Health Requirements

PURPOSE: This rule establishes health requirements for child care providers and children in license-exempt child care facilities. (1) Facility staff shall meet the following health requirements: (A) The director or other caregiver shall report to the local health department when any child in a facility is suspected of having a reportable communicable disease listed in 19 CSR 20-20.020(1)–(5). In the event of an unusual outbreak of a reportable communicable disease, caregivers shall implement control measures recommended by the department or local health department; (B) Caregivers shall use proper handwashing techniques with soap and warm, running water after toileting, after assisting a child with toileting, after diapering a child, and at other times as needed. Good hygiene practices shall be followed during food preparation. These practices include, but are not limited to, washing hands properly after smoking, eating, drinking, using the restroom, after touching raw food products and before preparing and serving food. Hands shall be dried with single-service towels. Caregivers shall teach and see that children wash their hands at appropriate times: before eating, after toileting and as needed when hands are soiled; (C) Caregivers shall not work when ill and likely to transmit an illness that might endanger the health or well-being of children. This may include symptoms such as fever, coughing, upper respiratory infection, vomiting or diarrhea; (D) All caregivers working in a facility during child care hours shall be in good health. They shall have a physical assessment, including a tuberculosis status assessment by a licensed physician or registered professional nurse. A physical assessment report, signed by a licensed physician or registered professional nurse, shall be on file at the time of employment or within thirty (30) days following employment. 1. Physical assessment reports shall be completed not more than twelve (12) months before beginning work in the facility. The reports may be transferred to another facility for future employment. 2. The facility may use the department’s physical assessment form, MO 580-1879 (694), or the facility may use its own form if it contains all the information on the department’s form. 3. After the initial physical assessment, all caregivers working in a facility during child care hours shall be tested for tuberculosis at least every two (2) years. Caregivers with previously positive tuberculin tests shall be under the management of a physician; and (E) No person shall smoke or use tobacco products in any area of a child care facility while children are in care. (2) Within thirty (30) days following the admission of an infant, toddler or preschool child, a physical assessment report signed by a licensed physician or registered professional nurse shall be on file at the facility. The facility may use the department’s physical assessment form, MO 580-1878 (6-94), or the facility may use its own form if it contains all the information on the department’s form. The report shall have been completed not more than twelve (12) months before admission. (3) Child care facilities shall meet immunization requirements for children as defined by section 210.003, RSMo. (4) A parent of a school-age child shall provide a statement at the time of enrollment indicating the child’s health history, any current health problems and any restrictions necessary for the child’s care. (5) Each child shall be observed for contagious diseases and other signs of illness on arrival and throughout each day. (6) A parent or guardian shall be contacted when signs of illness are observed. (7) When a child exhibits any of the following in subsections (7)(A)–(O) of this rule, the parent(s) shall be contacted and the child shall be sent home. Parental contact shall be recorded and filed in the child’s records. Symptoms that require parental contact and sending a child home are— (A) More than one (1) abnormally loose stool; (B) Red or blue in the face or makes highpitched croupy or whooping sounds after coughing; (C) Difficult or rapid breathing—especially important in infants under six (6) months of age; (D) Yellowish skin or eyes; (E) Tears, redness of eyelid lining or irritation, followed by swelling or discharge of pus; (F) Unusual spots or rashes; (G) Sore throat or swallowing difficulty; (H) An infected skin patch—crusty, bright yellow, dry or gummy areas of the skin; (I) Unusually dark, tea-colored urine; (J) Gray or white stool; (K) Fever over one hundred one degrees Fahrenheit (101°F) by mouth or one hundred degrees Fahrenheit (100°F) under the arm; (L) Headache and stiff neck; (M) Vomiting more than once; (N) A child is in the contagious period of a disease; or (O) Severe itching of the body or scalp or scratching of the scalp which may be symptoms of lice or scabies. (8) An ill child shall be kept isolated from the other children and a caregiver shall be in close proximity to the child until a parent arrives. Close proximity means that a caregiver is close enough to hear any sounds a child might make that indicate a need for assistance. (9) A parent of each child shall be notified when any reportable communicable disease in 19 CSR 20-20.020(1)–(5) occurs in the facility. (10) Providers are not required to administer medication, but may if they choose. (A) All medication shall be given to a child only with the dated, written permission of a parent, stating the length of time the medication may be given. (B) Prescription and nonprescription medication shall be in the original container and labeled with the child’s name, instructions for administration, including the times and amounts for dosages, and the physician’s name. Sample medication provided by a physician may be used. (C) All medication shall be stored out of reach of children or in a locked container. (D) Medication shall be returned to storage immediately after use. (E) Medication needing refrigeration shall be kept in the refrigerator in a container separate from food. (F) Unused medication shall be returned to the parent or disposed of immediately after it is no longer needed. (G) The date and time(s) of administration, the name of the individual giving the medication and the quantity of medication given shall be recorded promptly after administration. This form shall be filed in the child’s record after the medication is no longer necessary. (11) In case of an accident or injury to a child, the provider shall notify a parent immediately. If a child requires emergency medical care, a parent’s prior written instructions shall be followed. A form shall be completed indicating the circumstances and the date and time of the injury. The form shall be signed by the caregiver and his/her supervisor. A copy of the form shall be given to the parent the day of the accident or injury and necessary explanations shall be given. The form shall be filed in the child’s record. AUTHORITY: sections 210.221.1(3) and 210.252.5, RSMo Supp. 1999.* This rule was previously filed as 19 CSR 40-60.060. Original rule filed Dec. 1, 1994, effective July 30, 1995. Changed to 19 CSR 30-60.060 July 30, 1998. Emergency amendment filed March 1, 2000, effective March 11, 2000, expired Sept. 6, 2000. Amended: Filed March 1, 2000, effective August 30, 2000. Moved to 5 CSR 25-300.050, effective Aug. 30, 2021. *Original authority: 210.221, RSMo 1949, amended 1955, 1987, 1993, 1995, 1999; 210.252, RSMo 1993, amended 1999.