Managing illnesses and outbreaks in child care

The illness tracking form offers 2 important benefits:

Capture and maintain information

• Child care staff record all symptoms of illness on one form, making it easy to track illnesses.
• Staff can keep the monthly records organized in a labelled file folder or binder for convenient access.

Track trends and respond to changes

Child care staff will be able to determine if the number of absences due to illness is higher than usual or if an outbreak is starting, which will require steps to prevent the spread of further illness.

Call Peel Public Health and discuss your concerns.

How to use the Illness Tracking form

• Use 1 illness tracking form monthly for each classroom.
• Use the form to record any symptoms of illness and any absences due to illness.
• Write the date and child's initials. Check off the applicable symptoms on the form. Indicate if the child is absent or has been sent home.
• If the child is absent or has been sent home, record the date when the child returns to the centre.
• Record the child's initials only once for each occurrence of illness. Make sure all required dates, symptoms, other observations, and notes are included.

Under the Health Protection and Promotion Act, child care centre operators are to report to the local Medical Officer of Health any person who may be infected with a communicable disease.

Review the list of reportable diseases to help you decide when to report to Peel Public Health as certain diseases, confirmed by a doctor, require an immediate response by public health to prevent further spread.

To report, call Peel Public Health at 905-799-7700 or toll-free 1-888-919-7800.

It’s not necessary to report other less urgent diseases such as hepatitis, Lyme disease or sexually transmitted infections. These diseases are already reported to Peel Public Health by laboratories and community physicians as required by Ontario law.

Also, individual cases of common childhood sicknesses such as pink eye, hand foot and mouth disease, or ring worm are not reportable to Peel Public Health unless special surveillance is being conducted on one of these diseases.

For information on these or other common childhood sicknesses refer to: Health conditions and treatments.

Diseases under special surveillance

Peel Public Health monitors certain diseases in the community such as Chickenpox

To report Chickenpox in your child care centre, use Notification of Chickenpox (Varicella) in schools and child care form.

Access the sample Chickenpox notification letter for parents.

Children

• Separate sick children from well children. Symptomatic children should be placed in the designated isolation area (for example a sick room).
• Keep sick children comfortable by providing separate cots and toys. Clean and disinfect cots and toys after use. Do not allow sick children to participate in group water play activities.
• If possible, designate specific staff to care for sick children. Ideally, child care staff should not care for sick and well children at the same time. Staff caring for sick children should wear PPE including a medical mask and eye protection. Gloves and a gown may be worn if needed.
• Contact parents to pick up sick children and remind them of the exclusion policy.
• Follow policies and procedures for exclusion periods, as developed by the Canadian Paediatric Society.
• Update the illness tracking form.
• Post the yellow Illness sign or a similar notification at the front entrance of the child care centre to inform parents and visitors about the symptoms of illness. If necessary, prepare and provide fact sheets or letters to parents.

Child care staff

Sick child care staff should not work. They must follow the child care centre's policy about sick employees.

Sick children and child care staff should not return to the centre because they may be infectious. To prevent the spread of illness in the centre, sick children and child care staff must adhere to re-entry requirement.

Children and child care staff can return to the child care centre when they are symptom-free of:

• Respiratory symptoms such as cough and sneezing for at least 24 hours.
• Gastrointestinal symptoms such as vomiting and diarrhea for at least 48 hours.

For other illnesses, refer to Caring for Kids.

Definition of an outbreak

• An outbreak is when a greater than expected number of children and child care staff have similar symptoms (fever, diarrhea, vomiting, rash, and respiratory symptoms) and are sick or absent due to illness in a given period of time.
• A warning signal is when 10% of the children are sick with a similar illness. You can use the illness tracking form to help determine this.

Gastrointestinal and respiratory outbreaks

Gastrointestinal and respiratory outbreaks are the most common types of outbreaks that occur in child care centres.

Symptoms of a gastrointestinal illness include diarrhea, vomiting, nausea, stomach cramps, headache or weakness. Germs that can cause gastroenteritis are Salmonella, Norovirus, Rotavirus, E. coli 0157 and others.

Symptoms of a respiratory illness include fever, headache, cough, sore throat, runny nose, sore muscles and tiredness. Germs that can cause respiratory illness include rhinovirus (common cold), seasonal influenza, pN1H1 influenza, RSV and others.

Managing outbreaks

• Call Peel Public Health at 905-799-7700 and ask to speak to a public health inspector who will help provide advice and steps necessary to control the outbreak.
• Email the illness tracking form to your Peel Public Health inspector.
• Give frequent handwashing reminders to all children and child care staff.
• In an outbreak of gastroenteritis, save all leftover food (if available) for analysis, as it may be a source of illness. Keep food in the refrigerator. Your public health inspector can arrange to have the food tested.
• Separate sick children and staff at the child care centre from well children and staff. Ensure that only designated child care staff have contact with the sick children and that the same staff do not assist with the well children.
• Instruct parents or guardians to take sick children home and to a physician if necessary. Remind everyone, including parents, of the child care centre’s exclusion policy.
• Enhance cleaning and disinfecting of toys and environmental surfaces.
• Clean and disinfect thoroughly, and more often, and ensure infant and toddler areas get special attention.
• Ensure cleaning staff are notified that extra cleaning is necessary.
• Use a disinfectant effective against common outbreak pathogens (Norovirus, rotavirus, etc.).
• Check the disinfection chart for child care centres for concentration of bleach and water disinfectant.
• Stop all group water play for the duration of the outbreak.
• Post the red outbreak sign or a similar notification at the front entrance of the child care centre to inform parents and visitors. Prepare and provide fact sheets or letters to parents.
• During a gastrointestinal outbreak, Peel Public Health may distribute stool kits to collect stool samples. Peel Public Health will provide the stool kits, along with a letter to parents instructing them on how to use the kits. Contact Peel Public Health at 905-799-7700 when stool kits are ready to be picked up.
• Consult daily with your public health inspector regarding new cases, change in symptoms, lab results, pick-up/drop-off of specimen kits, the need for on-site meetings, etc.

Declaring an outbreak over

Only a Peel Public Health inspector can officially declare that an outbreak is over and instruct you to remove the red outbreak sign and post the green healthy sign at the front entrance of your child care centre.

Child care staff should communicate with parents to obtain information on the child's health and well-being. The centre can also post signs at the entrance that communicates your centre’s health status.

Green healthy sign reminds parents and visitors of the importance of handwashing, covering your cough or sneeze and keeping ill children at home. This sign remains posted until there is an increase in illness.

Yellow illness sign notifies parents and visitors of the symptoms the children in the centre are experiencing. This sign also prompts parents to report any symptoms their child may be experiencing. The child care operator posts this sign when there is an increase of illness in the centre.

Red outbreak sign is posted when the centre is experiencing an outbreak. Peel Public Health will declare the beginning and end of an outbreak in your centre and notify you when the sign can be changed.

When parents need to communication with the centre

• Inform the centre when the child is sick.
• Describe the symptoms the child is experiencing.
• Keep the child away from the centre when they are sick.