Most churches have nursery policies that sometimes are based more on parent comfort than medical fact. In a brief search of nursery policies on the internet I came across a couple things that I felt warranted some comment.

Fever: A fever is defined as a core body temperature above 100.4 degrees. When I looked at nursery policies I noticed that some define fever as greater than 98.6 degrees, some said greater than 99.0. Body temperature in children is variable and it is better to think of temperature in terms of range of normal rather than a specific precise temperature. Regardless, anything greater than 100.4 is a fever.

Vomiting and Diarrhea: Most policies excluded children after a single episode of diarrhea and vomiting in the last 24 hours. A single episode of vomiting or a single loose diaper is not concerning and may be due to reflux, eating fibrous foods, something “not agreeing” with the child, coughing, or choking. In all of these cases the loose stool or vomiting is not indicative of a communicable disease. However, if the child has more than one episode of throwing up or diarrhea in the past 24 hours it is advisable to exclude them from the nursery.

Rashes: Many rashes are not contagious. Most rashes without behavior changes or other signs of illness are not considered by the Red Book¹ as grounds for exclusion from daycare. Many rashes appear after infectious risk has diminished. Because we are discussing church nurseries you still may want to have this as an exclusion criteria until a physician has indicated a rash is not contagious. Rashes that do not require exclusion are diaper rashes, eczema, or dry irritated skin.

Coughs and colds: Most children with coughs and colds are excluded from church nurseries. Because these colds are so common and relatively harmless (except occasionally from a parental sanity standpoint), the Red Book does not recommend exclusion of children with colds and coughs from daycare. From a parent’s perspective, I would prefer that my child not get a bad cough. However, practically, if I had a policy of keeping my children from the nursery for having a runny nose either my wife or myself would have had to stay at home for about 6 of the last 8 Sundays.

Most nursery policies differentiate between clear runny nose and green or yellow. The color and consistency of nasal drainage does not correlate with severity and infectivity of an illness, and as such it is nearly meaningless. I do not think that runny nose, regardless of color or consistency, should be a nursery exclusion criterion, unless you would like the parents of small children to miss half of the services while they have children less than 2 years old.

Many nurseries exclude children with eye discharge. In many cases this is not necessary as eye discharge without eye redness or other signs of illness is not considered infections. Eye discharge from a red or swollen eye is cause for exclusion, or if it is associated with an ill appearing or febrile (feverish) child.

Parasites, any form of lice, mites, scabies or ringworm: Excluding children with these parasites is appropriate although may it not be absolutely necessary. Children who have nits without lice, or have been treated for lice do not need to be excluded from a medical point of view.

Developing a nursery policy can be difficult. Medical exclusion criteria in many cases are at odds with parental conceptions, preferences, and beliefs. There are parents who will not put their child in the nursery if any other child has even the slightest runny nose. Then there are parents who are willing to put a febrile, contagious child in the nursery. In developing an infectious disease policy, it is important to consider both medical reality and social reality, with the willingness to adapt when the social reality changes or new medical information is available.

Sample Nursery Infectious Disease Policy. Based upon Red Book¹recommendations for child care centers.
Children should be excluded if they have:

Illness that prevents them from being comfortable
Illness that requires more care than staff can provide

Fever > 100.4, lethargy, irritability, persistent crying, difficulty breathing, or other manifestations of possibly severe illness

Diarrhea (by definition- more than one loose stool) or stool with or mucus

Vomiting more than twice in the previous 24hours

Mouth sores associated with drooling (unless cleared by a doctor)

Rash associated with fever or behavior change

Pink or red eyes with eye drainage

Strep throat until 24h after treatment

Impetigo until 24h after treatment

Lice

Chickenpox (until lesions have dried and crusted), measles (until 4 days after rash), mumps (until 9 days after saliva gland swelling), hepatitis A (until a week after onset)

RSV (until child is well)

Children do not need to be excluded for:

Clear eye drainage without pink eye, red eye, fever, or eye pain.

Rash without fever or behavior change. Many viruses that cause rash are not

infectious at the time of the rash.

5ths Disease (Parvo Virus B19)

Nits if 24 hours of treatment

Sore throat unless known strep throat exposure, or 24 hours of treatment (children under 3 rarely get strep throat)

Ear infection unless fever, irritability, or ill appearing

Runny nose, cold, cough

Diaper rash

Thrush

Eczema (dry itchy skin with bumps often around mouth, lower abdomen, inside of elbows and backs of knees)

Illnesses that may be infectious but do not require exclusion. It depends how strict one wants the nursery policy:

Coughs

Colds

Sore throat

Many rashes

1. Red Book: 2003 Report of The Committee on Infectious Dioseases. 26th. Ed. Elk Grove Village, Il: American Academy of Pediatrics; 2003:126-28 [back]

Posted by Lee Brock on Thursday, December 1st, 2005 at 12:59 pm.