1. (a) No child or staff shall be admitted who has a contagious or infectious disease.

2. (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.

3. (c) It is recommended that the caregiver determine if the illness:

   1. (1) Prevents the child from participating comfortably in activities;
   2. (2) 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. (3) Poses a risk of spread of harmful diseases to others.

4. (d) The caregiver shall temporarily exclude from child care if a child has:

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

      1. (A) Lethargy or lack of responsiveness;
      2. (B) Unexplained irritability or persistent crying;
      3. (C) Difficulty breathing; and
      4. (D) A quickly spreading rash;

   2. (2)

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

5. (i) Pain;

   1. (ii) Behavior changes; or

      1. (iii) Other symptoms of illness.
      2. (B) An infant younger than two (2) months with any increased temperature shall get urgent medical attention within an hour.
      3. (C) An infant younger than six (6) months with any increased temperature shall be medically evaluated;

   2. (3)

      1. (A) “Diarrhea” means watery or runny stools, if frequency:

         1. (i) Exceeds two (2) or more stools above normal for that child; and
         2. (ii) Is not related to a change in diet or medication.

      2. (B) Exclusion from child care is required if diarrhea:

         1. (i) Cannot be contained in the diaper; or
         2. (ii) Is causing soiled clothing in toilet-trained children;
   3. (4) Blood or mucus in stools, unless caused by hard stools;
   4. (5) Vomiting illness (two (2) or more episodes of vomiting in the previous twenty-four (24) hours);
   5. (6) Abdominal pain that lasts more than two (2) hours;
   6. (7) Mouth sores with drooling;
   7. (8) Rash with fever or behavior change;

   8. (9)

      1. (A) Conjunctivitis or pinkeye, with white, yellow, or green eye discharge and red (bloodshot) eyes.

      2. (B) Exclude only if:

         1. (i) Child has fever;
         2. (ii) Child has eye pain;
         3. (iii) Child has redness or swelling of the skin around the eyes; or
         4. (iv) More than one (1) child in the program has symptoms;
   9. (10) Pediculosis (head lice), from the end of the day until after the first treatment;
   10. (11) Active tuberculosis, until a healthcare provider or health official states that the child is on appropriate therapy and can attend child care;
   11. (12) Impetigo, until treatment has been started;
   12. (13) Strep throat, until twenty-four (24) hours after antibiotic treatment has been started;
   13. (14) Chicken pox, until all lesions have crusted, usually six (6) days after the rash appears;
   14. (15) Rubella, until six (6) days after onset of rash;
   15. (16) Pertussis (whooping cough), until five (5) days of antibiotic treatment;
   16. (17) Mumps, until five (5) days after onset of gland swelling;
   17. (18) Measles, until four (4) days after onset of rash; and

   18. (19) Hepatitis A, until:

       1. (A) One (1) week after onset of illness; or
       2. (B) As directed by the Department of Health.
6. (e) Illness in the home shall be handled to protect all children in care.

7. (f)

   1. (1) In case of critical illness or injury, and if the parents cannot be reached, the physician named by the parent shall be called.
   2. (2) If necessary, the child shall be taken to the nearest emergency room.
   3. (3) Injuries that require the attention of medical personnel shall be reported to the parent immediately.
8. (g) In case of critical illness or injury that requires the attention of medical personnel, the childcare licensing specialist shall be notified within one (1) business day.

9. (h)

   1. (1) The caregiver shall notify the child’s parents of significant events that affect the children.

   2. (2) This shall include, but is not limited to:

      1. (A) Cases of serious contagious disease; or

      2. (B) Any injury incurred by a child.

         1. (i)
   3. (1) The communicable diseases listed in Appendix D, 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).

   4. (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; or
      8. (H) E. coli.

10. (j) 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 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 used in the diagnosis.
       2. (B) Please give the laboratory name; and
    6. (6) Any treatment information, if known.

11. (k)

    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.

       1. (l)
    5. (1) Within fifteen (15) days of enrollment of a child, the home shall verify that the child has been immunized as required by the department or the child cannot remain in care.

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

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

    9. (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.
    10. (4) School-age children may apply sunscreen to themselves with supervision.
    11. (5) Blanket permission may be obtained annually.

12. (n) 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.

Codification Notes: This section as promulgated prior to codification into the Code of Arkansas Rules contained the following at the end of subdivision (l)(1) of this section: "(Arkansas Code § 20-78-206 as amended by Act 870 of 1997.)".