Library: Policy
340:110-3-311. Addendum requirements for programs for sick children
Issued 1-1-16
(a) Programs for sick children. Programs for sick children serve children with illnesses or symptoms that:
(1) prevent them from comfortable participation in activities in a program caring for well children; and
(2) require more care than personnel in a program caring for well children can provide without compromising the health and safety of other children in care.
(b) Common requirements. Programs are required to meet the common requirements in Oklahoma Administrative Code (OAC) 340:110-3-275 through 340:110-3-305, unless the addendum requirements in this Section state otherwise.
(c) Definitions. The following words and terms when used in this Part shall have the following meaning unless the context clearly states otherwise:
(1) "Health professional" means a registered nurse, pediatric nurse practitioner, physician's assistant, or physician with at least one year of pediatric or public health experience.
(2) "Level I program":
(A) means a component of a regular child care center licensed to care for no more than eight sick children and serves only mildly ill children; and
(B) does not serve children with illnesses or symptoms that meet the criteria for exclusion in a Level I program as defined in OAC 340 Appendix JJ, Exclusion Criteria for Children Who Are Ill.
(3) "Level II program" means a:
(A) program licensed to care for nine or more sick children;
(B) program licensed to provide child care only for sick children; or
(C) component of a regular child care center and serves both mildly and moderately ill children.
(4) "Mildly ill" means children with mild symptoms of an episodic minor childhood illness who do not present a risk of serious infection to other children. Mildly ill children show interest and involvement in program activities and are able to participate.
(5) "Moderately ill" means children with symptoms of an episodic illness preventing them from being cared for in a program serving only well or mildly ill children due to the risk for contagion and the need for increased care. Moderately ill children display more severe symptoms than mildly ill children.
(d) Inclusion and exclusion criteria. A program for sick children may serve any child who exhibits symptoms or illnesses for which they are excluded from a program caring for well children unless prohibited by the exclusion criteria specified in OAC 340 Appendix JJ - Exclusion Criteria For Children Who Are Ill.
(e) Admission criteria. The guidelines for admission in a center for sick children are described in (1) and (2) of this subsection. A provider is not obligated to admit a child if the provider does not have adequate information about the child's condition or diagnosis to determine whether he or she can be safely included in the program.
(1) For Level I programs a written physical assessment of the child is conducted by the director or designated caregiver to determine the appropriateness of the child's attendance that day or the need for a medical evaluation prior to admission. The assessment includes:
(A) any pertinent information from parents or authorized adults relevant to the child's condition and symptoms; and
(B) an evaluation of the child's general appearance, including physical appearance, demeanor, mood, and activity level.
(2) For Level II programs a written medical evaluation that includes a diagnosis from a licensed physician indicating a child is eligible for admission is required before a child can be admitted to a Level II program.
(f) Policy and procedure. The program has written policies and procedures approved in writing by a licensed physician or by a pediatric nurse practitioner.
(1) In addition to the program policy requirements in OAC 340:110-3-278(d), the program policy must also include:
(A) the criteria for admission in the program;
(B) intake and admission procedures;
(C) plans for the daily care of children including methods used to monitor the condition of children;
(D) plans for personnel training and communication with parents and health care providers; and
(E) procedures for injury prevention and infection control.
(2) A health professional provides ongoing consultation to the program in its overall operation and the management of illness for individual children.
(g) Personnel qualifications. In addition to the general personnel requirements per OAC 340:110-3-284 personnel caring for sick children are required to have completed:
(1) at least one year of satisfactory full-time experience in a child care setting; or
(2) a minimum of 20 documented clock-hours of professional development in child development, early childhood education, or a closely related subject.
(h) Personnel training. The professional development requirements for personnel caring for sick children are contained in (1) through (4) of this subsection.
(1) Personnel caring for sick children have cardio-pulmonary resuscitation (CPR) and first aid certification per OAC 340:110-3-284(d).
(2) Prior to working with sick children, personnel must complete the Licensing approved training for the care of sick children conducted by a health professional. The training includes:
(A) policy and procedures relating to the care of sick children;
(B) recognizing signs and symptoms of illness;
(C) administration of medication;
(D) when and how to call for medical help;
(E) taking children's temperatures;
(F) infection control procedures including hand washing, handling contaminated items, use of disinfectants, and food handling;
(G) communicating with parents concerning a child's illness; and
(H) any other care that may be required for admissible illnesses and conditions.
(3) Personnel caring for sick children must obtain two hours of professional development annually related to the care of sick children and the prevention and control of communicable disease.
(4) All professional development required for personnel who care for sick children counts toward the annual training required for all personnel listed per OAC 340:110-3-284(d).
(i) Indoors. In addition programs meet the requirements listed in (1) through (7) of this subsection.
(1) Toilets are in a restroom that is adjacent to or opens directly into each room used to care for sick children.
(2) Sinks for hand washing are located in each room used for the care of sick children or in a restroom that opens directly into the room.
(3) The use of potty chairs is prohibited.
(4) Rest equipment is available and accessible for use by children throughout the day and is placed three feet apart when in use.
(5) Mats may not be used as rest equipment.
(6) The use of carpet is prohibited; however, rugs may be used when they are washed daily.
(7) In Level I programs:
(A) rooms used for the care of sick children are separated from other components of the program by floor to ceiling walls; and
(B) rooms, fixtures, furniture, equipment, and supplies used by sick children are not used by personnel or children from any other component of the program when sick children are in care.
(j) Outdoor play areas. Programs are exempt from the outdoor play area requirements per OAC 340:110-3-301(c). However, when outdoor play areas are provided:
(1) all outdoor play area requirements are met; and
(2) when the same area is shared by well and sick children it is used at separate times.
(k) Health. In addition to the health requirements per OAC 340:110-3-294, programs:
(1) require personnel to monitor and record the condition of each child throughout the day. The monitoring includes:
(A) temperature taking;
(B) amount of fluid and food intake;
(C) output including urine, vomit, and stools, as appropriate;
(D) medication administered; and
(E) sleeping patterns and general behavior;
(2) notify parents immediately of any significant change in a child's condition; and
(3) take additional precautions to prevent the spread of disease, including:
(A) cleaning and disinfecting floors, basic and play equipment and furniture daily or more often when necessary, or before use by another group of children;
(B) providing liquid soap from mounted dispensers for hand washing;
(C) using paper towels from a dispenser with waste containers provided for disposal;
(D) providing play equipment that is non-porous and easily washable; and
(E) prohibiting personnel and children who begin the day in the area serving sick children to transfer to any other part of the facility during that day.
(l) Food and nutrition. In addition to the nutrition and food service requirements per OAC 340:110-3-298 and 340:110-3-299, programs:
(1) modify menus to meet the individual physical condition of each child in care;
(2) prohibit personnel involved with food preparation or service from changing diapers or assisting children with toileting;
(3) use only single-use and disposable eating and drinking utensils. Infant bottles and spill-proof cups may be used when they are sent home daily;
(4) prohibit the use of drinking fountains; and
(5) require personnel to frequently offer drinking water and other fluids to each child.
(m) Additional requirements for Level II programs. In addition to the requirements in this Section, Level II programs meet the requirements listed in (1) through (7) of this subsection.
(1) A physical assessment of each child is conducted by a health professional as the child is admitted to the program.
(2) A health professional or licensed practical nurse (LPN) with immediate, direct access to a health professional remains on-site at all times when sick children are in care.
(3) The LPN may not make the determination whether to admit a child into the program. The LPN may provide care and collect clinical information, and must report to the health professional.
(4) Children are cared for in separate rooms unless grouped with other children diagnosed with the same illness.
(5) Separate outside ventilation is required when care is provided for children diagnosed with:
(A) measles;
(B) diphtheria, until five days of the appropriate antibiotic therapy, that is to be given a total of 14 days;
(C) rubella;
(D) tuberculosis; or
(E) chicken pox.
(6) In a Level II program that is a component of a program caring for well children:
(A) rooms are separated from other components of the facility by floor to ceiling walls; and
(B) rooms, furniture, equipment, and supplies used by sick children are not used by children or personnel from other components of the facility.
(7) A separate entrance is required for sick children.
