Illness, Infection and Exclusion

At Chingford House School (CHS) we have many policies and procedures in place to safeguard and promote the health and wellbeing of the children, staff, parents and users of the setting.

We recognise that children can become ill, and therefore the welfare of a sick child will be our priority until the parent/carer arrives to resume responsibility. This policy demonstrates the procedures that will take place to support the unwell child, however we have a duty to the remaining children and staff to safeguard, prevent and protect them from contracting a communicable disease, illness, or the spread of infection. Therefore, the nursery has a provision whereby the Owner/Manager reserves the right to exclude children who they feel are unfit to attend nursery because of an infectious illness or where they feel that the nursery would not be conducive to their recovery or one to one attention is not practical.

In our experience, we have found that children do not always cope well when they are ill, often wanting to be at home with their parents who can provide the individual comfort and support that is needed (which cannot always be managed at the nursery); to this end, the Key Person or familiar adult will remain with the child and the parents will be called to collect him/her. Similar to all children, a child who becomes unwell is treated with sensitivity and respect and will be fully supported until their parents arrive to collect them.

Procedure:
Promoting good health includes monitoring children for signs and symptoms of communicable illnesses such as chickenpox, measles, meningitis, vomiting and diarrhoea, coronavirus and so forth.

We follow these procedures to ensure the welfare of all children within the nursery:

If a child becomes ill during the nursery day, the parents/carers/appointed person will be contacted and asked to collect their child as soon as possible.
During this time the child will be cared for in a quiet, calm area with their Key Person or another familiar member of staff
If a child has an infectious illness, such as sickness and diarrhoea, they cannot return to nursery for at least 48 hours after their last bout of sickness

It is vital that we follow the advice given to us by Waltham Forest and exclude specific contagious conditions, e.g. gastric bugs and chickenpox to protect other children and staff. Illnesses such as these are very contagious, and put others at risk of the infection.

If we have a case of a contagious infection in the nursery, we will email parents advising them of the signs and symptoms, so that they are informed enough to be able to spot the early signs of an illness. Under no circumstances will we divulge which child or children are ill/infectious, but will inform parents in which classroom/s the infection is located.

If an unwell or infectious child comes to nursery:
The Owner/Manager or Deputy Manager reserves the right not to accept a child who is unwell when being dropped at the nursery. It is the Manager’s (or Deputy’s) duty to make an assessment taking into account the validity of the child being at the nursery balanced with safeguarding the other children from a possible contagious illness.

If a child becomes unwell whilst at the nursery:
If a child begins to show signs or symptoms that pertain to an illness whilst they are at nursery, firstly, they will be comforted by staff (preferably the Key Person).
The child’s Key Person or room leader will fill in a sickness monitoring form.
The child’s Key Person or familiar adult will attempt to find out what is wrong and help them to feel better, i.e. give them a drink of water or taking off a jumper to reduce a temperature.

Medication will not be administered unless permission has been obtained from the parent/carer that day, stating the dosage and the time the medication should be administered (see below).

The Manager or Deputy Manager will be informed of a child who appears to be unwell; if, after staff have done everything they can to make the child more comfortable and there are no signs of improvement, then the Manager or Deputy, in conjunction with the child’s Key Person, will discuss whether or not to contact the parents/ carers to collect their child.

If it is deemed to be in the best interests of the child to go home, the Manager will ring the parents/carers, the signs and symptoms will be explained, and the parent/carer will be asked to collect the child.

If the Manager is unable to contact the parent/carer they will then go to the next person on the contact list, usually the second parent/carer, continuing down the list of authorised persons as necessary.
Whilst their parents/carers are being contacted the child will continue to be comforted by the Key Person/familiar adult.

Plenty of fluids will be offered to the child, and if their temperature is higher or lower than usual this will be addressed immediately. Any other symptoms will be treated as necessary.

The child will be treated with the utmost sensitivity and respect, as feeling poorly can be distressing and quite frightening for a child. The child will have as much privacy as possible and be in a quiet area away from other children, with their Key Person (where ratios permit).

Should a child’s symptoms seriously deteriorate whilst waiting for their parents/carers, the Manager will be informed. If the Manager feels that it is necessary, they will call for an ambulance. The Manager will then inform the parents/carers to meet them at the local hospital. First Aid will be administered to the child as necessary.

Contagious illnesses:
This policy has been updated as of March 2020 specifically to include the coronavirus covid-19 which as of that month was declared pandemic. Chingford House School is seeking daily guidance from LBWF, DfE, PHE, the government and the WHO.

Coronavirus (Covid-19):
Is a new virus which affects the lungs and airway (respiratory) and mostly presents in a high temperature and a new and persistent cough (see full coronavirus statement for other symptoms). If children or staff are suspected of having coronavirus they will be isolated immediately (whilst the child’s parents are contacted) and sent home, where they will have to isolate for 7-14 days.

Chickenpox:
Is a virus which initially presents as a normal cold (runny nose, slight temperature); it is generally when the spots occur that we realise that a child has chickenpox. Children will be excluded and can only return after all the spots have scabbed over, which is generally 5-7 days.

Meningitis:
If a parent informs the nursery that their child has meningitis, the Manager will contact the local public health team. The health team will offer guidance and support for the family and the nursery. If the child develops symptoms whilst at the nursery, the Manager will call the parents as well as an ambulance so that the child can get immediate medical attention. The child will be excluded and will be able to return following medical advice.

Febrile convulsions, anaphylactic shock and any other fit or seizure:
If a child has a convulsion of any sort, an ambulance will be called immediately, and the parents will be informed.
Anaphylaxis typically presents with many different symptoms over minutes or hours with an average onset of 5 to 30 minutes; the most common areas affected include the skin (80-90%) respiratory (70%), gastrointestinal (30-45%)
Anaphylaxis is a medical emergency that may require an administration of epinephrine (EpiPen); in extreme cases and if the EpiPen fails to work, then resuscitating measures such as airway management may be needed. Only staff with Epi-pen training will be able to administer the epi-pen.

Diarrhoea and Vomiting:
Children must be kept away from the nursery for a minimum of 48 hours after the last episode of diarrhoea or vomiting. If a child is sent home from the nursery the 48 hours will commence from then; therefore, if a child is due in the following day, they will not be able to attend. Children should only return to nursery when they no longer have diarrhoea or have stopped vomiting.

Conjunctivitis:
Children can still attend the nursery after 24hrs if they have started a course of eye drops (for a bacterial infection).

Headlice:
Parents are requested to check their children’s hair on a regular basis. If a parent finds that their child has headlice, they should inform the nursery so that other parents can be alerted to check their child’s hair. Children can still attend nursery, but the child and family’s hair must be treated accordingly.

Administering medication:
We are able to administer medication that is not prescribed such as teething gels/powders, fever relief medication (i.e. Calpol) or creams for skin conditions such as eczema.

A temperature can indicate an underlying symptom of an illness; medication such as Nurofen or Calpol will be administered; most of the child’s clothing will be removed to bring down their temperature. Staff will monitor the child and determine, whether they are well enough to remain at the nursery. Parents will be called if after following the above procedures that the temperature does not go down. We will seek medical advice if the temperature exceeds 40˚ and will call for an ambulance if deemed necessary. The parents will be advised of this.

All medication, including prescribed ones such as antibiotics or aspirins will only be administered with the parent’s written consent; medication such as Calpol or inhalers can be administered as and when necessary, however the parents must indicate this on the original medication form. Staff will administer the medication as signed for by the parents, detailing:
the name of the medication, the dosage, the time it should be administered, the last time it was administered, and how long the child will need to be on the medication. A record will be kept, and parents will be asked to sign to acknowledge that the child has received the medication at the end of the day (or at the end of the prescribed period).

The Key Person (familiar adult in their absence) is responsible for administering medication to their Key child; a senior member of staff will witness when the medication is administered.
The staff will follow the directions on the bottle, detailing how the medication should be stored (e.g.. in the fridge); medicines that do not need to be stored in the fridge will be kept out of children’s reach. Staff will record how much medication is given as directed by the doctor (or indicated on the bottle if unprescribed). The expiry date will also be recorded.
As stated, if a child is on antibiotics, the parents will sign at the end of the first day and then will sign once the course of antibiotics have finished (or at the end of the first week).

Nursery staff have the right to refuse to administer any medication with which they feel uncomfortable. Parents/carers must respect staffs’ decision, i.e. a child may be too distressed when administering eye drops; if this is the case, the child may need to be excluded to prevent infection from spreading to the other children and staff.

Training for staff to administer medicines that require technical /medical knowledge:
Some medication may require specialist training or medical knowledge i.e. epi-pen or type 2 diabetes training. The Manager will liaise with the child’s parents and health professionals.
If training relates to generic medication such as administering Epi-pens, then staff do not have to have training for each individual child. However, some children may require more specific medical intervention, and in these cases, staff will be trained in relation to a particular child’s individual needs.

Transporting children to hospital procedure
If a child’s condition is serious, the Manager will call for an ambulance immediately. Under no circumstances will staff attempt to transport the sick child in their own car unless a parent/carer is present, and the ambulance is very delayed.
Whilst waiting for the ambulance, the Manager will contact the parents and arrange to meet them at the hospital (if they cannot get to the nursery in time).
The Key Person will accompany the child (as they have the best relationship and will be able to comfort and reassure the child). The Key Person will take contact details, any relevant medical forms, medication and the child’s comforter (if appropriate).

Calling an ambulance:
The Manager (or other member of staff) will call 999 and ask for an ambulance, answering all questions honestly and clearly.
When asked, the following details will be given:
Chingford House School
22 Marlborough Road
Chingford
London
E4 9AL

A report will be written by the Manager/ Deputy outlining the illness/infection, the symptoms and why the child had to go to the hospital; this information will be kept on file.

The nursery may be required to inform appropriate agencies about any infectious, notifiable or communicable illnesses (Waltham Forest/Ofsted); the nursery will endeavour to maintain confidentiality however this may not always be possible. Parents will be informed if this is the case.

Staff may be affected by a child’s illness especially if it results in them going to the hospital, Chingford House School have provisions in place so that staff can talk through any issues they may have.

We have procedures in place to reduce the spread of infection (see our hygiene and infection control policy); equipment and resources that may have come into contact with a contagious child will be cleaned and sterilised thoroughly.

Policy created by: Manager

Signed off by: Owner

Date: March 2020

Date of next review: March 2021