For all ailments, parents should seek the advice of a doctor. However, the following guidelines are an indication of early symptoms of a variety of common illnesses and how long, following diagnosis, a child should be kept out of the nursery environment.

CHICKEN POX AND SHINGLES

• Flu-like symptoms
• Itchy blisters appearing on chest, face and limbs. The blisters fill with pus and then burst and crust over, so that by two weeks all the blisters have burst.

Incubation period: 14-21 days
Infectious: from about 1-2 days before, to not more than 6 days after last crop of spots
Exclusion: Until the spots have all scabbed over.

Chickenpox is caused by the same virus that causes shingles in adults. Scars can be formed if a blister becomes infected, for example, after scratching it. As far as possible, affected children must be prevented from scratching the rash. A number of lotions and medicines are available from the chemist to ease the itching. Occasionally, the virus can cause pneumonia and, more rarely, inflammation of the liver and brain. A treatment is available for chickenpox if it is extremely severe: 'immunoglobulin' and/ or anti- viral medicines are given. A vaccine has been developed but it is not currently part of the routine childhood immunisation programme in the UK.

COLD SORES (HERPES SIMPLEX) Infectious: via direct contact while lesions are moist
No treatment.

Young children up to 7 years may be better at home until the lesion has cleared.
Tend to heal and reoccur.
Discourage from kissing.
Personal hygiene is important.

COMMON COLD

• Runny or stuffy nose. This may lead to blockage of the nasal passages
• Irritability, restlessness, poor appetite, decreased activity level
• Dry cough
• Sudden, slight fever
• Head/chest congestion

Vomiting may occur A cold can last from two to seven days and is infectious. No exclusion period unless fever develops. Treatment not necessary unless symptoms are severe. There are over 200 viruses that can cause a cold. Most infants and children will have several mild upper respiratory infections each year.

CONJUNCTIVITIS (STICKY EYE)

• Weeping eyes
• Itchiness and redness around eye area

Incubation period: 1-3 days
Infectious: Very infectious for those in direct contact.
Exclusion Until 24 hours of treatment is completed or when the eye appears normal again.

DIARRHOEA Incubation: Variable Infectious: During acute stage and sometimes for a variable period afterwards. Exclusion until advised by the consultant in communicable diseases. Cross infection is largely owing to poor hygiene, although very difficult to control in a group setting with very young children who have a tendency to put fingers and toys in mouths.

DIPHTHERIA

• Runny nose
• Swelling of the larynx and airways
• Difficulty breathing

Incubation: 3-7 days
Infectious: 2 weeks from on-set of symptoms
Exclusion: The infected child should be excluded as soon as diphtheria is suspected and immediate treatment sought. The child can return once the doctor has certified that three consecutive nasal swabs and throat swabs (taken on different days) have proved negative.

Diphtheria is rare in the UK due to immunisation, however it is wise to be aware of its existence. The diphtheria bacteria passes from person to person in much the same way as a cold. The bacteria causes inflammation of the throat and a grey-coloured membrane develops on the lining of the throat, which can cause breathing difficulties. In severe cases it inflames the heart and nerves. This is a dangerous disease, and hospital treatment must be given quickly.

GASTROENTERITIS (STOMACH FLU)

• Nausea & vomiting
• Diarrhoea
• Loss of appetite
• Abdominal cramps and pain
• Sometimes accompanied with a fever

Incubation: Most types of gastroenteritis lasts for 12 hours to a couple of days. Infectious through bodily fluids. General hygiene important.
Exclusion until child has fully recovered.
Inflammation of the lining of the stomach and intestines. It is the most common cause of vomiting and diarrhoea.

GERMAN MEASLES (RUBELLA)

• Small pinprick rash

Incubation: 14-21 days but usually 16-18 days
Infectious: 1 week before to about 4 days after onset of rash
Exclusion: 7 days after onset of rash All young women should be notified immediately, to ensure immunity.

GLANDULAR FEVER Incubation: 14-40 days
Infectious: Not known
Exclusion: Whilst unwell

HAND, FOOT AND MOUTH Incubation: 3-5 days
Infectious: During acute phase
Exclusion: Whilst unwell.

Hygiene is important. May be excreted in stools for several weeks.

HEPATITIS A In some cases, people with hepatitis have no symptoms at all. However, most attacks of acute hepatitis produce a range of flu-like symptoms at first, including:

• Fatigue
• Headache
• Loss of appetite
• Nausea or vomiting
• Fever
• Jaundice (yellowing of the skin)
• Brown urine
• Pale faeces
• Abdominal pain

Incubation: 2 weeks
Infectious: Until all symptoms have disappeared.
Exclude infected child as soon as hepatitis is suspected, until symptoms have subsided (usually after two weeks) and on doctor’s recommendation

Hepatitis is the inflammation of the liver, which may be acute (a short episode) or chronic (a prolonged illness). Hepatitis A is a viral infection spread by ingesting substances contaminated with the virus. There are many hepatitis viruses; the three most common are called hepatitis A, B and C.

IMPETIGO Infectious:Very infectious until treated.
Exclusion: Until 48 hours of treatment completed and as long as septic spots are discharging pus. All lesions must be covered

INFLUENZA

• Fever
• Shaking/chills
• Body aches
• Headache
• Fatigue
• Dry cough
• Runny nose
• Sore throat
• Nausea vomiting

Incubation: 2-3 days
Infectious: 1-2 weeks from when the symptoms first appear. Until symptoms have subsided and child feels well.

Flu is caused by a group of viruses which have the ability to change, so escape the body’s immune system. The infection is spread from person to person by droplets from coughing and sneezing. It can also be spread by hand contact through droplets from the nose and the hands.

JAUNDICE

• Yellowing of skin

Incubation: 15-50 days
Infectious: From 7-14 days before to 7 days after onset of jaundice
Exclusion: 7 days from onset of jaundice

Hygiene very important. Hand washing etc should be emphasised.

LICE

• Scratching of head
• Little white eggs which are attached to individual hairs

Infectious: Whilst harbouring lice
Exclusion: None once treated

Ensure whole class including staff and families of children are treated appropriately. Prevention is better than cure. See appropriate treatments in parents handbook.

MEASLES Incubation: 10-15 days
Infectious: Few days before to 4 days after onset of rash
Exclusion: About 7 days from onset of rash Children can be immunised. Advise parents of non-immunised children.

MENINGITIS

• Fever
• Inability to tolerate light
• Migraine
• Purple rash that does not disappear when pressed with a glass

Incubation: Depends on type Infectious: While organism is present in nose or throat Exclusion: Until recovered (usually in hospital)

MUMPS

• Swelling of glands in neck

Incubation: 14-21 days (usually about 18)
Infectious: Mainly about 2 days before onset of illness, but until about 4 days after swelling subsides
Exclusion: Until swelling has subsided. Minimum of 7 days

POLIO (POLIOMYELITIS) In most cases there are no outward symptoms or serious effects, however these symptoms may occur:

• Mild: fever, nausea, head-aches
• Severe: weakness, breathlessness, paralysis, muscle pain, difficulty swallowing

Incubation: 3-21 days
Infectious: From two days after first contact of virus until six weeks or longer after on-set
Exclusion: Until treatment has been sought and on the recommendation of a GP Polio is rare in the UK because of immunisation. However it is wise to be aware of its existence. The virus damages the nerves that supply the muscles, including the breathing muscles and in severe cases can cause paralysis. Polio is spread through contact with infected faeces.

RINGWORM Incubation: variable
Infectious: Until lesions have resolved
Exclusion: Until at least 24-hours of treatment completed.

Personal hygiene is important

SCABIES Incubation: Variable may be several weeks
Infectious: Until mites and eggs are destroyed
Exclusion: 24 hours after treatment

Child itchy and uncomfortable. This may persist for some time after treatment

SCARLET FEVER (STREP THROAT)

• Severe sore throat
• Difficulty swallowing
• High temperature
• White/yellow spots
• Headache
• Swollen glands

Incubation: 1-3 days
Infectious: If not treated up to 21 days. Most infectious while symptoms present. Usually non-infectious after 48 hours of treatment
Exclusion: Until treated and feeling better Strep throat is most common in children aged 3-15. Strep throat is caused by a virus which is passed from person to person through the coughs or sneezes of an infected person inhaled by a healthy person.

SLAPPED CHEEK SYNDROME (Fifths disease) Incubation: 7-28 days
Infectious: Not known
Excusion: Whilst unwell

Rash may be prolonged

TETANUS (LOCKJAW)

• Cut or graze for bacteria to gain entry into the body
• Inability to open the mouth, difficulty swallowing, contraction of facial muscles
• Irritability

Incubation: 3-20 days
Infectious: Tetanus is not contagious
Exclusion: Until the child feels well.

Tetanus is an infection by bacterial spores which enter the body through a wound.

TUBERCULOSIS (TB) Infectious: Up to 14 days following instigation of treatment
Exclusion: According to information from doctor.

WHOOPING COUGH (PERTUSSIS) Incubation: 7-10 days
Infectious: Mainly in early catarrhal stage, but until 3-4 weeks after onset of paroxysmal cough. This may be shortened to 7 days if treated with antibiotics Exclusion: If treated with antibiotics, may return after 7 days if well enough.

WORMS (THREADWORMS) Infectious: While worms are live in the intestine. Treatment is usually effective rapidly.
Exclusion: Not warranted. Strict attention to hygiene is necessary.