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Preventing and Managing Illnesses

Child Care Infection Control Manual

Children are particularly susceptible to illnesses for several reasons. They have not been exposed to many common germs, their immune systems are still developing, and let’s be honest, they usually have poor hygiene habits.

Child care centre owners and staff play an important role in protecting children from, and minimizing the impact of, infection and illness. The Leeds, Grenville and Lanark District Health Unit has created a number of infection control resources to help you:

  • Prevent infections from occurring and spreading
  • Identify and control illnesses and outbreaks
  • Know when to contact the Health Unit about an illness or outbreak
  • Communicate with parents about an illness or outbreak

View the full version of the Preventing and Managing Illnesses in Child Care Centres Manual.

Hand Hygiene (Hand Washing)

Hooray for Handwashing Poster; print and post these 6 easy, kid-friendly hand washing steps above the sinks in your centre

Keep Our Centre Healthy Poster; 3 every day practices that help prevent illness in your child care centre

Wash Your Hands Poster for Adults

Immunization Requirements


Before a child is admitted to a child care centre, child care staff should ensure the child is immunized according to the Ontario Publicly Funded Immunization Schedules for Ontario. See the Attending Licensed Child Care page for detailed information on required immunizations and forms for child care enrollment.

Staff and Volunteers

Child care staff and volunteer immunizations should follow the requirements of the Medical Officer of Health for Leeds, Grenville and Lanark as specified in the Child Care Employee and Volunteer Pre-Employment Immunization Form which includes a review of exemptions from immunization requirements.  These requirements are based on the Ontario Publicly Funded Immunization Schedules for Ontario

Staff Tuberculosis screening requirements are also outlined in the same pre-employment immunization form noted above.

Cleaning and Disinfecting

How often should toys be cleaned? When should we discard sensory play items? The Child Care Centre Cleaning and Disinfecting Schedule lists the minimum frequency for cleaning surfaces in your facility and when to discard items or materials.

For more tips on infection control and sensory play items, see the Pedagogical Learning Approach – Infection Control Recommendations page.

Check out the Cleaning up Spills poster for a refresher on the 7 steps for cleaning up a spill of blood or body fluids, such as vomit or urine.

Diapering and Toileting

Diapering Steps Poster

Toileting Steps Poster

Cloth Diapers: Infection Control Considerations

Animals in Child Care Centres

See pages 9–12 of the Preventing and Managing Illnesses in Child Care Centres Manual for more information on having visiting animals and resident animals in your centre.

Monitoring and Tracking Illness

Seven signs and symptoms of illness to look for:

  1. Unusual behaviour
  2. Runny nose, cough or difficulty breathing
  3. Vomiting
  4. Diarrhea
  5. Change in skin colour
  6. Rash
  7. Fever (Temperature above 37.8°C)

Exclude a child who has any of the following symptoms:

  • Fever
  • Fever AND a combination of other symptoms (e.g., nausea, vomiting, cough)
  • Fever AND a body rash
  • Diarrhea – two or more liquid stools or a change in the normal pattern of bowel movement (e.g., runny, watery or bloody stools)
  • Vomiting – two or more times in the last 24 hours
  • Eye discharge – watery or yellowish
  • Severe cough
  • Unexplained runny nose/Stuffy nose
  • Yellowish skin or eyes (jaundice)
  • Irritability, continuous crying or requires more attention than can be provided

Seven Steps for Exclusion

  1. Separate sick children from well children. Symptomatic children should be placed in the designated isolation area (e.g., sick room).
  2. Keep sick children comfortable by providing separate cots and toys. Clean and disinfect cots and toys after use. Do not allow sick children to participate in group water or sensory play activities.
  3. If possible, designate specific staff to care for sick children. Ideally, child care staff should not care for sick and well children at the same time.
  4. Contact parents to pick up sick children and remind them of the exclusion policy.
  5. Follow policies and procedures for exclusion periods. Refer to the Childhood Diseases poster for exclusion time frames.
  6. Update the Childcare Line Listing.
  7. If necessary, prepare and provide fact sheets or letters to parents.

Call the Leeds, Grenville and Lanark District Health Unit 1-800-660-5853 to report a communicable disease or an outbreak.

What is an Outbreak?

An outbreak is when a greater than expected number of children and child care staff at the facility have similar symptoms (e.g., fever, diarrhea, vomiting, rash, respiratory symptoms) in a given period of time. Some diseases (e.g., measles) should be treated like an outbreak even if there is only one case. If you are unsure whether one case of an illness is an outbreak, call the Health Unit (613-345-5685 or 613-283-2740) and ask to speak to a nurse or public health inspector on the Infectious Disease team.

Gastrointestinal and respiratory outbreaks are the most common types of outbreaks that occur in child care centres.

Enteric Outbreaks

Childcare centres must report to the Health Unit when they have two (2) or more children or staff with gastrointestinal symptoms in a room or 10% across the entire centre within a 48 hour period.

Case: Individual experiencing more than 2 or more bouts of unexplained vomiting or diarrhea or both within 24 hours.

Respiratory Outbreaks

Respiratory outbreaks are not often declared in childcare centres, as there are many exposures external to the centre which are beyond the centre’s control. However, an increase in respiratory symptoms above what is normal for your centre should be reported so that the Health Unit can assist with illness management and help limit the impact of illnesses on the childcare setting   In September 2023 licenced childcare centres received a notice from the Health Unit requesting that they report absenteeism rates of 30% or higher, where absenteeism is due to illness.  A copy of the notice is available in the link below in addition to a link to a convenient absenteeism rate calculator and reporting tool.

10 Steps to Managing an Outbreak

  1. Call the Health Unit Infectious Disease Team (during office hours call 613-345-5685 or 613-283-2740; outside of office hours call 1-800-660-5853 and leave a message on answering machine) who will provide advice and help you control the outbreak. Fax the Childcare Line Listing to 613-345-5777 or 613-283-1679.
  2. Separate sick children and staff at the child care centre from well children and staff. If possible, have a designated staff person care for only ill children, and other staff care for only well children.
  3. Instruct parents or guardians to take sick children home and to a Health Care Provider if necessary. Remind everyone, including parents, of the exclusion policy at the child care centre.
  4. In an outbreak of gastroenteritis, save 200g of leftover food for analysis, as it may be a source of illness. Keep food samples in the refrigerator. Your Public Health Inspector can arrange to have the food tested.
  5. Give frequent handwashing reminders to all children and child care staff.
  6. Clean and disinfect toys and environmental surfaces thoroughly and more often, paying special attention to infant and toddler areas.
    • Notify cleaning staff that extra cleaning is necessary
    • Use a disinfectant effective against common outbreak pathogens (Norovirus, rotavirus, etc.)
    • Refer to Cleaning and Disinfection page 5 and 6 for instructions on preparing bleach solutions
  7. Stop all group water and group sensory play for the duration of the outbreak.
  8. Post the Red Outbreak Sign or a similar notification (Be Aware of Symptoms We Are Experiencing Sign) at the front entrance of the child care centre to inform parents and visitors. Prepare and provide fact sheets or letters to parents.
  9. The Leeds, Grenville and Lanark District Health Unit will provide stool kits to parents if necessary during a gastrointestinal outbreak.
  10. Regular communication is recommended for discussing the line listing, changes in symptoms, lab results, the need for on-site meetings, etc.

Other Helpful Links

This manual Adapted with permission of Public Health, Region of Peel