(b)

1. (1) The parent or legal guardian shall be notified as soon as possible when a child has any symptom that requires exclusion from the facility.
2. (2) The child shall be separated from other children and closely monitored until the parent arrives to pick the child up.

(c)

1. (1) The caregiver shall determine if the illness:

   1. (A) Prevents the child from participating comfortably in activities;
   2. (B) Results in a greater need for care than the childcare staff can provide without compromising the health and safety of the other children; or
   3. (C) Poses a risk of spread of harmful diseases to others.

2. (2) The caregiver shall temporarily exclude the child from child care if the child has:

   1. (A) Sudden change in behavior, such as:

(i) Lethargy or lack of responsiveness;

1. (ii) Unexplained irritability or persistent crying;

   1. (iii) Difficult breathing; or

      1. (iv) A quickly-spreading rash;

   2. (B)

      1. (i) Fever over one hundred one degrees (101°) oral or one hundred degrees (100°) axillary, or equivalent method, in a child who also has:

(b) (b) Behavior changes; or

1. (c) (c) Other symptoms of illness.

   1. (ii) An infant younger than two (2) months with any increased temperature shall get urgent medical attention within one (1) hour.

      1. (iii) An infant younger than six (6) months with any increased temperature shall be medically evaluated;

   2. (C)

      1. (i) “Diarrhea” means watery and runny stools, if frequency:

(b) (b) Is not related to a change in diet or medication.

1. (ii) Exclusion from child care is required if diarrhea:

(b) (b) Is causing soiled clothing in toilet-trained children;

1. (D) Blood or mucus in stools, unless caused by hard stools;

   1. (E) Vomiting illness (two (2) or more episodes of vomiting in the previous twenty-four (24) hours);
   2. (F) Abdominal pain that lasts more than two (2) hours;
   3. (G) Mouth sores with drooling;
   4. (H) Rash with fever or behavior change;

   5. (I)

      1. (i) Conjunctivitis or “pink eye” with white, yellow, or green eye discharge and red, bloodshot eyes.
      2. (ii) Exclude only if:

(b) (b) Child has eye pain;

1. (c) (c) Child has redness or swelling of the skin around the eyes; or

   1. (d) (d) More than one (1) child in the program has symptoms;
   2. (J) Pediculosis (head lice), until after the first treatment;
   3. (K) Active tuberculosis, until a healthcare provider or health official states that the child is on appropriate therapy and can attend child care;
   4. (L) Impetigo, until treatment has been started;
   5. (M) Strep throat, until twenty-four (24) hours after antibiotic treatment has been started;
   6. (N) Chicken pox, until all lesions have crusted, usually six (6) days after the rash appears;
   7. (O) Rubella, until six (6) days after onset of rash;
   8. (P) Pertussis (whooping cough), until five (5) days of antibiotic treatment;
   9. (Q) Mumps, until five (5) days after onset of gland swelling;
   10. (R) Measles, until four (4) days after onset of rash; and

   11. (S) Hepatitis A, until:

       1. (i) One (1) week after onset of illness; or
       2. (ii) As directed by the Department of Health.
       3. (d)
2. (1) Any child who is injured shall have immediate attention.
3. (2) Parents shall be notified of all injuries.
4. (3) Injuries that require the attention of medical personnel shall be reported to the parent immediately and to the Child Care Licensing Unit within one (1) business day.

(f)

1. (1) Medication shall be given to children only with signed parental permission that includes:

   1. (A) Date;
   2. (B) Type;
   3. (C) Drug name;
   4. (D) Time and dosage;
   5. (E) Length of time to give medication; and
   6. (F) What the medication is being given for.

2. (2) It shall:

   1. (A) Be in the original container with a child-resistant cap;
   2. (B) Not have an expired date; and
   3. (C) Be labeled with the child's name.

3. (3)

   1. (A) Aspirin substitutes, such as ibuprofen and acetaminophen, may be provided by the facility if parental permission has been granted.
   2. (B) These medications shall be in the original container.
4. (4) Staff shall not dispense medications in dosages that exceed the recommendations stated on the medication bottle.

(g)

1. (1) Children with special healthcare needs (ex. asthma, seizures, diabetes, etc.) who require scheduled daily medications or medications to be given on an emergent basis (Benadryl, EpiPen, rescue asthma medication, etc.) shall have a care plan.
2. (2) Care plans shall have clearly stated parameters, directions, and symptoms for giving the medications.
3. (3) Care plans shall be updated as needed, but at least yearly.

(h) The facility shall share information with families regarding medical homes for children.

1. (i) Medication shall be returned to the parent or disposed of properly when:
2. (1) A child withdraws from the program; or
3. (2) The medication is out of date.

(k)

1. (1) A first-aid supply shall be kept out of reach of the children.
2. (2) A first-aid kit containing medications shall be locked.

3. (3) This kit shall include the following:

   1. (A) Adhesive Band-Aids of various sizes;
   2. (B) Sterile gauze squares;
   3. (C) Adhesive tape;
   4. (D) Roll of gauze bandages;
   5. (E) Antiseptic;
   6. (F) Thermometer;
   7. (G) Scissors;
   8. (H) Disposable gloves; and

   9. (I) Tweezers.

      1. (l) Medicine shall be:
4. (1) Kept out of the reach of the children when dispensing; and

5. (2) Stored in a locked area at all other times.

   1. (m) The staff person who administers the medication shall:
6. (1) Initial the permission slip; and
7. (2) Record the date, time, and dosage administered.

(n)

1. (1) Facilities shall comply with the Clean Indoor Air Act of 2006, Arkansas Code § 20-27-1801 et seq.
2. (2) Smoking, including e-cigarettes, in a childcare center is prohibited at all times.

3. (3) This includes:

   1. (A) All areas of the facility, regardless of whether children are in care, including time periods such as nights, weekends, holidays, etc., and also including office areas or other areas of the facility that share the same ventilation systems;
   2. (B) Outdoor play area or areas;
   3. (C) Other outdoor areas when children are present; and
   4. (D) In any vehicle used to transport children, whether children are present in the vehicle or not.

(o) The facility shall follow any health or medical care plans and medical documentation as provided by the child’s:

1. (1) Physician;
2. (2) Parent; or
3. (3) Guardian.

(p)

1. (1) It is recommended that universal precautions be used when handling and disposing of materials containing bodily secretions such as wet or soiled diapers, fecal matter, etc.
2. (2) Universal precautions shall be used when handling items contaminated by blood.
3. (3) These items shall be disposed of separately and by using rubber gloves that shall be properly disposed of after each use.
4. (4) Note. Hands must be washed even after gloves are used.

(q)

1. (1) Garbage and soiled diapers shall be kept in closed containers.
2. (2) Garbage and trash shall be removed from the center daily and from the grounds at least once a week.

(r) The facility shall be free of:

1. (1) Insects;
2. (2) Rodents; and
3. (3) Pests.

(s)

1. (1) There shall be no pets or animals allowed that present a health and safety threat.
2. (2) A licensed veterinarian shall certify that dogs and cats have a current vaccination against rabies.

(t)

1. (1) The communicable diseases listed in Appendix A, whether suspected in a child or adult, shall be reported within twenty-four (24) hours to either the local county health unit or the toll-free reporting system (800-482-8888).

2. (2) Immediate notification is recommended for the following:

   1. (A) Hepatitis;
   2. (B) Rash illness, including measles and rubella;
   3. (C) Whooping cough (pertussis);
   4. (D) Meningitis;
   5. (E) Mumps;
   6. (F) Tuberculosis;
   7. (G) Salmonellas, including typhoid; and
   8. (H) E. coli.

(u) Reporting data should include:

1. (1) The reporter’s:

   1. (A) Name;
   2. (B) Location; and
   3. (C) Phone number;
2. (2) The name of the disease reported and the date of onset;

3. (3)

   1. (A) The patient’s:

      1. (i) Name;
      2. (ii) Address;
      3. (iii) Phone number;
      4. (iv) Age;
      5. (v) Sex; and
      6. (vi) Race.
   2. (B) Please spell the patient’s name;

4. (4) The attending physician’s:

   1. (A) Name;
   2. (B) Location; and
   3. (C) Phone number;

5. (5)

   1. (A) Any pertinent clinical and laboratory information used in the diagnosis.
   2. (B) Please give the laboratory name; and

6. (6) Any treatment information, if known.

   1. (v) A roster shall be maintained on infants and toddlers who have not completed the minimum immunization requirements, and parents shall be notified of the needed immunization or immunizations.

(w)

1. (1) Within fifteen (15) days of enrollment of a child, the childcare facility shall verify that the child has been immunized as required by the Department of Health and the Department of Education or the child cannot remain in care (Arkansas Code § 20-78-206, as amended by Acts 1997, No. 870).

2. (2) A current immunization schedule is provided as an insert in this publication.

   1. (x) It is recommended that all staff members who have direct contact with children receive:
3. (1) Annual influenza (flu) immunizations;
4. (2) A one-time Tdap (diphtheria, tetanus, and pertussis) immunization; and
5. (3) The recommended series of immunizations for chicken pox, mumps, measles, and rubella or evidence of immunity.

(y)

1. (1) Children shall be protected from overexposure to the sun.
2. (2) Sunscreen shall be used if needed and as directed by the parent.

3. (3) Suntan lotions and sunscreens used for infants, toddlers, and preschool children shall be:

   1. (A) Kept out of the children’s reach; and
   2. (B) Administered only with written parental permission.
4. (4) School-age children may apply sunscreen to themselves with supervision.
5. (5) Blanket permission may be obtained annually.

(z) It is recommended that the facility have:

1. (1) An automated external defibrillator on-site; and
2. (2) A staff member or members on-site who are trained in the proper use of this device.