Exclude if directed to do so in the chart below or if:

  • The child’s health care professional recommends exclusion.
  • The child is unable to participate in activities, as normal.
  • The child needs more care than staff can provide without compromising the health and safety of other children.
  • The child has a fever (taken at armpit or orally).
  • A child older than two months has a temperature of 101 degrees Fahrenheit or higher
  • An infant younger than two months has a temperature of 100.4 degrees Fahrenheit or higher
  • The child has two or more episodes of vomiting within a 12-hour period.

Regular and thorough hand washing is the most important method of preventing the spread of communicable diseases. Always wear gloves when handling blood or body fluids contaminated with blood.


DiseaseOverviewSymptomsPreventionExclusion
Chicken Pox (Varicella Zoster infection)Infection caused by the varicella zoster virus.- Rash (small, red, blistering bumps)
- Fever
- Runny nose
- Cough
- Varicella vaccine
- Proper surface sanitation
- Keep room well ventilated
- Regular and thorough handwashing
Contact local Health Department* for outbreaks of three or more cases .
Exclude if chicken pox or a rash suggestive of chicken pox
CMV
(Cytomegalovirus)
Viral infection, common in children.- Mild to no symptoms- Regular and thorough handwashing
- Can be harmful to fetus
Exclusion not required .
Women of childbearing age are at higher risk as the consequences of a fetus exposed to CMV can be serious.
Diarrheal illness:
cause unknown
There are many causes of diarrhea in children under age five. Illness may be mild and not require medical attention.- Stool frequency exceeding two or more stools above normal for that child
- Stools containing blood or mucus
- Stools that are not contained in a diaper
- Fecal accidents by a child who is normally toilet trained
- Proper surface disinfection
- Proper food storage and preparation
- Regular and thorough handwashing
Exclude until diarrhea ends.
Diarrhea (Campylo- bacteriosis)Infection caused by Campylobacter Bacteria.- Bloody diarrhea
- Fever
- Vomiting
- Abdominal cramping
- Proper surface disinfection
- Proper food storage and preparation
- Regular and thorough handwashing
Contact local Health Department* .
Exclude until diarrhea ends.
Diarrhea
(Cryptosporidiosis)
Infection caused by Cryptosporidium parasite.- Loose stools (watery or bloody)
- Abdominal pain
- Weight loss
- Proper surface disinfection
- Regular and thorough handwashing
Contact local Health Department* .
Exclude until diarrhea ends.
Exclude from water play until two weeks after
diarrhea ends.
Diarrhea
(Shiga-toxin producing E. Coli)
Infection caused by Shiga-toxin producing E. coli such as E. coli O157:H7.- Loose stools (watery or bloody)
- Abdominal pain
- Fever
- Proper surface disinfection
- Proper food storage and preparation
- Regular and thorough handwashing
Contact local Health Department* .
Exclude until
- diarrhea ends
- two consecutive negative stool samples 24 hours apart
- cleared for readmission by local health
department
Diarrhea
(Giardiasis)
Infection caused by Giardia lamblia parasite.- Loose stools (watery or bloody)
- Excessive gas
- Abdominal pain
- Decreased appetite
- Weight loss
- Proper surface disinfection
- Regular and thorough handwashing
Exclude until diarrhea ends.
Diarrhea
(Norovirus)
Viral infection.- Acute onset of watery diarrhea
- Abdominal pain
- Nausea
- Vomiting
- Proper surface disinfection
- Regular and thorough handwashing
Exclude until 48 hours after diarrhea ends.
Diarrhea
(Rotavirus)
Viral infection, most common cause of diarrhea
and vomiting.
- Non-bloody diarrhea
- Nausea and vomiting
- Surface disinfection
- Immunization recommended
- Regular and thorough
handwashing
Exclude until diarrhea ends.
Diarrhea
(Salmonellosis)
Infection caused by Salmonella bacteria.- Diarrhea
- Fever
- Abdominal cramps
- Nausea or vomiting
- Dehydration (dry mouth, no tears, no urine in eight hours)
- Proper surface disinfection
- Proper food storage and preparation
- Avoiding contact with reptiles, amphibians, poultry, and other animals
- Regular and thorough handwashing
Contact local Health Department* .
Exclude until diarrhea ends for non-typhoidal serotypes.
For Salmonella Typhi exclude until child cleared by local health
department.
Diarrhea
(Shigellosis)
Infection caused by the Shigella bacteria.- Loose, watery stools with blood or mucus
- Fever
- Headache
- Abdominal pains
- Convulsions
- Proper surface disinfection
- Regular and thorough handwashing
Contact local Health Department* .
Exclude until asymptomatic for 48 hours and one negative
stool sample.
Fifth Disease (Erythema Infectiosum)Infection caused by Human Parvovirus B19.- Fever, headache
- Muscle and joint aches
- Red, lace like rash on cheeks, torso, arms, and thighs that lasts 1- 3 weeks
- Proper surface sanitation
- Disposal of tissues contaminated with blood or mucus
- Regular and thorough handwashing
- Can be harmful to fetus
Exclusion not required .
German Measles
(Rubella)
Uncommon, mild infection caused by Rubella virus.- Red or pink rash on the face and body
- Swollen glands behind ears
- Slight fever
- MMR vaccine required
- Regular and thorough handwashing
- Can be very harmful to fetus
Contact local Health Department* .
Exclude for seven days after the beginning of the rash.
Exclude non-immunized children.
Hand Foot and Mouth Disease (Coxsackievirus)Infection caused by Coxsackievirus, more common in summer and fall.- Tiny blisters in the mouth, on the fingers, palms or hands, buttocks, and soles of feet
- Common cold like symptoms (sore throat, runny nose, cough,
fever)
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough handwashing especially after handling contaminated tissues or changing diapers
- Ensure proper disinfection
Exclusion not required .
Head Lice
(Pediculosis Capitis)
Small insects that draw blood from the scalp and lay tiny eggs (nits) on hair shafts.- Itchy skin on scalp or neck
- Scratching around ears and at the nape of the neck
- White nits glued to hair
- Do not share brushes, hats, blankets, or pillows
- Launder contaminated fabric with hot water and high heat drying
- Regular and thorough
handwashing
Exclude until completion of first treatment.
Hepatitis A
(HAV)
Viral infection, causes liver inflammation- Fever, fatigue
- Jaundice (yellowing of skin or eyes)
- Decreased appetite, abdominal pain,
vomiting, diarrhea
- HAV vaccine is recommended
- Ensure proper disinfection
- Regular and thorough handwashing
Contact local Health Department* .
Exclude until one week after onset of illness or
jaundice.
Hepatitis B
(HBV)
Viral infection, causes liver inflammation.- Flu like symptoms, fatigue, decreased appetite
- Jaundice
- Joint pain
- HBV vaccine required
- Cover open wounds/sores
- Wear gloves when handling blood or blood containing fluids
- Disinfect surfaces contaminated with blood
- Regular and thorough handwashing
Contact local Health Department* .
If local health department determines there is a significant risk of transmission, the child must be placed in an
alternate child care.
Hepatitis C
(HCV)
Viral infection, causes liver inflammation.- Nausea, decreased appetite, fatigue
- Jaundice
- Muscle and joint pain
- Cover open wounds or sores
- Disinfect surfaces contaminated with blood
- Regular and thorough handwashing
Contact local Health Department* .
HIV/AIDSViral infection, progressively destroys the body’s immune system.- Slow or delayed growth
- Enlarged lymph nodes
- Swelling of salivary glands
- Frequent infections
- Wear gloves when handling blood or blood containing fluids
- Disinfect surfaces contaminated with blood
- Regular and thorough handwashing
Contact local Health Department* .
If local health department determines there is a significant risk of transmission, the child must be placed in an
alternate child care.
ImpetigoInfection caused by Streptococcal or Staphylococcal bacteria.- Small, red pimples or fluid filled blisters with crusted, yellow scabs on the skin- Wash infected areas and cover any open sores or wounds
- Proper surface sanitation
- Regular and thorough
handwashing
Exclude until 24 hours after treatment has started.
InfluenzaInfection caused by the Influenza virus.- Fever, chills, headache
- Cough and sore throat
- Muscle aches
- Decreased energy
- Flu vaccine is recommended
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough
handwashing
Exclude until 24 hours after fever subsides.
MRSA
(Methicillin Resistant Staphylococcus aureus)
Infection caused by Staph bacteria resistant to broad spectrum antibiotic
treatment.
- Small, red, pimple like bumps
- Abscesses (collection of pus under the skin)
- Proper surface sanitation
- Do not share towels, clothing, or bedding
- Keep wounds covered
- Regular and thorough
handwashing
Exclusion not required unless open sores cannot be covered.
Measles
(Rubeola)
Infection caused by the measles virus, highly contagious.- Fever, cough, runny nose, red and watery eyes
- Small, red spots in mouth
- Rash spreading from the hairline downward
- MMR vaccine required
- Proper surface sanitation
- Regular and thorough handwashing
Contact local Health Department* .
Exclude for at least four days after the beginning of the rash.
Exclude non-immunized children.
Meningitis (Haemophilus influenzae type b , Pneumococcus, Meningococcus)Bacterial or viral infection, causes swelling or inflammation of brain and spinal cord tissue.- Fever, headache
- Nausea, loss of appetite
- Stiff neck
- Confusion, drowsiness, irritability
- Hib vaccine required
- Pneumococcal vaccine (PCV13) required if born after 7/1/15 (recommended for all children)
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough
handwashing
Contact local Health Department* .
Exclude as soon as infection suspected until cleared by a health care professional.
Molluscum ContagiosumSkin infection caused by a virus, similar to warts.- Small, flesh colored bumps on the skin
- Cover lesions when possible with clothing or bandages
- Do not share towels, washcloths, or blankets used by an infected child
- Scratching may cause additional lesions and bacterial infection
- Regular and thorough handwashing, especially
after touching bumps
Exclusion not required .
Mononucleosis
(Mono)
Infection caused by the Epstein Barr virus.- Mild to no symptoms in young children
- Rare symptoms are fever, sore throat, fatigue, swollen lymph nodes, enlarged liver/spleen, rash from
ampicillin or penicillin
- Do not share objects contaminated with mucus or saliva
- Regular and thorough handwashing
Exclusion not required , unless ordered by a health care professional.
Mumps
(Rubulavirus)
Viral infection with swelling of one or more salivary glands.- Swollen glands
- Fever, headache, earache
- MMR vaccine required
- Regular and thorough handwashing
Contact local Health Department* .
Exclude for at least five days after the beginning of swelling.
Exclude non-immunized children.
Pink Eye
(Conjunctivitis)
Bacterial or viral infection causes inflammation of eye tissue.
Other causes: allergies and blocked tear
ducts in infants.
- Red or pink, swollen, itchy eyes
- Yellow or green discharge and crusting in the eyes
- Regular and thorough handwashing especially before and after touching the eyes, nose, and mouth
- Thorough sanitation of objects touched by hands or faces
Exclusion not required.
Pinworms
(Enterobiasis)
Infection caused by small thread like roundworm.- Itching and irritation around the anal or vaginal area- Regular and thorough handwashing, keep nails short
- Proper surface sanitation and disinfection
- Launder bedding often
- Avoid shaking bedding to prevent spreading eggs through the air
- Treat other affected household members
Exclusion not required .
PneumoniaBacterial or viral infection, causes inflammation of lungs.- Cough, fever
- Difficulty breathing
- Loss of appetite
- Muscle aches
- Fatigue
- Proper surface sanitation
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Dispose tissues contaminated with mucus
- Regular and thorough
handwashing
Exclusion not required .
RSV
(Respiratory Syncytial Virus)
Viral infection caused by Respiratory Syncytial virus, causes common cold, occurs mostly in winter and early spring.- Cold like symptoms
- Respiratory problems (wheezing, difficulty breathing)
- Proper sanitation of hard surfaces and toys
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Dispose tissues contaminated with mucus
- Regular and thorough handwashing
Exclusion not required .
RingwormInfection caused by several kinds of fungi, may affect the body, feet, or scalp.- Red, circular patches on the skin
- Cracking and peeling of skin between toes
- Redness, scaling of scalp
- Cover skin lesions
- Do not share objects that come in contact with the head (hats, brushes, bedding, etc.)
- Treat other affected household members
- Regular and thorough
handwashing
Exclude until treatment started.
Roseola (Human Herpesvirus 6)Viral infection causing a rash in children 6-24 months old.- High fever
- Red, raised rash
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough handwashing
Exclusion not required .
Scabies
(Sarcoptes scabei)
Infestation on the skin by small insects (mites)- Rash, severe itching
- Itchy red bumps or blisters in skin folds
- Itching may take a few days to subside after treatment
- Contain clothing and bedding that cannot be laundered in plastic bags for at least four days
- Launder bedding and clothing in hot water with a hot dry cycle
- Treat other affected household members
- Regular and thorough handwashing
Exclude until treatment started .
Scarlet FeverInfections caused by Group A streptococcus bacteria.- Sunburn like rash with tiny bumps that may itch
- Fever, sore throat, swollen glands
- Yellow or white coating on tongue and throat
- Avoid direct contact with potentially infected individuals
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough
handwashing
Exclude until antibiotics administered for at least 12 hours and no fever is present.
Strep ThroatInfections caused by Group A Streptococcus bacteria.- Sore throat, fever, headache
- Decreased appetite, stomachache
- Swollen lymph nodes
- Avoid direct contact with potentially infected individuals
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough
handwashing
Exclude until 12 hours after antibiotic treatment has started and no fever is present.
TB (Tuberculosis)Infection caused by a bacterium, usually affecting the lungs.- Chronic cough
- Weight loss
- Fever, chills, night sweats
- Positive skin test
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough handwashing
Contact local Health Department* .
Exclude until health care professional provides a written statement that the child is not infectious.
Whooping Cough
(Pertussis)
Contagious bacterial infection that causes mild to severe coughing.- Cold like symptoms
- Coughing that leads to vomiting, loss of breath, or blue face
- Whooping sound when inhaling after coughing
- DTaP vaccine, for children less than seven years of age
- Tdap vaccine, for persons 10 years and older
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough handwashing
Contact local Health Department* .
Exclude until five days after treatment has started.
Exclude untreated cases for 21 days from the date
cough began.

*Physicians, school administrators, and child care operators (G.S. § 130A-135 through 130A-139) must report cases or suspected cases of reportable diseases to their local health department. The local health department then reports this information to the N.C. Division of Public Health (G.S. § 103A-140). 

References:

  1. North Carolina Administrative Code: Chapter 9, Child Care Rules
    • .0804 Infectious and Contagious Diseases
    • .1720 Medication Requirements
  2. Managing Infectious Diseases in Child Care and Schools, A Quick Reference Guide, 4th Edition, American Academy of Pediatrics
  3. North Carolina Administrative Code: Title 10A Health and Human Services, Chapter 41 Epidemiology Health,
    For more specific information

    • Call your Local Health Department
    • Contact the NC Child Care Health and Safety Resource Center (1-800-367-2229)
    • Visit the CDC website Diseases and Conditions