Sunnyside Guidance on illnesses (Signs and Symptoms)
Sunnyside Guidance on illnesses (Signs and Symptoms)
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These are general guidances based on Ottawa Public Health, in order to prevent the spread of illnesses and create an outbreak; leading to a temporary shut-down of the Daycare and/or compromise the other children and their families. For most illnesses, including infectious diseases, a doctor’s note is NOT necessary for returning to a child care setting.
In general, a child can return when they meet ALL the following conditions:
Symptoms are improving and the child is feeling better and can meaningfully participate in routine child care activities.
The daycare provider can meet child’s care needs without compromising the health and safety of the other children.
If these criteria are not met, the child must stay home. Please refer to your alternate childcare arrangements, agreed during the interview process.
If a child has been evaluated by a medical professional, the childcare provider may incorporate that professional's recommendations into the decision regarding the child's readiness to return. This determination will also consider the well-being of the other children in care and the operational capacity of the facility. Furthermore, the resumption of non-daycare activities (e.g., extracurricular or outdoor pursuits) following illness may require additional clearance criteria, as deemed appropriate.
Abdominal pain/stomach-ache
Definition: Pain experienced anywhere between the chest and groin; pain may be continuous or may come and go. Stomach-aches are tricky to detect on small children because they can't communicate directly. To diagnose, look for signs of fussiness, grumpiness. Doesn't sleep or eat. Cries more than usual. Inspect stool and vommit for anything unusual and tell the doctor.
May attend daycare unless the child has one of the following:
Pain is severe enough that child has difficulty participating in routine activities
Pain starts after an injury
Bloody or black stools
Diarrhea (see "Diarrhea")
Vomiting (see "Vomiting")
No urine for 8 hours (dry diaper, or ask older children if they have urinated since they woke up)
Fever (see "Fever" for return guidance)
Cough and cold symptoms
Definition: May include runny/stuffy nose, sore throat, sneezing, congestion, body aches, and/or cough, typically lasting up to 7–10 days.
May attend daycare unless the child has one of the following:
Fever (see "Fever" for return guidance)
Difficulty with or rapid rate of breathing (see “Difficult or noisy breathing”)
Cough is severe or child cannot catch breath after coughing
For a cough suspected to be associated with asthma: coughing that cannot be controlled by the medications that the child care has been instructed to use
Note: For diagnosed conditions, follow the advice of the child's healthcare provider.
Diarrhea
Definition: Stools that are more frequent (typically at least two more than normal) or less formed than usual for that child AND not associated with a change in diet. Note that young infants may normally have frequent, somewhat watery stools, particularly if breastfed.
May attend daycare unless the child has one of the following:
Stool not contained in the diaper or toilet (when toilet-trained)
Stool looks like it contains blood or mucus, or appears like sticky black tar
Yellow skin/eyes (jaundice)
Diarrhea that occurs during an outbreak, and exclusion is recommended by Ottawa Public Health
Note: If the child has been diagnosed with a specific infection (such as Shigella, Salmonella/typhoid, Shiga toxin-producing E. Coli, norovirus, etc.), follow the advice of Ottawa Public Health if they are involved, or the guidance of the child’s health care professional.
If there is concern for an outbreak at home (more persons with diarrhea than would be expected in the setting for that time of year), revirew the Ottawa Public Health site for guidance and consult with your child's family doctor immediately.
Difficult or noisy breathing
Definition: Wheezing (high-pitched sounds) that can be heard when a child breathes in or out, chest retractions (see below) OR extra effort is required to breathe.
May attend daycare unless the child has one of the following:
Wheezing that is new for the child or cannot be controlled by medications the child care has been instructed to use for known conditions (e.g., asthma plan)
Skin or lips seem purple, blue, or grey, depending on skin tone.
Fever (see “Fever” for return guidance)
Behaviour changes
Very rapid breathing or increased effort to breathe, such as chest retractions (space between ribs sinks with each breath), belly breathing (belly goes up and down with breathing)
Breathing problem that causes child to have pursed lips, difficulty speaking, or difficulty feeding
Note: Seek medical attention for new symptoms such as wheezing or breathing difficulties, even if mild.
Earache
Definition: Pain (dull, sharp, or burning sensation) experienced inside the ear.
May attend daycare unless the child has one of the following:
Fever (see “Fever” for return guidance)
Behaviour changes
Pain prevents participation in routine activities
Note: For diagnosed conditions, follow the advice of the healthcare provider.
Eye irritation, pink eye, or drainage
Definition: Red or pink appearance to the white part of the eyeball. Child’s eye may also be itchy, have crusted/matted eyelashes, more watering than normal, or yellow/white drainage.
May attend daycare unless the child has one of the following:
Problems seeing (vision changes)
An injury to the eye involving forceful impact to or penetration of the eye
Pain or discomfort the child cannot tolerate
Note: Pink eye (i.e., conjunctivitis) is inflammation of a layer that covers much of the eyeball. It is most often caused by a virus, and children with viral pink eye typically get better after 5-6 days without antibiotics. Staying home from child care is not necessary. Frequent hand washing should be encouraged. Eye irritation can also result from allergies or chemical exposures (e.g., air pollution, smoke, or swimming in chlorinated pool water).
Fever
Definition: An oral (under the tongue), temporal (forehead), rectal, or axillary (underarm) temperature above 38°C (100.4°F). Axillary (underarm) measurements should be used only if other options are not available. Follow instructions for the specific thermometer, including directions for use, cleaning and covers (if applicable). If a temperature is close to 38°C (100.4°F), repeat to confirm the result.
It is ONLY recommended to take a child’s temperature if the child seems ill, feels hot, or has other symptoms or signs of illness. Checking the temperature of a child or group of children to allow entry (also known as screening) is NOT recommended in child care settings.
Unless otherwise directed by a healthcare provider, a child with another symptom or sign of illness who also has a fever should NOT attend child care.
May attend daycare when the child has the following:
Fever went away in the night – without using fever reducing medications, e.g., Tylenol®, Advil®, Motrin® (acetaminophen or ibuprofen) - and is still gone in the morning; AND
Other symptoms are improving and the child can participate comfortably in routine activities.
Note: NEVER medicate a child to mask symptoms which potentially prevent them from being sent home if they become unwell during the day. This can lead to serious medical complexities that can endanger the child's condition, jeopardize their safety and potentially compromise the child's health and well-being during their regular day activities. By concealing symptoms, caregivers risk overlooking the progression of a potentially serious condition, such as: An escalating infection or side effects that lead to significant health complications if left untreated, including febrile seizures, brain damage, and even death.
The welfare of the child, alongside the health of others in the community, depends upon transparent and accurate assessment of a child's condition, which is only possible when symptoms are observable and not artificially suppressed.
Headache, stiff or painful neck
Definition: Pain experienced in any part of the head ranging from sharp to dull; may occur along with other symptoms. Headaches are tricky to detect on small children because they can't communicate directly. To diagnose, look for signs of fussiness, changes in feeding or sleeping, excessive crying or sensitivity to light and sound.
May attend daycare unless the child has one of the following:
Concussion symptoms: Pain occurs after a fall or other injury to the head and is severe or associated with vomiting, vision changes, behavior change, or confusion.
Possible infection: Stiff neck, headache and fever can be symptoms of meningitis a potentially serious infection. Meningitis can also cause sensitivity to light, vomiting, and/or confusion. A stiff neck is most concerning if the child can’t look at their belly button (putting chin to chest) due to pain or the BACK of the neck is painful (not soreness in the sides) along with the other symptoms above.
Note: For either of the above conditions, you must get your child immediate medical attention.
Rash or itching
Definition: An area of the skin that has changes in colour or texture and may look inflamed or irritated. The skin may be darker than or lighter than normal or red or purple. It may be, warm, scaly, bumpy, dry, itchy, swollen, or painful. It may also crack or blister.
May attend daycare unless the child has one of the following:
Oozing, open wound or infection that cannot be covered and is in an area that might come in contact with others.
Skin that looks bruised without a known injury or in an unusual location.
Rapidly spreading dark red or purple rash (may indicate a rare but severe bacterial infection; usually accompanied by fever).
Tender, red area of skin, rapidly increasing in size or tenderness.
Associated symptoms of a serious allergic reaction (rash with throat closing, abdominal pain, vomiting, or wheezing).
Fever (see "Fever" for return guidance)
There is concern for a disease like chickenpox or measles. If this is the case, consult with your child's family doctor immediately, to assess the likelihood of a highly contagious disease or virus; the child should avoid public spaces; follow the advice of Ottawa Public Health for information on quarantine and vaccines.
Note: For diagnosed conditions, follow the advice of the healthcare provider. In general, for conditions such as lice, impetigo, ringworm, scabies, and pinworms, no specific waiting period is typically necessary after starting treatment and the child may return after the appropriate treatment started is working.
Sore throat (pharyngitis) and/or mouth sores
Definition: Sore throat includes pain or irritation of the throat often resulting from a viral or bacterial infection (e.g., cold, flu, strep throat). May feel worse when swallowing.
Mouth sores include white patches on the tongue, gums and/or inner cheeks (oral thrush/yeast infection); white/red spots in the mouth, blisters on lips or inside mouth; or painful ulcers inside cheeks or on gums (canker sores).
May attend daycare unless the child has one of the following:
Inability to swallow
Fever (see "Fever" for return guidance)
Breathing difficulties
Excessive drooling or muffled voice
Note: Most children with sore throat have viral infections. Children younger than 3 years of age usually do not have strep throat. If a child is diagnosed with strep throat, they should receive antibiotics for at least 12 hours before returning.
Vomiting
Definition: Forceful expelling of stomach contents out of the mouth 2 times or more in 24 hours.
Note 1: Not all vomiting is due to an infection and other causes (e.g., spit-up in a healthy infant with reflux, motion sickness, overeating) should be considered.
May attend daycare unless the child has one of the following:
Vomiting has occurred 2 or more times in 24 hours.
Fever (see "Fever" for return guidance)
Concern for a serious allergic reaction, such as hives appearing with vomiting.
Vomit appears green or bloody
Child has not urinated in the past 8 hours (i.e., has dry diapers, or ask older children).
Recent head injury.
Looks or acts very ill.
Return when:
Vomiting ended during the night and child is able to hold down food or liquids in the morning.
Note 2: If there is concern for an outbreak at home (more persons with vomiting than would be expected in the setting for that time of year), contact your child's family doctor immediately, as Norovirus should be suspected and children should not return until 48 hours after all symptoms have resolved.
For certain symptoms (e.g., diarrhea, vomiting), special attention to hand washing is recommended.
When Ottawa Public Health issues an outbreak or pandemic notice, everyone is expected to follow their advice.
If a child has been diagnosed with a specific illness or develops compatible symptoms after an exposure to a contagious disease or during an outbreak of a contagious disease, follow instructions for when the child may return to child care based on that illness and maintain the daycare updated.
Additionally, all symptoms listed in this page warrant medical attention, sometimes immediately. Please consult your child's family doctor and follow their advice.
This list is illustrative, NOT definitive. The parent or guardian must consult a physician whenever the childcare provider judges that a child’s condition warrants medical evaluation. The provider will immediately notify the parent upon making this determination
Please note, face masks should never be used on babies or children under 2 years of age. Face masks should be considered for children 2 years of age and older with respiratory symptoms (e.g., runny nose, cough, sore throat) -only while awake, to lower the chances of getting others sick.
DUTY OF CARE: A child’s parent or guardian will be notified if their child has any of the signs or symptoms listed in the options above. However, in the event of a deteriorating health condition, the primary responsibility is to secure emergency medical aid. Therefore, if a parent or guardian cannot be immediately contacted or is unable to pick up the child, the provider must notify emergency services (911) for safety reasons. The well-being of every child in our care is, and always will be, our paramount and non-negotiable priority!
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