Policies for the exclusion of ill children from group day care: an unresolved dilemma.

Although the problem of how to manage children with mild infectious illnesses who attend group day care programs arises often, appropriate criteria for the exclusion of ill children have not been determined. Substantial variation in the policies of different programs for excluding ill children exists. Studies of the epidemiology of common infectious illnesses indicate that asymptomatic children may transmit infections and that symptomatic children often shed infectious particles both before the onset and after the resolution of symptoms. The little information that is available supports the contention that the exclusion of mildly ill children has little effect on the incidence of infections among children who attend group day care programs. Consequently, policies for exclusion should focus on the needs and behavior of the ill child rather than on easily measured but less germane factors such as the child's body temperature. If the facilities and staff available are adequate to meet the needs of both the ill child and other children in the group, it is appropriate to allow children with mild infectious illnesses to attend group day care programs.