Communicable Diseases

Protecting young children against infections is an ongoing process with special challenges. Children’s immune systems are still developing, which means they are more vulnerable to infection when exposed to new germs. Also, young children are far more likely to transmit an infection in a group setting by doing what comes naturally to them – mouthing toys, sharing utensils, playing closely with other children, holding hands, drooling and sometimes forgetting to wash their hands.

There are many circumstances when a child becomes ill while at your child care centre or arrives ill. The symptoms, child’s history and numerous other variables will help determine your course of action to manage the child while protecting other children and staff.

See the Childcare Guide to Communicable Disease to learn when you need to report an illness.

What is an infectious disease?
Infectious diseases, sometimes called communicable diseases, are caused by viruses, bacteria, fungi or parasites which can be transmitted from one source to another through indirect or direct contact.
How do I identify an illness?

Following daily routine practices to prevent the spread of germs is a cornerstone of health in child care. The next best way to manage infection is to be alert for telltale signs of illness. Watch for anything different about each child each day. If you observe just one sign or symptom, it may mean you have a sick child on your hands. It should prompt early and effective steps to manage the infection.

No matter how careful you are, there will be some infectious illnesses in child care centres. The following steps will help you identify illness:

1. Observe each child daily before they interact with others in the centre.

2. Assess each child for the following symptoms of illness:

  • Fever >38℃ (100℉), flushing, pallor, listlessness
  • New nasal discharge or coughing
  • Vomiting or diarrhea
  • Red eyes or ears or discharge
  • Yellowish skin or eyes
  • Unusual spots or rashes
  • Unusual behaviour (irritability, fussiness, restlessness)

3. If the above symptoms appear, be prepared to:

  • Isolate the ill child from other children until medical assessment can be arranged.
  • Notify parents promptly and request that they take the ill child home.
  • Ask the parents to keep the child at home until s/he is able to participate in usual activities and/or the child is no longer infectious.
  • Be aware of any children in the child care centre with cancer, including leukemia or other immune deficiency illnesses as these children may need special attention due to increased risk of illness.
  • Make notation of illness or injury in the child’s file and in the daily journal.

Note: Please see Ontario's COVID-19 Self-assessment tool.

When to report an illness to the Health Unit

Many diseases must be reported to the health unit as soon as you are aware of the illness. The health unit will make recommendations and assist you in preventing the spread of diseases to other children in your centre. Observe exposed children who have not had the disease for symptoms during the incubation period.

You are required to report medically diagnosed communicable diseases to the Infectious Disease team at the Huron Perth Public Health at 1.888.221.2133. See the Childcare Guide to Communicable Disease to learn when you need to report an illness.

Have available the following information when you call:

  • Name of child and parent/guardian
  • Date of birth
  • Address
  • Telephone number
  • Physician’s name and telephone number
  • Name of hospital (if child is admitted)
  • Immunization information

Report to the health unit if there is an increase in the number of children ill. This may indicate a potential outbreak. Contact the health unit immediately and review Outbreak Control Measures.

Signs of illness and what to do next


Diarrhea can be defined as any change from the child’s normal solid or semi-solid stool to a liquid or semi-liquid state. Diarrhea stools are often more frequent than usual and the child may lose bowel control. Nausea and vomiting may sometimes accompany diarrhea.

Infants and toddlers can become critically ill with severe diarrhea because fluid loss leads to dehydration.


Diarrhea occurs when the bowel is stimulated or irritated in an unusual way. The causes can be infectious or non-infectious. To identify infectious causes, a medical examination and laboratory tests are required. All children with unexplained diarrhea should be excluded from the child care centre until 48 hours after symptoms have resolved or a medical explanation has been obtained.

What to Do
  • If a child has one episode of diarrhea, separate him/her from the group for one hour and watch for other signs of illness.
  • If no further diarrhea occurs, and the child does not appear to be ill, inform the parents at the end of the day (unless you have been given different direction from the parents).
  • If more diarrhea episodes occur during that day, inform the child’s parents as soon as possible. Tell them to keep the child home until 48 hours after diarrhea stops. Suggest that the parent take the child to their health care provider and request a stool culture if diarrhea persists. Record the incident in the child’s file and daily journal.
  • Frequent diarrhea in a sick looking child with fever, stomach pain or blood in the stool indicates that the child needs immediate medical attention. Inform the parents immediately, asking them to pick up the child and seek medical advice. Exclude the child until 48 hours after the diarrhea stops.
  • Clean up and disinfect the child’s surroundings, including anything that might have been touched by the child’s stool, as soon as possible after the diarrhea episode. Take special care with the diaper change area and with handwashing.

There are many kinds of rashes in children and most are not caused by infection. When you are registering a child, ask the parents about chronic or recurrent rashes so you will not worry unnecessarily when assessing the child for illness.

Many infectious rashes are mild and very common. When a rash occurs in conjunction with fever, infection may be the cause.

Most infectious rashes are spread by coughing or sneezing before the rash is apparent. There are some rashes which require the exclusion of children from the child care centre. Please refer to the Guide to Communicable Disease or call the health unit at 1.888.221.2133.

If there is a child within the centre with childhood cancer, leukemia, or other immune deficiency, notify the parents immediately when infectious rashes occur in other children.

Heat Rash

This appears as tiny red pimples, bumps or spots. It usually appears on the back of the neck or lower back, but can involve the entire body. It occurs due to a mix of sweat, heat and clothing.

Contact Rash

Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating or allergy causing substance.

Irritant dermatitis, the most common type of contact dermatitis, involves inflammation from contact with materials such as soaps, detergents, or other chemicals. The reaction usually resembles a burn.

Allergic contact dermatitis is caused by exposure to a substance or material to which a person has become extra sensitive or allergic. Common allergens are poison ivy, poison oak, rubber or latex and perfumes to name a few. The skin is usually red and raised with red pimples and/or blisters and the area is itchy.

Note: The description of the rash is important to determine the cause. Try to use these terms to describe the rash when documenting and informing parents/guardians.

Rash with a fever

A child with a rash accompanied by a fever should be excluded from child care until symptoms have resolved or a physician has determined that the rash is non-communicable.

Rash and trouble breathing

Call 911 immediately if a child has a rash that is accompanied by difficulty breathing and/or swelling of the throat or tongue.

Recognizing rashes
Recognizing rashes
Raised You can feel a bump when you rub your fingers over the rash.
Flat Discolouration that lies flat on the skin and cannot be felt.
Pimply Very small, raised bumps with a tiny white spot in the middle, just like a pimple.
Blister A bump with a clear fluid-filled middle.
Pustule A pus-filled blister.
Welt Raised, part red and part skin-coloured area. It can be small or large. An example of a welt is hives.
Colour May range from flesh colour to purple to red.
Lacy Looks like a piece of fancy lace placed on the skin and then removed, leaving a red imprint of the lace on the skin.
Spots Flat spots on the skin that cannot be felt.
Blotches Like a welt, but flat and usually varies in colour; some areas are red and some are flesh-toned.

Children vomit more readily than adults and often with much less discomfort. Children may vomit as a result of problems not directly related to the bowel or stomach. The cause may be infectious.

Young children sometimes vomit because of a fever, especially a high one. If the child also has episodes of diarrhea, you should suspect an infectious cause.

What to Do
  • If a child has an episode of vomiting, separate the child from the group and watch for other signs of illness.
  • Give the child small drinks of water. Do not offer solid food or milk.
  • Inform parents after vomiting occurs and observe child if otherwise well.
  • If more than one bout of vomiting occurs, inform the child’s parents or emergency contact person immediately and request they pick the child up. Tell them to keep the child home until they have completely stopped vomiting for 48 hours.
  • Call the child’s parents if the child has other symptoms such as an earache, stiff neck or a change in behaviour. Ask parents to pick the child up and seek medical attention.
  • If the child appears to have pain in the abdomen, inform parents immediately. Ask them to pick the child up and seek medical attention.
  • Germs from vomit can spread easily from person to person; handwashing is very important for the staff and children.
  • Clean and sanitize the area where the child vomited as soon as possible.
  • Wash hands thoroughly.