This guide provides child care directors, teachers, and caregivers with essential information on infectious diseases in group care settings. It includes a robust section of more than 55 quick reference fact sheets on common infectious diseases and symptoms. Additionally, it includes forms that can be photocopied and used with families. As always, the reference is easy to use, providing clear, authoritative information on infectious diseases.

In the United States, more than two-thirds of children younger than 6 years, and almost all children older than 6 years, spend significant time in early childhood education (ECE) settings, such as child care centers and family child care homes, religious-based programs, Head Start, and many others. Exposure to groups of children increases the risk of infectious diseases and has important personal, public health, economic, and social consequences. This book provides an easy-to-use reference for those responsible

for preventing and managing infectious diseases in ECE programs and schools—educators, pediatric clinicians, public health professionals, and parents/legal guardians.

In this sixth edition of the book, new topics have been added at the request of enthusiastic users. Review of scientific evidence since the previous edition led to a few changes as well. The text was cross-checked and updated to be consistent with 2 other publications: the American Academy of Pediatrics (AAP) Red Book®: 2021–2024 Report of the Committee on Infectious Diseases, 32nd Edition, and the AAP, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 4th Edition.

This edition will be the first for Dr Andrew Hashikawa, a pediatrician and emergency medicine specialist at the University of Michigan, who has many years of experience consulting with ECE programs, conducting research about the spread of infectious diseases in child care centers, and advocating for safe and healthy child care for young children. We would also like to pay tribute and sincerely thank Dr Susan Aronson for her previous contributions to the first through fifth editions. In 2000, Dr Aronson, along with Dr Shope and the AAP, first recognized the need to address the extreme variability, lack of evidence-based practices, and gaps in knowledge regarding the management of infectious diseases in children in ECE programs and schools, leading to the inception of this book. Dr Aronson’s vision, and its practical application in the form of this book, started the transformation of practices and state policies. As of 2016, in an unpublished Centers for Disease Control and Prevention/AAPsponsored survey of licensed US child care centers, Managing Infectious Diseases in Child Care and Schools was used by 73%. Dr Aronson’s contributions to this publication are just one example of the tremendous efforts she has put forth over a long career as a pediatrician and fierce advocate for improving health and safety in ECE settings. She is truly a pioneer in this area—establishing the need to address specific public health issues in ECE, placing the responsibility to address that need in the pediatric health professional sphere of influence, and tirelessly working to address the need in practical ways that have provided actionable solutions for early childhood educators, parents, and pediatric health professionals.

Educators (including directors, teachers, and other education professionals from ECE and school settings) will find easy-to-read explanations for how infectious diseases spread, how to prepare for inevitable illness, and how to incorporate measures that limit illness in group activities. The Signs and Symptoms Chart (Chapter 5) will help educators have greater insight into what might cause various signs and symptoms. The Quick Reference Sheets (Chapter 6) describe infectious diseases in common terms, with guidance about spread and what may need to be done by educators, children, and families when someone has a disease. By using this book as a handy reference, educators can feel more confident in making decisions about the inclusion and exclusion of ill children. This book may prompt educators to seek advice from medical and public health professionals when necessary to reduce the burden of infectious diseases. Educators can send copies of the reference sheets home to parents.

Child Care Health Consultants (licensed health professionals with education, experience, and training in child and community health and health practices recommended for ECE programs) may find this book helpful in assisting programs and schools to create model policies and best practices for managing children with infectious diseases.

Pediatricians and other health professionals, including school and summer camp nurses, will find this book helpful as a reference that facilitates communication with educators. Pediatric health professionals can use the book’s content to identify exclusion and inclusion recommendations, supplement their communications with educators about infectious diseases of patients, and augment their instructions for those involved in the child’s care. They also can use the book to link educators with public health

authorities when necessary.

Parents will benefit because the book’s content provides a common means for communication among family members, pediatric health professionals, and educators based on the latest evidence and expert opinion about best practices. The Quick Reference Sheets describe a condition or infection affecting a child or a group of children. Parents can copy the Quick Reference Sheets to share with educators.

This book also addresses the subject of exclusion and return-to-care criteria. Educators, pediatric clinicians, public health professionals, and parents often disagree about which conditions require exclusion. There is no scientific evidence that exclusion reduces the spread of most common infectious diseases; however, this is a common requirement for most vaccine-preventable diseases. Exclusion and quarantine have been common requirements during the COVID-19 pandemic. Because children and adults can be contagious before they become ill, without ever becoming ill, and for days after becoming ill, the effectiveness and proper length of exclusion require more study. There is a tradeoff between the potential benefit of reducing the spread of an infectious disease against parental lost work, lost income for programs, and lack of continuity of education. Additionally, each state health department and licensing agency has unique rules or exclusion criteria for determining which symptoms, diseases, and conditions require exclusion from ECE programs or school.

For the sixth edition of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, we need to acknowledge the profound effects the COVID- 19 pandemic has had on ECE programs, schools, children, parents, and educators. This edition is being produced amid a pandemic that has had many unpredictable twists and turns affecting everyone’s lives and well-being. Current evidence shows that while COVID- 19 spread can occur in ECE programs and schools, unlike other common respiratory viruses like influenza and respiratory syncytial virus, these settings do not seem to be accelerating community spread. COVID-19 transmission rates in these settings are much lower than in households. With this in mind, as well as increasing immunization and infection rates in the population and the vaccination of young children in ECE, we hope that a transition from pandemic (everyone in the world is vulnerable) to endemic (COVID-19 becomes a less-severe background infection similar to other respiratory viruses like seasonal influenza) is underway. For this reason, we have maintained the basic recommendations for exclusion and return-tocare for most infectious diseases, symptoms of infections, and infection control and prevention procedures and highlighted areas that are different due to the pandemic, pointing readers to the latest Centers for Disease Control and Prevention guidelines. We do acknowledge new variants on the horizon and humility in predicting what will happen next. For the first time, this edition includes a website where we can update COVID-19–related material as it becomes available: www.aap.org/midupdates.

The book’s recommendations are based on the best available scientific evidence determined by AAP infectious diseases experts. Most of the practices suggested in this book can be followed without conflict with existing state or local rules or regulations. But in some cases, the recommendations in this book may differ from state or local regulations, guidance, or firmly held beliefs (whatever they may be). We hope this book can be a basis for change in these cases.

Timothy R. Shope, MD, MPH, FAAP

Andrew N. Hashikawa, MD, MS, FAAP