Managing Infections

4.1 If a child is sick

This section has information on monitoring children who become sick while in the education and care service. This includes sickness from common infectious diseases and adverse effects after immunisation (see also section 2.1 Managing symptoms after vaccination). This section also describes how to keep health records.

See section 4.3 Excluding children and adults for information on how to identify the need for exclusion.

Watching for symptoms in children

Because you care for the children in your group every day, you are familiar with the way each of them looks and behaves when they are well.

Watch for symptoms of sickness in every child in your care, especially if you know a family member or carer is sick. If you notice symptoms, consider these questions:

• Does the child need medical attention immediately? If a child has any serious symptoms, call an ambulance (000) and the parent or carer. If a child has concerning symptoms that are severe or rapidly getting worse, or has several concerning symptoms, consider calling an ambulance.
• Does the child have symptoms that suggest they must go home or be separated from others immediately? See Concerning symptoms and What to do if a child seems sick for further guidance.
• Does the child have symptoms that require medical attention to make a more specific diagnosis? Discuss all symptoms with the parent or carer and give them details that will help them decide about care and whether the child needs to see a doctor. Take care to tell the parent or carer if the symptoms are severe or if they developed rapidly.

Identifying severe sickness

Educators and other staff should understand the symptoms that suggest that a child may be very sick and need urgent medical attention.³⁷ Remember that sickness in babies and infants can progress very quickly.

Serious symptoms

If a child has any of the following serious symptoms, call an ambulance (000) immediately:

• Breathing difficulty – the child may be breathing very quickly or noisily, or look pale or blue around the mouth. The child may be working hard at breathing, with the muscles between the ribs or at the base of the neck being drawn in with each breath.
• Drowsiness or unresponsiveness – the child is less alert, sleepier than normal or difficult to wake from sleep, or they are not responding as they usually do (for example, making less eye contact than usual, or less interested in their surroundings than usual).
• Poor circulation – the child looks very pale, and their hands and feet feel cold or look blue.

Concerning symptoms

Other symptoms may be concerning but do not necessarily mean that a child is severely sick. These symptoms may also occur in combination with the serious symptoms. The more of these concerning symptoms you see, the more likely it is that the child is severely ill.

If you see any of these symptoms, contact the child’s parent or carer and monitor the child carefully. Consider calling an ambulance (000) if:

• any symptoms are severe
• symptoms rapidly get worse
• multiple symptoms develop.

Concerning symptoms include:

• Lethargy and decreased activity – the child wants to lie down or be held rather than participate in any activity, even activities that would normally interest them.
• Fever – fever by itself is not necessarily an indicator of severe sickness. However, a fever (temperature more than 38.0 °C) in a child is usually a sign of infection and may need to be investigated. Children less than 3 months of age with a fever of more than 38.0 °C should see a doctor. Ensure you measure temperature accurately (see Taking your child’s temperature from Raisingchildren.net.au). See the Fever fact sheet for more information.
• Poor feeding – the child has reduced appetite and eats and drinks much less than usual.
• Poor urine output – the child is going to the toilet less often or not at all; for babies, there are fewer wet nappies than usual.
• Pain – a child may or may not tell you they are in pain. Facial expression is a good indicator of pain in small babies or children who do not talk. General irritability or reduced physical activity may also indicate pain in babies or infants.
• A stiff neck, irritability (excessive or high-pitched crying) or sensitivity to light – this may indicate meningitis.
• New red or purple rash – rashes may be caused by viral infections and other causes (for example, nappy rash). Rapidly developing rashes may be a symptom of more serious diseases. Monitor the child carefully if the rash develops rapidly or if it is combined with other concerning symptoms.

What to do if a child seems sick

If a child is not well enough to participate in activities, follow your service’s policy for contacting parents, carers or emergency contacts. Tell them that the child is sick and must be taken home. A child who is feeling sick is better off at home with close supervision from a parent or carer.

Separate the sick child from the other children until they can be collected by the parent or carer. For example, they could lie on a floor cushion or mat in a corner of the room where you can still comfort and supervise them.

Monitor the child to make sure their condition does not get worse. If a child develops any serious symptoms, call an ambulance (000).

If the child has a fever, see the Fever fact sheet for more information.

Your education and care service may have a policy about giving children medication (such as paracetamol or ibuprofen) to relieve pain or fever. Check that the parent or carer has given permission before giving the child any medication.

When caring for a sick child, remember the main ways to break the chain of infection:

• Remind a child who is coughing or sneezing to cough or sneeze into their elbow. If the child covers their mouth with their hands, ask them to do hand hygiene.
• If you wipe a child’s nose, dispose of the tissue in a plastic-lined rubbish bin then do hand hygiene.
• If you touch a child who might be sick, avoid touching other children until you have done hand hygiene.
• Consider wearing a mask when caring for the child.

When the parent or carer picks up the child, talk with them about the child’s symptoms. Make sure you provide all the details that will help the parent or carer make decisions about care and whether the child needs to see a doctor. For example, describe the severity of the symptoms, how rapidly they developed and progressed, and how sick the child seemed. If appropriate, give them a fact sheet about the symptoms.

Recommend that the child sees a doctor if:

• any symptoms are severe
• symptoms rapidly get worse
• multiple symptoms develop.

After the child leaves, clean the areas where the child was, and the mattress or floor cushion where they were resting, before using them again. Some harmful germs can persist on surfaces and may cause infection even if an object looks clean or is wiped clean. See cleaning information in Part 3 A healthy environment.

Keeping records

Keep records of any sickness in children, educators or other staff at the education and care service. Templates to record sickness and medication use are available on the ACECQA website.

Record information with as much detail as you can, such as:

• symptoms you see
• the time you first noticed each of the symptoms
• action taken (for example, exclusion or review of nappy changing practices)
• which area of the education and care service the child or staff member was in for most of the day
• doctor’s diagnosis, if there is one.

If the disease is one that the service must notify public health authorities about, record when and where the notification was sent, and which staff member made the notification (see section 4.6 Notifiable diseases).

Keeping health records helps to identify outbreaks by showing any increase in illness among staff and children. It also helps to prevent the spread of infection – records show when your approach to infection control is working. Further, parents or carers and the child’s doctor may find written information on the child’s sickness useful.

In some circumstances, the records may help identify the cause of an outbreak and how to control it.

4.2 If a staff member is sick

Educators and other staff should stay home whenever they have a disease that may be infectious, even if they do not feel very sick.

Educators and other staff should notify their supervisor or service manager as soon as possible if they feel sick and think they may have an infectious disease (see also Responsibilities of management and staff in the Introduction).

If symptoms of the infectious disease appear while they are still at home, they should call the service and stay home.

If symptoms of the infectious disease appear while they are at work, they should go home as soon as possible. If they need to wait to be collected, they should isolate themselves from children and other staff and continue to practice good hand hygiene and respiratory hygiene.

Contact their emergency contact person if the staff member is not well enough to drive home. Call an ambulance (000) for urgent medical attention if needed.

Provide the staff member with a copy of, or a link to, the relevant fact sheet.

Use appropriate cleaning procedures after the staff member has left the service (see section 3.2 Cleaning).

Staff members should not return to the service until symptoms have resolved. Follow the exclusion periods for symptoms (Table 4.1) and specific conditions (Table 4.2).

4.3 Excluding children and adults

The aim of exclusion is to reduce the spread of infectious disease. The less contact there is between people who have an infectious disease and others, the less chance the disease has of spreading.

Excluding children, staff and parents who are at risk of transmitting infection to others limits the spread of infection in education and care services.

Identifying people who are at risk of transmitting infection to others will generally be based on symptoms. Although some infections can be spread before the person becomes sick, people are usually most infectious when they have symptoms. For this reason, it is best to exclude children, staff, and parents and carers from education and care services when they are sick.

By excluding anyone who is sick, you can protect many other people from becoming sick.

The exclusion procedure

Education and care services should be mindful of the circumstances of each family. Services should work with families to make arrangements that consider the needs of the sick child and minimise the spread of disease, while limiting the impact on employment and other requirements, if possible. See Involving parents and carers for strategies to inform and collaborate with parents and carers on exclusion requirements.

The minimum exclusion periods recommended here aim to reduce the spread of infectious diseases between children, educators and other staff, and families visiting early education and care services. The exclusion periods are based on how long a person with a specific disease is likely to be infectious.

The need for exclusion and the length of time a person is excluded depend on:

• the type of infection
• if symptoms are present and how severe they are
• how easily the infection or disease can spread
• how long the person is likely to be infectious
• how severe the infection or disease can be.

As soon as you have identified that a person may have an infectious disease, the person should leave the education and care service and not return until they are well (see Returning to the service).

• Children – keep the child separated from other children until their parent or carer can pick them up (see What to do if a child seems sick).
• Educators and other staff – they should leave as soon as they start to feel sick.
• Parents, carers and other people who make short visits to the service – ask them not to attend the service if they are sick. If it cannot be avoided (for example, if no-one else is available to pick up a child), minimise risk by meeting the parent outside or restricting their movement in the service.

Provide the parent, carer or staff member with the relevant fact sheets for the symptom or disease.

Identifying the need for exclusion

To determine when a person should be excluded, check whether the symptoms or diagnosed sickness have an exclusion period. Table 4.1 lists the recommended minimum exclusion periods for symptoms, and Table 4.2 lists periods for diagnosed conditions.

Sometimes people who have been in contact with a person infected with a specific condition may also need to be excluded (see Table 4.2).

The recommendation ‘Not excluded’ means that exclusion is not required. However, the person with symptoms or a condition can still be infectious. Encourage staff to help prevent the spread of disease by staying home whenever they are sick. Encourage parents and carers to keep a sick child at home, even if the child is not very sick or if the disease is not serious (for example, if they have a cold).

Table 4.1 and Table 4.2 are support tools; they do not replace clinical assessment, management or judgement. They should be used together with any medical management plans provided by a doctor (for example, for an immunocompromised child). Encourage parents and carers to seek medical advice for any concerning symptoms or if symptoms continue. See the fact sheets for more information about each of the symptoms and conditions.

Contact your local public health unit if you have any questions about the recommended exclusion periods.

Exclusion based on symptoms

In most cases, exclusion will be based on symptoms (Table 4.1). Symptoms are the most obvious triggers for action.

Using your best judgement, assess whether the person’s symptoms indicate that they are probably infectious. Follow these principles:

• Assess whether the symptoms have a known cause that is not infectious. For example, if a child has chronic asthma, they may have a cough but not be infectious.
• Assess whether symptoms are new. Symptoms that have been present for a long time or that recur are likely to have a non-infectious cause.
• Assess symptoms together, rather than separately. For example, a child with a cough would not usually be excluded, but a child with a cough who also had a fever and runny nose should be excluded until the symptoms have resolved or until the sickness is diagnosed.
• Assess general wellness as well as specific symptoms. For example, a child with a cough who is unhappy and lacks energy is more likely to be sick than a child who has a cough but is happily playing (see Identifying severe sickness for lists of serious and concerning symptoms).

Follow these principles and the guidance in Table 4.1 to decide on exclusion periods for individual cases. Communicate clearly with parents and carers about exclusion periods and when the child can return to the service.

Whenever a medical professional has diagnosed a specific condition, use the exclusion periods in Table 4.2.

People in the service who have been in contact with a person with symptoms do not need to be excluded. Contacts should only be excluded for specific conditions once the sickness is diagnosed (Table 4.2).

The recommendations in Table 4.1 are practical guidelines that try to balance the risk of infection with the risk of sending children or staff home unnecessarily. Minimising the spread of infection is important even with mild diseases, because these diseases can have serious effects on very young or immunocompromised people. When you are making decisions about exclusion, consider whether keeping the sick person at the service would put other people at risk.

Only use the recommendations in Table 4.1 for children without serious symptoms. If a child has serious symptoms, call an ambulance (000) immediately.

Exclusion based on a diagnosed condition

If a medical practitioner has diagnosed a specific condition, use the exclusion periods for that condition (Table 4.2).

Some states and territories may have different requirements for certain conditions. Check with your local public health unit if your state or territory has different or additional requirements.

Contact your local public health unit for information and support if you have a disease outbreak, or a case of a notifiable or concerning disease.

Note that exclusion advice is consistent with the Communicable Diseases Network Australia Series of National Guidelines, if available.

Returning to the service

Following all the steps to break the chain of infection at all times should minimise the chance of disease spreading, as long as sick people stay at home until they are better.

The exclusion periods in Table 4.1 and Table 4.2 are the minimum exclusion periods. People may need to stay home for longer to be well enough to return to the education and care service. For some diseases, additional public health recommendations and exclusion periods may apply. Contact your local public health unit as indicated and follow their advice.

For most conditions, once symptoms have gone, the person can return to the service.

If there are mild ongoing symptoms (for example, occasional cough after other acute respiratory symptoms have gone) and the person otherwise feels well, the person can return to the service.

In some cases, the person may still be infectious once symptoms have gone (see Part 1 Understanding infection). For this reason, the person should pay close attention to hand and respiratory hygiene when they return to the service.

Use the information in the Staying healthy guidelines to decide on your service’s response to a sickness (for example, the required exclusion time).

Tell the parent or carer when the child can return to the education and care service. If it is an educator or other staff member who is sick, tell them when they can return to work.

If a sick child has been diagnosed and treated by a doctor, your service can still make the decision about when the child can return, based on your own criteria and judgement. Services are not required to follow letters from doctors stating that the child can return to care. Services should also not require ‘clearance’ from a doctor to allow the child back to the service.

Your local public health unit can also help you if you are in doubt about exclusion.

Involving parents and carers

Written policy

Parents and carers may find their child’s exclusion difficult because of work, study or other family commitments. Some parents and carers may put pressure on educators or other staff to vary the exclusion rules, which may lead to stress and conflict.

The best way to avoid conflict is to have a written policy that clearly states the exclusion criteria. This includes:

• the minimum exclusion periods (Table 4.1 and Table 4.2)
• a statement that additional public health recommendations and exclusion periods may apply for some diseases and outbreaks
• discussion of the principles that will be used to exclude someone based on symptoms (see Exclusion based on symptoms)
• any other conditions or exclusion periods that your education and care service may have.

Give a copy of the policy to all parents and carers, educators and other staff when they first join your service, and regularly remind them about the policy. Provide further information about infectious diseases in education and care services and the need for exclusion – for example, Starting Blocks provides clear information for parents and carers about illness in early learning services.

Plans for immunocompromised children

If a child who is immunocompromised attends your service, talk to the parent or carer about their needs. The parents or carers and the child’s doctor can develop a written medical management plan that includes specific decisions in advance about whether the child should stay at home during disease outbreaks. The doctor may decide to modify the general exclusion recommendations (Table 4.1 and Table 4.2) for an immunocompromised child.

4.4 Public health units

Public health units are run by departments of health in each state and territory. Public health staff play a critical role in protecting people from infectious diseases and preventing harm from hazards involving chemicals, poisons or radiation. Public health units conduct disease surveillance and control initiatives, including responding to disease outbreaks. They also make sure that public health laws are followed.

Public health unit support for education and care services

Public health units are valuable resources for education and care services. They can provide support and information about diseases that may occur in your service.

Public health staff can provide general advice and support about infectious diseases, infection control practices and public health issues. Contact your local public health unit with any questions.

Most importantly, public health staff can provide valuable advice, support and resources that can help manage cases or outbreaks of infectious diseases. Some of the important diseases that public health units can provide advice on and help to control are hepatitis A, Hib (Haemophilus influenzae type b), measles, meningococcal disease, tuberculosis, typhoid and paratyphoid infection, whooping cough and outbreaks of gastroenteritis.

If there is a case of one of these diseases in your service, staff from public health units can help to explain to educators and other staff:

• symptoms to watch out for and what to do if children or staff develop those symptoms
• how to control further spread of the infection (for example, immunisation, exclusion, cleaning, and education such as written information for parents, carers and staff).

Additionally, some of these diseases can cause concern among parents and carers and sometimes interest from the media. If this occurs, your local public health unit can provide information and support.

Contacting your public health unit

Public health units are based in each region – larger states and territories have several units and the Australian Capital Territory (ACT) and Tasmania each have one unit.

To contact a public health unit, you will need to identify the unit for your region. Visit your state or territory health website to find contact details for your local unit: 

• ACT - ACT Health Directorate – Health Protection Service 
• New South Wales - NSW Health – Public Health Units
• Northern Territory - Northern Territory Department of Health – Centre for Disease Control
• Queensland - Queensland Health – Public health units
• South Australia - SA Health – Communicable Disease Control Branch
• Tasmania - Tasmanian Department of Health – Public and Environmental Health Service
• Victoria - Victorian Department of Health
• Western Australia - Western Australian Department of Health – Public health units

4.5 Disease outbreaks

Disease outbreaks are when there is a sudden increase in the number of cases of a disease in a specific region or area. The definition of ‘sudden increase’ depends on the disease and how many cases normally occur in a population. For some rare diseases, a single case can be considered an outbreak.

An outbreak can occur within the education and care service, in the local area or more widely.

• If a disease outbreak occurs within your service, you may need to:
• be more stringent about exclusion periods and criteria
• make your cleaning practices more intense or more frequent
• consider closing the service for a short time to break the cycle of disease.

Contact your local public health unit for guidance if you suspect an outbreak or are experiencing an outbreak. Some states and territories require notification if you suspect an outbreak of gastroenteritis (see section 4.6 Notifiable diseases).

If you are aware of outbreaks in your local area, contact your local public health unit for guidance. If an outbreak is occurring, your public health unit will often provide local information and fact sheets about specific diseases.

4.6 Notifiable diseases

Education and care services may need to act if you have a case of a notifiable disease or a disease that causes community concern.

A notifiable disease is any disease that is required by law to be reported to government agencies. The reporting allows the authorities to monitor the disease and prevent its spread.

Your local public health unit may contact you if a notifiable disease occurs in your service. They will tell you if there is action you should take to help prevent further cases.

Each state and territory has a list of diseases that your local public health unit must be told about if they occur. Most notifiable diseases are the same across the country (see the National Notifiable Diseases Surveillance System), but some are only notifiable in a few jurisdictions.

In most cases, it is doctors and laboratory staff who are responsible for the reporting. However, education and care services must report some diseases in some states. Check Table 4.3 to find out the reporting requirements for your state or territory.

References

³⁷ Healthdirect (2021). Symptoms of serious illness in babies and children, Healthdirect, Canberra.

³⁸ Department of Health and Aged Care (2023). Post-exposure prophylaxis needed within 6 days (144 hours) of 1st exposure for people exposed to measles, in Immunisation Handbook, Australian Government, Canberra.