015):

• The names, both the common and the medical name, of the diagnosed disease to which the child was exposed, whether there is one case or an outbreak, and the nature of the exposure (such as a child or staff member in a shared room or facility)
• Signs and symptoms of the disease for which the parent/guardian should observe
• 疾病传播方式
• Period of communicability and how long to watch for signs and symptoms of the disease
• 卫生署建议的疾病预防措施（如适用）
• Control measures implemented at the facility
• Pictures of skin lesions or skin condition may be helpful to parents or guardians (e.g., chicken pox, spots on tonsils, etc.)

The notice should不确认患有传染病的孩子。

In some cases, your program may need to contact medical professionals or public health officials. There are certain illnesses that are considered "reportable illnesses." Your program will need to follow health guidelines to notify families and staff about the occurrence of these types of illness. A list of reportable illnesses is updated annually by the Centers for Disease Control and Prevention (CDC) and is available athttp://wwwn.cdc.gov/nndss/downloads.html.

To make illness less stressful, you should work with families to make sure a plan is in place for an ill child. Families, staff, and programs should make sure:

• 当他们的孩子生病时，家庭有另一种照顾孩子的安排
• Programs have a safe place for sick children to wait until families can pick them up; this space should be supervised by an adult that the child knows
• 关于疾病后的排除和再入院的书面政策已到位；该政策与家庭共享
• Lines of communication are open; staff share information with families about their child's wellness, and families share information with staff about a child's wellness. This includes communicating with the program when a child has been diagnosed with an infectious disease.

最后，请记住，作为一名员工，你也有传播疾病的能力。如果你生病了，呆在家里。如果你有任何列在排除名单上的疾病，你应该呆在家里不工作，直到你符合返回的标准。

疫苗接种

疫苗接种help prevent serious diseases. For immunizations to be effective, they must be given as scheduled. Researchers regularly discover new information concerning immunizations, such as who should receive them and when, so it might be helpful for you to stay up to date on the latest recommendations. You can learn more about immunization on the Centers for Disease Control and Preventions website athttp://www.cdc.gov/vaccines/schedules/index.html.

尽管了解免疫知识对您很有帮助，但您的经理有责任从家庭获得免疫信息，以确保您的计划符合所有与健康相关的法规。对教师和照料者进行免疫接种也是很重要的，所以要确保你在为员工推荐的免疫接种方面遵循你的计划指导方针。