6.2 Managing children who are sick, infectious, or with allergies

(Including reporting notifiable diseases)

Policy statement

At Thorpe Acre Preschool Playgroup, we provide care for healthy children through preventing cross infection of viruses and bacterial infections and promote health through identifying allergies and preventing contact with the allergenic trigger.

During the COVID-19 outbreak, any child showing symptoms, such as high temperature; a new, contagious cough; loss of taste or smell, the following sequence of actions need to be taken:

1. Child present with symptoms: parents are requested to collect child and seek diagnosis from the GP or take further advice from NHS 111.
2. Child’s parents are requested to inform setting of outcome/diagnosis and keep child at home fo the recommended exclusion period. For cases of suspected Coronavirus, staff and service users must adhere to current Government advice regarding self-exclusion even if no symptoms are present.
3. For confirmed cases of a notifiable disease and Coronavirus the setting must contact their local Health Protection team (HPT) as soon as possible for further guidance. The Manager will inform the Committee and retain a confidential record.
4. Acting on the advice of the local HPT, the setting will either:

• Close for a set period of time and undertake a deep clean.
• Carry on as usual but also undertake a deep clean.
• If a notifiable disease is confirmed, staff MUST inform the manager immediately and Ofsted must be informed within 14 days. Cases of Coronavirus should be treated as a notifiable disease.
• A deep clean is undertaken at the soonest opportunity following ant illness outbreak. Hand hygiene messages are reinforced and staff are vigilant to any further signs of infection.
• The manager continues to liaise with the HPT as required and keeps a full record of children affected, how long they are away from the setting and the date on which they return.

Procedures for children who are sick or infectious

• If children appear unwell during the day – have a temperature, sickness, diarrhoea or pains, particularly in the head or stomach – a member of staff calls the parents and asks them to collect the child, or to send a known carer to collect the child on their behalf.
• If a child has a temperature, they are kept cool, by removing top clothing, sponging their heads with cool water, but kept away from draughts.
• The child’s temperature is taken using a thermometer strip, kept in the first aid box.
• In extreme cases of emergency NHS direct or the emergency services would be called for further advice or treatment and the parent informed.
• Parents are asked to take their child to the doctor before returning them to the setting, the setting can refuse admittance to children who have a temperature, sickness and diarrhoea or a contagious infection or disease, or who seem very unwell on arrival.
• Where children have been prescribed first time antibiotics/medicines for an infectious illness or complaint, parents are asked to keep them at home for 48 hours before returning to the setting.
• After diarrhoea, parents are asked to keep children home for 48 hours, after the last episode and when a formed stool is passed.  Parents are also asked to follow the same procedure if the child has been sick.
• A notice is displayed on the Parents Notice Board informing parents of this.
• Some activities such as sand and water play, playdough and self-serve snacks where there is a risk of cross contamination, may be suspended for the duration of any outbreak.
• The setting has a list of excludable diseases and current exclusion times. The full list is obtainable from www.gov.uk/government/publications/health-protection-in-schools-and-other-childcare-facilities and includes common childhood illnesses such as measles.

Reporting of ‘notifiable diseases’

• If a child or adult is diagnosed as suffering from a notifiable disease under the Health Protection (Notification) Regulations 2010, the GP will report this to the Health Protection Agency.
• When the setting becomes aware, or is formally informed of the notifiable disease, the manager informs Ofsted and contacts Public Health England and acts on any advice given.

HIV/AIDS/Hepatitis procedure

• HIV virus, like other viruses such as Hepatitis A, B and C are spread through body fluids. Hygiene precautions for dealing with body fluids are the same for all children and adults.
• Single use vinyl gloves and aprons are worn when changing children’s nappies, pants and clothing that are soiled with blood, urine, faeces or vomit.
• Soiled clothing is bagged for parents to collect.  Spills of blood, urine, faeces or vomit are cleared using mild disinfectant solution and antibacterial floorwipes; cloths used are disposed of with the clinical waste.
• Tables and other furniture, furnishings or toys affected by blood, urine, faeces or vomit are cleaned using a disinfectant.

Nits and head lice

• Nits and head lice are not an excludable conditions, although in exceptional cases a parent may be asked to keep the child away until the infestation has cleared.
• On identifying cases of head lice, all parents are informed and asked to treat their child and all the family if they are found to have head lice.
• When cases of head lice are reported or observed by staff, written and verbal information will be related to all parents.

Procedures for children with allergies

• When parents start their children at the setting they are asked if their child suffers from any known allergies. This is recorded on the registration form.
• If a child has an allergy, a risk assessment form is completed to detail the following:

• The allergen (i.e. the substance, material or living creature the child is allergic to such as milk, nuts, eggs, bee stings, cats etc).
• The nature of the allergic reactions e.g. anaphylactic shock reaction, including rash, reddening of skin, swelling, breathing problems etc.
• What to do in case of allergic reactions, any medication used and how it is to be used (e.g. Epipen).
• Control measures – such as how the child can be prevented from contact with the allergen.
• Review.

• This form is kept in the child’s personal file and a copy is displayed where staff can see it.
• A health care plan will also be completed.
• Parents train staff in how to administer special medication in the event of an allergic reaction.
• Generally, no nuts or nut products are used within the setting.
• Parents are made aware, if a child is found to have an allergy, so that no nut or nut products are accidentally brought in, for example at lunchtime or for events.

Insurance requirements for children with allergies and disabilities

• The insurance will automatically include children with any disability or allergy but certain procedures must be strictly adhered to as set out below. For children suffering life threatening conditions, or requiring invasive treatments; written confirmation from your insurance provider must be obtained to extend the insurance.

Oral medication

Asthma inhalers are now regarded as ‘oral medication’ by insurers and so documents do not need to be forwarded to your insurance provider.

• Oral medications must be prescribed by a GP or have manufacturer’s instructions clearly written on them.
• The setting must be provided with clear written instructions on how to administer such medication.
• All risk assessment procedures need to be adhered to for the correct storage and administration of the medication.
• The setting must have the parents or guardians prior written consent. This consent must be kept on file. It is not necessary to forward copy documents to your insurance provider.

Life saving medication & invasive treatments

Adrenaline injections (Epipens) for anaphylactic shock reactions (caused by allergies to nuts, eggs etc) or invasive treatments such as rectal administration of Diazepam (for epilepsy).

• The provider must have:

• a letter from the child's GP/consultant stating the child's condition and what medication if any is to be administered;
• written consent from the parent or guardian allowing staff to administer medication; and
• proof of training in the administration of such medication by the child's GP, a district nurse, children’s nurse specialist or a community paediatric nurse.
• Treatments, such as inhalers or Epipens are immediately accessible in an emergency.

Key person for special needs children - children requiring help with tubes to help them with everyday living e.g. breathing apparatus, to take nourishment, colostomy bags etc.

• Prior written consent from the child's parent or guardian to give treatment and/or medication prescribed by the child's GP.
• Key person to have the relevant medical training/experience, which may include those who have received appropriate instructions from parents or guardians, or who have qualifications.
• Copies of all letters relating to these children must first be sent to the Early Years Alliance Insurance Department for appraisal (if you have another provider, please check their procedures with them). Written confirmation that the insurance has been extended will be issued by return.

If you are unsure about any aspect, contact the Pre-school Learning Alliance Insurance Department on 020 7697 2585 or email insurance@earlyalliance.org.uk.

Further guidance

• Managing Medicines in Schools and Early Years Settings (DfES 2005)
   

Other useful Pre-school Learning Alliance publications

• Good Practice in Early Years Infection Control (2009)
• Medication administration record 2013

Updated June 2020