2. HEALTH POLICIES AND PROCEDURES²⁸

1. Requirements for Children

Unless exempt based on religious beliefs, requirements for children are as follows:

1. 1. Each child under 2 years of age has an initial health exam not more than 6 months prior to nor later than 3 months after being admitted to the school, and a follow-up health exam at least once every 6 months after admission.²⁹
   2. Except for a school-age child, each child 2 years of age and older shall have an initial health exam not more than 1 year prior to nor later than 3 months after being admitted to the school, and a follow-up health exam at least once every 2 years after admission.
   3. Families provide the child's health history on the required “Health History and Emergency Care Plan" enrollment form, which is kept on file at the school.³⁰
   4. Families provide a record of the child's immunization history, which is kept on file at the school. All children must be current in their immunization.³¹

2. Requirements for Staff and Volunteers

Unless exempt based on religious beliefs, requirements for staff are as follows:

• All staff and volunteers that work directly with children shall have a health examination within 12 months prior to beginning work. The health provider signed report indicates the staff is free from any communicable disease which presents a safety or health risk to children, including tuberculosis, and that the person is physically able to work with young children. Staff and volunteers will update these records every 2 years. Staff will submit a copy of their current level of immunization records.
• No staff, volunteer, visitor or family member with symptoms of illness, communicable disease, or whose behavior gives reasonable concern for the safety of children may be on the premises of the center

3. Hand Washing and Personal Cleanliness³²

1. Staff must wash their hands upon arriving at the center, before and after diapering children, after using the bathroom or assisting a child in the bathroom, before handling food, after eating, after wiping a child’s nose, after coughing or sneezing, before giving medications, and after playing with animals or changing animal bedding.
2. Children must wash their hands upon arriving at the center, after toileting or diapering, before and after eating or handling food, after coughing or sneezing, before and after involvement in sensory activities.
3. Hand sanitizer:

1. 1. May not be used on children’s hands due to the possible risk of alcohol poisoning, if ingested.
   2. Adults may not use hand sanitizer in place of soap and water.
   3. Hand sanitizer must be stored where it is not accessible to children

4. Hand washing procedures are as follows:

1. 1. Turn on the water.
   2. Apply soap from a pump dispenser or if using a bar of soap, rinse the bar under water before using.
   3. Lather well, moving hands and fingers back and forth, paying attention to the thumb and areas between the fingers. Wash the whole hand including the area under the fingernails, the wrists and the backs of hands
   4. Rinse
   5. Dry with a paper towel.
   6. To avoid recontamination, turn off the water with the paper towel.

4. Disinfecting

1. Use a two-step process for disinfecting toys and other surfaces:

1. 1. clean with soap and water
   2. spray with approved (registered with the U.S. EPA) disinfectant that is allowed to sit on the surface for 30 seconds and then wipe dry.

2. Furnishings and other equipment must be washed and disinfected when they become soiled. Articles of clothing can be disinfected in the washing machine using detergent and hot water. Dry using heat.
3. Tables used for eating must be washed and disinfected before and after each use.
4. Diapering areas and equipment must be disinfected after each use.
5. Potty-chair receptacles must be emptied and disinfected immediately after each use.
6. Toys and hard classroom surfaces must be washed and disinfected immediately if mouthed by children and as toys are rotated into the classroom setting. Washing in the dishwasher can disinfect toys that are dishwasher safe.
7. Cot sheets and blankets must be washed after every 5 days of use.
8. Cots must be washed and disinfected weekly or immediately if soiled.
9. Water tables must be drained after each day’s use, washed, sprayed with approved disinfectant (registered with the U.S. EPA) and left to air-dry overnight. Utensils and playthings that are used in the water table must also be disinfected.
10. Wading pools must be disinfected daily. If the children are in diapers only one child may be in the pool at a time and then it must be disinfected before another child is allowed to use it.
11. School facilities, including bathrooms, must be thoroughly cleaned and disinfected as needed by staff and at least daily by custodial staff.
12. Diaper containers must be washed and disinfected daily.

5. Dishwashing Procedures

1. Manual-hand washing

1. 1. Wash in water between 110 and 125 degrees F. using an effective soap
   2. Rinse by immersing dishes and utensils in clean, hot water to remove soap.
   3. Sanitize by submerging dishes and utensils for at least 2 minutes in an approved sanitizer
   4. Let dishes air dry on the rack.

2. Dishwasher

1. 1. Wash at 130 to 150 degrees F. for 20 seconds using an effective cleaning agent
   2. Rinse and sanitize at 180 degrees F. for 10 seconds or more, using an automatic rinse injector
   3. Let dishes air dry in rack

6. Diapering and Toileting³³

1. General information

1. 1. All staff will be expected to change a diaper, if necessary.
   2. To respect the privacy of the children, no unauthorized people will observe or enter the bathrooms when in use by the children.³⁴
   3. It is not necessary for children to be toilet trained before they attend the Child Development Laboratory.
   4. Toilet training must be planned in cooperation with the family so that a child’s toilet routine is consistent between the center and the child’s home.
   5. No routine attempts may be made to toilet train a child less than 18 months of age.
   6. Individual toileting and diaper changing procedures must be posted in the diaper changing area so that all staff can be consistent.
   7. Diapers are to be checked for wetness every two hours, and changed every time a diaper is soiled.
   8. Families must furnish their own supply of diapers and diaper wipes. Cloth diapers may be acceptable (families are asked to check with their child's teacher to determine if cloth diapers can be accommodated).³⁵
   9. Lotions and powders cannot be applied unless the family provides specific written instructions on the “Medical Authorization Form”.

2. Diaper changing procedures.

1. • Wash hands
   • Gather supplies: diaper, wipe, gloves, and ointment (use only if parent/guardian permission is on file). Put on gloves.
   • Place the child on changing surface (never leave unattended and always keep one hand on the child)
   • Change diaper, making sure to wipe genitals front to back and between skin folds, even if only wet. Do not retract uncircumcised penis foreskin unless requested by the family.
   • Contain diaper within itself (fold front of diaper to the back and snap/Velcro sides to secure). Place clean diaper under child and apply cream as needed before securing clean diaper. If cloth diaper, make sure absorbent liner is attached to waterproof exterior cover. Dispose of gloves and wipes into waste container.
   • If cloth diaper, place soiled diaper within waterproof lined bag inside child’s designated small trash bin.
   • Wet-only disposable diapers, wipes and gloves may go directly into the waste container using the foot pedal only.
   • Soiled disposable diapers, wipes and gloves are placed in a plastic bag to contain odor. Dispose of plastic bag in the waste container, using the foot pedal only.
   • For children under age one, wipe the child’s hands with a wet wipe. If the child is over one, wash the child’s hands at the sink with soap and water and dry with a paper towel.
   • Clean the changing surface with soap and water.

1. 1. 1. Wipe it dry with a paper towel
      2. Then spray it with the approved disinfectant (registered with the U.S. EPA) and air dry for 1 minute or flip the changing mat if diapering another child.

1. • Wash your own hands with soap and water and dry.
   • Turn off the faucet with the paper towel.
   • Any toy that has been touched while changing a diaper should be placed in the dirty toys basket.
   • At child’s pick-up, zip waterproof bag with cloth diapers closed and remove from diaper bin to return to parents.
   • At the end of the day sanitize cloth diaper bin and disposable diaper bin with 2 step cleaning process (soap and water wipe down before sanitizer)
   • Wash hands

7. Illness & exclusion policy³⁶

1. Illness and exclusion policies at the Child Development Lab are designed to protect the health and safety of all participants. A child must be kept home if there is any indication he/she is too ill to comfortably carry out the day's routine (including outside playtime) or has other symptoms of illness. Whenever staff needs a health consultation, they contact the City of Madison Public Health Nurse or University Health Services.
2. Each child, upon arrival at the center, must be observed by a staff person for symptoms of illness and sent back home if ill. Staff will record the health check on the daily sign-in sheet. The reference book Managing Infectious Diseases in Child Care and Schools: A quick Reference Guide 4th Edition is available to staff (located in the Director’s office).
3. Signs of illness that will result in a child being excluded:

1. 1. Fever of 99.8 degrees or higher (for children under 6 months of age) and 100.5 degrees or higher (for children over 6 months of age) The child should be fever free for 24 hours without the use of fever reducing medications before returning to school.
   2. Diarrhea (three or more diarrhea stools within a 8-hour period)
   3. Vomiting (that is more than "spitting up" or mild digestive disturbances)

4. Signs of illness that may result in a child being excluded include:

1. 1. Significant changes in the child's activity level
   2. Excessive irritability
   3. Complaints of sore throat or stomachache
   4. Inflammation of the eyes
   5. Rash
   6. Persistent coughing, discolored runny nose, and fatigue

5. Procedures for checking for fever:

1. 1. When taking a child’s temperature, either use the under arm or in-the-ear method.
   2. Children 6 weeks to 6 months of age

1. 1. 1. If the temperature is 99.8 degrees or greater, recheck it after an interval of not less than 15 minutes and not more than 30 minutes. If a second reading is also 99.8 degrees or greater, exclusion from the center will be required. No other indications are necessary for exclusion. This policy is based on the concern that in young infants, from birth to 6 months of age, mild fever may be the only sign of serious illness.

              3. Children over 6 months of age

1. 1. 1. If the temperature is 100.5 or greater, exclusion from the center is required.
      2. If the child is over 6 months of age and the temperature is under 100.5, recheck the temperature every 15-30 minutes and observe the child for other signs of illness. Exclude if multiple symptoms are present. Provide the child with a cot in isolation but within sight and hearing of a staff member.

6. Procedures for sending a child home due to illness

1. 1. Isolate the child from other children in a quiet area in the classroom or near the administrative offices, but within sight and sound of a staff member³⁷ [PE9]
   2. Make the child as comfortable as possible.
   3. Contact the family using the information provided by the family on the Child Enrollment form.³⁸

1. 1. 1. First attempt to contact the parent/guardian by calling the phone numbers provided (home, cell, work) and then emailing.
      2. When contact is made, provide relevant information and tell them to pick-up the child within 1 hour.
      3. If no answer, leave a message with relevant information and ask that they contact the center as soon as the message is received

1. 1. If the parent/guardian cannot be reached, call one of the Alternate Contacts who is authorized to pick up the child. See section I. C. in SAFETY POLICIES & PROCEDURES
   2. Call the parent/guardian’s phone numbers again and leave a message that you have called the Alternate contact (tell them which one) and that they are going to be picking up the child. Also tell the parent/guardian where the child will be taken (i.e. to the person’s home).

7. Period of Exclusion

1. 1. Children should not return to school within 24 hours of having a fever, strep throat, diarrhea, or vomiting.
   2. Ear infections – If the child has a change in behavior and is not up to participating in regular daily activities, the child should stay home until feeling better and able to participate. The only time the 24-hr. fever rule can be overridden is: If a child sees a doctor and is diagnosed with an ear infection and is treated with an antibiotic, has a low-grade fever but no other symptoms of illness present and the child is up to participating in regular daily activities, they may return 12 hrs. from the time they started the antibiotic. (This is usually a rare situation).
   3. For all other communicable diseases, the "Managing Infectious Diseases in Child Care and Schools (4th Edition)", is a reference for questions about the child's health & wellness. Other information on communicable diseases can be found at their website.
   4. A written statement from a physician that the child's condition is no longer contagious may also be acceptable for re-admittance.
   5. In the case of head lice, please note that the CDL follows a no-nit policy. If there has been an identified instance of head lice in a classroom, all children will be checked daily, upon their arrival, for lice and nits. Families will be asked to take their children home if there is evidence of either lice or nits, even after treatment. Since after treatment it is virtually impossible to determine if a nit is dead or alive, we will require that all of the nits be individually removed. We understand that removing each nit from the hair can be a time-consuming process, but we will strictly hold to this policy, with no exceptions, to best guard against the spread to other children or staff.