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«1. Diarrhoea and/or Vomiting Signs and Symptoms As diarrhoea and vomiting is infectious please do not bring your child back to Nursery until he/she ...»

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Nursery Sickness Guidelines

Enclosed is a list of the most common communicable diseases that young children

experience. The list has been devised in consultation with the Health Commission and

Norfolk County Council Social Services for communicable diseases.

When your child enters the Nursery we will ask you to complete a medical

questionnaire. Once your child has had a vaccination or if your child’s medical

condition changes, please let us know, so that we can keep our records up to date.

The following information has been produced as a guideline for you but if you are concerned about your child and unable to get an appointment with your G.P. please consult a Pharmacist or NHS direct.

If your child is suffering from any of the following infectious illnesses please let a member of staff know, or contact the nursery on (01603) 773121. Once informed we will place a notice on the front door of the nursery to ensure that everyone has been notified of any communicable diseases in the nursery.

1. Diarrhoea and/or Vomiting Signs and Symptoms As diarrhoea and vomiting is infectious please do not bring your child back to Nursery until he/she has been clear of these symptoms for 48 hours.

This is a national policy from OFSTED regarding the care of children under the age of five years.

2. Measles Signs and Symptoms Early symptoms of measles may include a running nose, watery eyes, high temperature and a cough. Red spots with a white centre may also be seen on the inside of the mouth, behind the ears and on the face and limbs.

General Medical Advice As measles is infectious until five days after the appearance of the rash, please exclude your child from Nursery until the rash has disappeared.

Revised Dec 13 For review Dec 2014

3. Chicken Pox Signs and Symptoms Children who suffer with Chicken Pox can display a wide range of symptoms, but usually they will appear fretful, suffer with a loss of appetite and have a high temperature. A rash will appear on the trunk, face or limbs, and then small blisters will form which may cause an irritation.

General Medical Advice Please provide your child with lots of fluids to help them reduce their temperature. You may find calamine lotion soothes the irritation.

Parents Action Chicken pox is infectious for up to five days before and not more than five days after the appearance of the last spots. To reduce the risk to others your child must be excluded from Nursery for up to five days after the appearance of the spots, or until the spots are dry.

4. Mumps Signs and Symptoms Early symptoms of mumps can include swollen glands on one or both sides of the face, sore throat and a loss of appetite. Your child may also experience difficulty in swallowing.

General Medical Advice Mumps can be infectious for up to one week after the facial swelling appears.

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Please exclude your child from Nursery for five days from the onset of swelling.

Revised Dec 13 For review Dec 2014 Rubella ‘German Measles’ 5.

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Symptoms of German measles can include any of the following:

- Slight fever sometimes accompanied by a runny nose.

- Swollen glands behind the ears and around the neck.

- Loss of appetite, Sore throat.

- Rash that starts on the face and then spreads to the body. This rash usually lasts for about 3 days.

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It has an incubation period of up to 21 days. German measles is most contagious before the rash appears and then for about 5 days afterwards.

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Conjunctivitis causes the following symptoms in one or both eyes:

- soreness, itchiness, redness of the whites of the eye, watering or discharge and / or slight sensitivity to light.

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Conjunctivitis is often caused by an infection of the eye, which may be caused by a virus or bacteria. If you are concerned about your child’s eyes, please take them to be seen by a medical practitioner as this infection may need to have prescribed treatment.

To relieve the irritation you may bathe the eyes in a mild saline solution. Wipe from the centre to the outside of the eye and discard each piece of cotton-wool, it is also advised that you disinfect all toys, towels and face-cloths that your child has come into contact with.

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Please exclude your child from Nursery until they have been receiving treatment for 24 hours as conjunctivitis is highly contagious. Once the treatment has begun it is essential that the treatment is completed as the symptoms may re-occur.

Revised Dec 13 For review Dec 2014

7. Head-lice

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Head-lice are still common amongst school children and can very often be passed through to nurseries. They have a lice appearance and form eggs on the hair follicles. They spread very easily and are passed from one head to another during head to head contact. Symptoms may include your child scratching their head and eggs appearing particularly behind the ears.

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If you are at all concerned that your child might have head-lice, treatment is available from your chemist or pharmacist. It would be appreciated if you let a member of staff know if you are treating you child.

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Please treat your child’s hair appropriately before they return to nursery.

It may be advisable for you to routinely check your family’s hair, as the lice like to transfer to a clean head of hair. It is also advisable to treat the whole household.

8. Thread-worms

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If you note your child scratching his/her bottom, especially at night it may be due to threadworms. They are tiny, white thread-like worms that may be visible in faeces.

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They are easy to treat and medicine can be bought without prescription from a Pharmacist. It is wise to treat all the members of the household.

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No exclusion is necessary once treatment has been started.

Revised Dec 13 For review Dec 2014 ‘Fifth Disease’ Parvovirus B19 9.

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Fifth Disease is usually a mild illness caused by a human virus B19. It particularly affects children and typically causes a mild rash that may resemble a “slapped-cheek”. The rash then spreads to the trunk, arms, and legs. As the centres of the blotches begin to clear, the rash takes on a lacy net-like appearance. Other symptoms that can occur include joint pain (arthralgia), fever and general flu-like symptoms.

General Medical Advice

Parvovirus B19 spreads easily from person to person in fluids from the nose, mouth, and throat of someone with the infection, especially through large droplets from coughs and sneezes. The incubation period (the time between infection and the onset of symptoms) for fifth disease ranges from 4 to 28 days, with the average being 16 to 17 days.

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If your child is unwell then please exclude them from the nursery until they are well. If you're pregnant and develop a rash or if you've been exposed to someone with fifth disease (or to anyone with an unusual rash), consult your doctor for medical advice.

10. Hand, Foot and Mouth

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Hand, Foot and Mouth is usually a mild illness which often starts with a feeling of being unwell for a day or so. This might include a high temperature (fever). After this a sore throat commonly occurs, quickly followed by small spots that develop inside the mouth. Blisters also often appear on palms, soles of the feet as well as in the mouth. Spots sometimes also appear on the buttocks, legs and genitals.

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The incubation period is 3-6 days. If suffering from this, children are generally unwell in themselves. Please exclude your child from Nursery if the blisters are weeping or until they are “clinically well”.

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It can be infectious if the blisters are weeping or sore. Pregnant women should be made aware so that they can consult their doctor for advice if they are not immune.

Revised Dec 13 For review Dec 2014

11. Impetigo

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Impetigo is an infection of the skin caused by bacteria. It most commonly occurs in the skin around the nose and mouth, but it can also affect skin in other parts of the body. The spots may be clustered or merge together. The centre of each one rapidly becomes a blister, which then bursts, oozing a typical golden fluid. Crusts form over the red spots, which may be itchy or slightly sore.

General Medical Advice

An infected person scratching the rash, and passing it on their fingers, to another person usually spreads it. Good personal hygiene is very important, particularly through hand washing after touching the rash. The affected person should use separate towels and flannels until the rash has cleared.

Parents Action

If impetigo is suspected, you must take your child to see your doctor as the condition is infectious, and antibiotic treatment is important. In mild cases, antibiotic cream applied locally to the spots may be all that is needed, but in more severe cases antibiotic tablets or syrup must be taken. Because the condition is contagious, children with impetigo must be excluded from nursery until all the spots have crusted and dried.

12. Scabies

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Scabies is more of a nuisance than a serious medical problem. However, it does require medical treatment. Scabies it is caused by a tiny mite (half the size of a pinhead) which burrow into the surface of the skin causing visible raised lines or small red spots or blisters.

These occur particularly in the wrists, back of hands and between the fingers.

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It may take between 2-6 weeks from the first infestation for the itching to start.

Scabies can usually be successfully treated using special creams which need to be applied in two applications, one week apart. In order to prevent reinfection, it is important that all members of the household are treated at the same time.

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Children who are infested with Scabies should not attend Nursery until at least 24 hours has passed after the first application.

Revised Dec 13 For review Dec 2014

13. Meningococcal Meningitis Septicaemia

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Meningitis and Septicaemia are the inflammation of the lining covering the brain and spinal cord.

Symptoms in babies and small children include:

- Stiff body with jerky movements, or very floppy

- Irritability, or dislike of being handled

- A shrill cry or unusual moaning

- Refusal to feed

- Tense or bulging fontanelle (soft spot on head)

- Pale, blotchy skin

- Rapid breathing

- Fever/vomiting

- Drowsiness/impaired consciousness

- Severe headache, stiff neck and dislike to bright lights.

Not all the symptoms have to be present at the same time.

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In most cases someone with Meningitis or Septicaemia will become seriously ill rapidly. Trust your instincts – seek medical help immediately if you are concerned. You may also wish to try the glass tumbler test by pressing firmly against your child’s skin. If it is a Septicaemia rash, the rash will not fade, and you will be able to see the rash through the glass. If this happens get medical help immediately.

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When a case of Meningococcal Meningitis or Septicaemia is diagnosed the Public Health Doctor will make sure that all those who need antibiotics are contacted.

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If you think you are pregnant, please refer to the “communicable diseases guidance” on the parent’s notice board in the nursery reception area, and seek advice from your midwife and GP.

The above information is included in ‘Communicable Diseases – Guidance for Schools’ which was provided by Norfolk County Council Social Services Department.

Information and advice has also been provided by the consultant in control of communicable diseases who is based at Norfolk and Norwich Health Care Trust.

Breaks and Fractures We will need a letter from your doctor before your child can return to the nursery while having a cast on. This is for your child’s safety and to meet our insurance policy recommendations.

Revised Dec 13 For review Dec 2014 Medicines If your child has been prescribed anti-biotics, please bring them to Nursery with clear instructions of when you would like them to be given to your child whilst they are at Nursery.

For the best interests of your child and to allow the medication to begin working, your child must have been receiving the medication for 24 hours before they are able to return to nursery.

The administration or application of all other medications/creams will require the completion of a consent form and will be administered at our discretion. If a consent form has not been signed by either parent/carer then staff will not be able to administer medicine or apply creams. Verbal confirmation will not be acceptable.

All medications and creams need to be in their original packaging.

Calpol When your child starts the Nursery you will be asked to sign a form which gives permission for Calpol to be administered to your child. This will only be administered in order that we can reduce a temperature or treat minor ailments such as teething.

So that we do not put your child at risk we ask you to inform us if your child has had Calpol before they arrive at Nursery. With written consent we will administer Calpol to your child if their temperature exceeds 38C.

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