Delaware Delaware

Licensing Standards for Family DayCare


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CHILD HEALTH

160. The Caregiver shall have on file an age-appropriate health appraisal for each child enrolled not more than 30 days following admission. Health appraisals shall be certified by a licensed physician or nurse practitioner and shall be updated yearly up to age 5 and then in accordance with the recommended schedule for routine health supervision of the American Academy of Pediatrics. For children below school age, the health appraisal shall include:

A. Documentation of the immunization status, with a listing of day, month and year for each immunization, according to the recommendations of the Division of Public Health, as specified in Appendix, Immunization Schedules.

i. The Caregiver shall not permit a child to be admitted without written documentation from a licensed physician or nurse practitioner that the child has received at least one (1) dose of DPT or DT, one (1) dose of TOPV or IPV, the MMR vaccine and Hib conjugate vaccine, if required by the age of the child.

ii. If a child has not received adequate immunizations as required for his age, a written plan for updating the immunizations within a reasonable time frame is to be submitted to the Caregiver.

iii. Written documentation that all needed immunizations for that child have been completed shall be submitted to the Caregiver within four (4) months from the date of admission.

B. A description of any disability, sensory impairment, developmental variation, seizure disorder, or emotional or behavioral disturbance that may affect adaptation to child care (include previous surgery, serious illness, history of prematurity, etc. only if necessary for appropriate care);

C. An assessment of the child's growth based on developmental norms;

D. A description of health problems or findings from an examination or screening that need follow-up;

E. Results of screenings - vision, hearing, dental, nutrition, developmental, tuberculosis, hemoglobin, urine, lead, and so forth;

F. Dates of significant communicable diseases (e.g., chicken pox);

G. Prescribed medication(s) including information on recognizing, documenting, and reporting potential side effects;

H. A description of current acute or chronic health problems under or needing treatment;

I. A description of serious injuries sustained by the child in the past that required medical attention or hospitalization; and

J. Special instructions for the Caregiver.

K. For school-age children, the health record may consist of a copy of the child's school health record.

161. A Caregiver may administer medication only upon completion of approved training in accordance with State law.

162. The Caregiver shall report promptly to a parent any accidents, suspected illness, or other change observed in the health of a child.

163. When a communicable disease occurs, the Caregiver shall immediately notify the parent of an exposed child so that the child may be observed for symptoms of the disease.

164. The Caregiver shall require information from parents within 24 hours if the child has developed a known or suspected communicable disease, or if an immediate household member has developed such a disease.

165. A Caregiver shall not permit a child who has symptoms of illness specified below to be admitted or remain in the Caregiver's home unless written documentation from a licensed physician, or verbal approval with written follow-up, states the child has been diagnosed and poses no serious health risk to the child or to other children. The parent, legal guardian, or other person authorized by the parent shall be notified immediately when a child has a sign or symptom requiring exclusion from the Family Child Care Home. The symptoms of illness for possible exclusion shall include, but not be limited to any of the following:

A. The illness prevents the child from participating comfortably in activities;

B. The illness results in a greater care need than the Caregiver can provide without compromising the health and safety of the other children; or

C. The child has any of the following conditions:

i. Temperature: Oral temperature 101 degrees or greater; axillary (armpit) temperature 100 degrees or greater; accompanied by behavior changes or other signs or symptoms of illness- until medical evaluation indicates inclusion in the facility. Oral temperature shall not be taken on children younger than 4 years (or younger than 3 years if a digital thermometer is used). Rectal temperature shall be taken only by persons with specific health training.

ii. Symptoms and signs of possible severe illness (such as unusual lethargy, uncontrolled coughing, irritability, persistent crying, difficult breathing, wheezing, or other unusual signs)- until medical evaluation allows inclusion;

iii. Uncontrolled diarrhea, that is, increased number of stools, increased stool water, and/or decreased form that is not contained by the diaper- until diarrhea stops;

iv. Vomiting illness (two or more episodes of vomiting in the previous 24 hours) until vomiting resolves or until a health care provider determines the illness to be non-communicable, and the child is not in danger of dehydration;

v. Mouth sores with drooling, unless a health care provider or health official determines the condition is noninfectious;

vi. Rash with fever or behavior change, until a health care provider determines that these symptoms do not indicate a communicable disease;

vii. Purulent conjunctivitis (defined as pink or red conjunctiva with white or yellow eye discharge), until 24 hours after treatment has been initiated;

viii. Scabies, head lice, or other infestation, until 24 hours after treatment has been initiated;

ix. Tuberculosis, until a health care provider or health official states that the child can attend child care;

x. Impetigo, until 24 hours after treatment has been initiated;

xi. Strep throat or other streptococcal infection, until 24 hours after initial antibiotic treatment and cessation of fever;

xii. Chicken pox, until at least 6 days after onset of rash or until all sores have dried and crusted;

xiii. Pertussis, until 5 days of appropriate antibiotic treatment (currently; erythromycin) to prevent an infection have been completed and a licensed physician states in writing the child may return;

xiv. Mumps, until 9 days after onset of parotid gland swelling and a licensed physician states in writing the child may return;

xv. Hepatitis A virus, until 1 week after onset of illness or as directed by the health department when passive immunoprophylaxis (currently, immune serum globulin) has been administered to appropriate children and staff and a licensed physician states in writing the child may return;

xvi. Measles, until 6 days after onset of rash and a licensed physician states in writing the child may return;

xvii. Rubella, until 6 days after onset of rash and a licensed physician states in writing the child may return;

xviii Unspecified respiratory illness if it limits the child's comfortable participation in activities or if it results in a need for greater care than can be provided without compromising the health and safety of other children.; or

xix. Herpetic gingivostomatitis (cold sores), if the child is too young to have control of oral secretions.

166. The Caregiver shall report any reportable communicable disease, listed in the table below, to the Division of Public Health in accordance with Division of Public Health procedures and follow instructions of the Division of Public Health in the handling of the illness.

TABLE OF REPORTABLE COMMUNICABLE DISEASES

RESPIRATORY

CASTRO-INTESTINAL

Diphtheria

Giardiasis

German Measles

Hepatitis A

Hemophilus Influenza Disease

Salmonellosis

Measles (rubeola)

Shigellosis

Bacterial (spinal) Meningitis

Mumps

Pertussis (whooping cough)

Rubella

Tuberculosis

167. hild may return to the Family Child Care Home when the symptoms are no longer present or a licensed physician/Division of Public Health indicates the child poses no serious health risk to the child or other children.

168. child who has already been admitted to the Family Child Care Home manifests any of the illnesses or symptoms specified in Requirements 159-160, the Caregiver shall ensure that the child's individual needs for rest, comfort, food, drink and appropriate activity are met until the child can be picked up by the parent(s) or suitably cared for elsewhere.

169. The caregiver shall provide parents with a written health policy including guidelines for the prevention and control of communicable diseases, injuries, and child abuse.

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