7.2.54-C19: Exclusion of Sick Children

Purpose

The purpose of this policy is to ensure all staff members are aware of and adhere to the City of Toronto's position regarding the exclusion of sick children.

This Policy 7.2.54-C19 must be read together with Management and Reporting of Communicable Diseases 7.2.55-C19 and Children’s Sick Day 7.2.08-C19.

Sick Children Must Stay at Home

Children who are ill must stay at home.

To ensure a healthy environment, children, Primary Contacts and families who are or feel sick must not attend the program or enter the Child Care Centre, even if symptoms resemble a minor cold.  

Primary Contacts should advise the Child Care Centre of absences due to respiratory illness.

Symptoms to look for include, but are not limited to fever, new onset of cough, worsening chronic cough, shortness of breath, difficulty breathing, sore throat, difficulty swallowing, decrease or loss of sense of taste or smell, chills, headaches, unexplained fatigue/malaise/muscle aches, nausea/vomiting, diarrhea, abdominal pain, pink eye (conjunctivitis), or runny nose/nasal congestion without other known cause.

Children should be monitored for atypical symptoms and signs of COVID-19. For more information, please see the symptoms outlined in the ‘COVID-19 Reference Document for Symptoms’ on the Ministry of Health’s COVID-19 website: www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/2019_guidance.aspx#symptoms (opens in new window)

Sick While in Care

In the event that a child becomes sick and/or exhibit COVID-19 related symptoms while in the care of the Child Care Centre, the staff must:

  • Immediately move the child to an area isolated from the rest of the children and follow the steps below on How to Exclude a Child with Covid-19 Symptoms or How to Exclude a Child with NON Covid-19 Symptoms
  • Monitor the child until the child is picked up.
  • Contact the Primary Contact or emergency contact to notify of the child’s symptoms and to arrange pick up immediately. 
  • Refer the family for testing. While awaiting test results, symptomatic staff and children will be directed by Toronto Public Health to self-isolate at home. 
  • Document the symptoms of ill health in the child’s daily record and in the daily log.

If it appears that the child requires immediate medical attention, the child will be taken to the hospital by ambulance and examined by a legally qualified medical practitioner or a nurse registered under the Health Disciplines Act. R.R.O. 1990, Reg. 262, s. 34 (3).

Immediate Reporting

Toronto Public Health

The Supervisor must immediately report the following to Toronto Public Health by contacting the surveillance unit at 416-392-7411 during work hours (8:30am to 4:30pm, Monday to Friday) or 3-1-1 after hours:

  • One suspected case of COVID-19.
  • Clusters of suspected cases (e.g. two or more children or staff with COVID-19 symptoms within a 48-hour period).
  • Cases of COVID-19 among staff or child attendees that are laboratory-confirmed or probable (symptoms occurring among a staff or child who has been exposed to a person with confirmed COVID-19).

Ministry of Education - Serious Occurrence

Where a child or staff member is suspected of having or has confirmed case of COVID-19, the Supervisor will, in consultation with their Senior Manager, ensure a Serious Occurrence in the Ministry of Education’s CCLS portal is completed as set out in Exclusion of Sick Children 7.2.54-C19. Please refer to Serious Occurrence Policy 7.2.25.

Where a room or Child Care Centre closes due to COVID-19, LEF must report this to the Ministry of Education as a serious occurrence.

The Child Care Centre is required to post the serious occurrence notification form as required under the CCEYA, unless Toronto Public Health advises otherwise.

How to Exclude a Child with COVID-19 Symptoms

Staff Personal Protection

Staff providing direct care to a child with respiratory illness must:

  • Maintain physical distancing as best as possible
  • Practice frequent hand hygiene, and
  • Wear a surgical/procedure mask and eye protection at all times in accordance with the Health and Safety, PPE Policy 7.2.30.
  • Not interact with others.

Safe Conduct in the Isolation Room

In excluding a child with COVID-19 symptoms, staff must follow these steps:

  • One (1) staff will supervise the child in a designated room with a hand washing sink and/or hand sanitizer available.
  • Only one (1) staff should be in the designated exclusion room and attempt physical distancing.
  • Wear a mask and gloves. Eye protection must be worn if physical distancing of two (2) metres cannot be maintained and there is anticipation of contact with bodily fluids.
  • Perform frequent hand hygiene and attempt to not touch their face with unwashed hands.
  • Children older than two years should wear a mask (if tolerated) and they are able to use it properly (e.g. donning and doffing carefully, avoiding touching while on).
  • Increase ventilation in the designated exclusion room if possible (e.g., open outside windows and doors if it can be done safety)
  • Tissues should be provided to the child for proper respiratory etiquette, with proper disposal of the tissues.
  • The child can be encouraged to lie down on a cot or mat while waiting for the Primary Contact.
  • Clean and disinfect the area immediately after the child has been sent home set out below.
  • While cleaning and disinfecting, wear PPE (mask and gloves) in accordance with the Health and Safety, PPE Policy 7.2.30. 

How to Exclude a Child with NON COVID-19 Symptoms

In excluding a child with non-COVID-19 symptoms, staff must follow these steps:

  • One staff will supervise the child in a designated room with a hand washing sink and/or hand sanitizer available.
  • Notify the Primary Contact of the sick child for immediate pick up.
  • Only one staff should be in the designated exclusion room and attempt physical distancing. Staff must wear a mask and gloves. Eye protection must be worn if physical distancing of two (2) metres cannot be maintained and there is anticipation of contact with bodily fluids.
  • Perform frequent hand hygiene and attempt to not touch their face with unwashed hands.
  • Increase ventilation in the designated exclusion room if possible (e.g., open windows).
  • Clean and disinfect the area immediately after the child has been sent home.
  • While cleaning and disinfecting, wear PPE (mask and gloves) in accordance with the Health and Safety, PPE Policy 7.2.30.

Immediate Cleaning and Disinfecting

Immediately after the child has been picked up, staff must clean and disinfect the isolation area in accordance with Infection Prevention and Control (Sanitary Practices) 7.2.21. 

All items used by the sick person should be cleaned and disinfected. All items that cannot be cleaned (e.g. paper, books, cardboard puzzles) should be removed and stored in a sealed container for a minimum of seven (7) days). 

Cohort Exposure (Close Contacts)

Continued Cohorting

Staff and children who were exposed to an individual who became ill with symptoms (i.e.

suspected COVID-19 case) must continue to be grouped together (i.e. cohorted) and monitored for

signs and symptoms of illness.

Communication re Suspected Covid-19 Cases

If COVID-19 is suspected, the Supervisors must inform:

  • The Primary Contacts of children who were exposed to the ill child, and advise that they should monitor their child for symptoms, using the appropriate LEF COVID-19 communications document, and avoid being in contact with vulnerable person or settings where there are vulnerable persons.
  • The staff who were exposed to the ill child, and advise that they:
    • Should monitor their symptoms, using the appropriate LEF COVID-19 communications document.
    • Must not work in other child care settings.
    • Must avoid being in contact with vulnerable person or settings where there are vulnerable persons.

Communication re Confirmed Covid-19 Cases

Toronto Public Health will provide further advice about information that should be shared with other

staff and Primary Contacts in the event there is a case or outbreak of COVID-19 in the Child Care Centre.

Please refer to Management and Reporting of Communicable Diseases 7.2.55-C19 on the steps to take with respect to staff, families, the Cohort and the community.

Return to the Child Care Centre

  • Those who test negative for COVID-19 must be excluded for 24 hours after symptom resolution.
  • Those who test positive for COVID-19 or is considered a probable case must be excluded from the Child Care Centre for 14 days after the onset of symptoms and clearance has been received from Toronto Public Health.

Clearance tests are not required for children to return to the Child Care Centre.

Review and Signature

Exclusion of Sick Children Policy 7.2.54-C19 must be reviewed and signed at least annually by all C&F Employees.

7.2.54-C19:  Exclusion of Sick Children

Effective Date: July 2, 2020

Revised:            

Prepared and Approved by Executive Director