Common Childhood Illnesses: When to Keep Your Child at Home

Childhood illness is an unavoidable feature of early years and school-age childcare. Young children’s immune systems are still developing, and their tendency to share toys, surfaces and close physical contact with other children means that infectious diseases spread rapidly in group care settings. While this can be frustrating for families, it is important to understand that frequent minor illnesses in the first few years of life are part of the normal process by which the immune system matures. Most children who experience frequent colds and minor infections in their early years are not unusually unwell – they are building the immune repertoire that will protect them throughout later childhood.

Managing illness in childcare settings requires balancing the welfare of the sick child, the protection of other children and staff, and the practical realities of family life. Clear, evidence-based exclusion guidance (grounded in the actual risk of transmission) is the foundation of effective illness management. Both over-exclusion (sending children home or refusing admission for illnesses that pose no significant transmission risk) and under-exclusion (allowing children with genuinely infectious conditions to attend) are problematic and should be avoided.

UKHSA Exclusion Guidelines

The UK Health Security Agency (UKHSA – formerly Public Health England) publishes the definitive guidance on exclusion periods for common infectious diseases in schools and other childcare settings. The most recent version, “Guidance on Infection Control in Schools and Other Childcare Settings,” is available on the UKHSA website and should be the primary reference for all settings. Key exclusion periods include:

• Diarrhoea and vomiting: Children should remain at home until at least 48 hours after their last episode of diarrhoea or vomiting. This is the standard exclusion period regardless of the cause
• Chicken pox: Excluded until all blisters have crusted over, which typically occurs approximately five days after the rash first appears
• Measles: Excluded for four days from the onset of the rash
• Whooping cough (pertussis): Excluded for two days from the start of antibiotic treatment, or 21 days from onset of symptoms if no antibiotic treatment
• Impetigo: Excluded until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment
• Scarlet fever: Excluded for 24 hours after commencing appropriate antibiotic treatment
• Hand, foot and mouth disease: No exclusion required if child is well enough to attend; exclusion should not be imposed routinely
• Conjunctivitis: No exclusion required; appropriate treatment and hygiene measures are sufficient
• Head lice: No exclusion required; treatment should be carried out at home

Notifiable Diseases

Certain infectious diseases are legally notifiable under the Health Protection (Notification) Regulations 2010 – that is, they must be reported to the local health protection team (HPT) when a clinician suspects or confirms the diagnosis. In practice, schools and childcare settings are not required to make notifications directly – this is the responsibility of the treating clinician. However, settings should inform their local HPT of any cluster of cases of a notifiable disease that occurs in the setting, as this may trigger a public health investigation and control measures.

Notifiable diseases relevant to the childcare context include: measles; mumps; whooping cough (pertussis); meningitis and invasive meningococcal disease; tuberculosis (TB); typhoid and paratyphoid; and E. coli O157. The UKHSA publishes an up-to-date list of all notifiable diseases. Schools and settings that suspect a notifiable disease among their children should contact their local HPT immediately, even before a formal diagnosis is made.

Meningitis: Recognising the Signs

Meningitis (inflammation of the membranes surrounding the brain and spinal cord, usually caused by bacterial or viral infection) is a medical emergency. The most dangerous form is bacterial meningitis, particularly meningococcal disease, which can kill within hours of the first symptoms. Early recognition is critical. Symptoms include: severe headache; high temperature with cold hands and feet; neck stiffness; dislike of bright light; vomiting; and, in some but not all cases, a characteristic non-blanching rash (one that does not fade when pressed with a glass).

Not all children with meningitis develop the rash – and by the time the rash appears, the child is often very seriously ill. Settings should ensure all staff are familiar with the symptoms of meningitis and understand that any child presenting with this combination of symptoms requires an immediate 999 call. The Meningitis Research Foundation and Meningitis Now both provide free training materials for settings.

The Immunisation Schedule

Immunisation is the most effective and cost-efficient public health measure available for preventing serious childhood illness. The UK childhood immunisation schedule, delivered through the NHS, is one of the most comprehensive in the world and provides protection against 13 diseases from birth. Key vaccines in the childhood schedule include:

• the 6-in-1 vaccine (diphtheria, tetanus, polio, whooping cough, Hib, hepatitis B) at 8, 12 and 16 weeks
• the MMR vaccine (measles, mumps, rubella) at 12–13 months and 3 years 4 months
• the meningitis B vaccine at 8 weeks, 16 weeks and 12 months
• the flu nasal spray vaccine, offered annually to children aged 2–16

Coverage of MMR vaccination in England has fallen in recent years, dropping below the 95% threshold required for herd immunity in some areas and contributing to a significant increase in measles cases in 2024. Settings have a role in supporting immunisation uptake by encouraging parents to check their child’s vaccination status, by sharing evidence-based information about vaccine safety and by signposting parents to their GP or health visitor if their child has missed any vaccines. Childcare settings are not permitted to refuse admission on the basis of vaccination status in England, but they can and should engage with families where concerns about immunisation arise.

Managing Medicines in Settings

Settings may be asked to administer prescription or non-prescription medicines to children in their care. The EYFS requires that settings must not administer prescription medicines without written parental consent. Non-prescription medicines (including paracetamol (Calpol)) should not be administered without parental consent and are generally not appropriate for settings to keep and administer routinely. Settings should have a clear medicines policy that specifies: what medicines can and cannot be administered; the requirements for written consent; the records to be kept; and the training required for staff administering medicines.

Some children with chronic conditions (asthma, type 1 diabetes, epilepsy, severe allergy) will require regular or emergency medication management in the setting. These children should have individual healthcare plans developed in consultation with parents and, where appropriate, healthcare professionals. Staff caring for these children must receive the specific training needed to manage their condition safely.

For related guidance, see also our articles on health requirements under the EYFS, play-based learning, quality childcare provision and safeguarding responsibilities.