Health Care

PURPOSE: This rule sets forth the requirements for reporting communicable diseases, caring for a child when ill, medication, emergency care and handwashing. (1) General Requirements. The provider shall report to the local health department if any child in the facility is suspected of having a reportable disease as defined by section 210.003, RSMo. In the event of an outbreak of communicable disease in the facility, caregivers shall implement control measures recommended by a local state health authority as required by the department. (2) The Ill Child. (A) Each child shall be observed for contagious diseases and for other signs of illness on arrival and throughout the day. (B) Each child’s parent(s) shall be notified immediately when any contagious disease occurs in the facility. (C) Unusual behavior shall be monitored closely and parent(s) shall be contacted if the behavior continues or if other symptoms develop. These behaviors include, but shall not be limited to: 1. Is cranky or less active than usual; 2. Cries more than usual; 3. Feels general discomfort or seems unwell; or 4. Has loss of appetite. (D) The parent(s) or his/her designee shall be contacted when signs of illness are observed. Unless determined otherwise by the parent(s) or provider, a child with no more than one (1) of the following symptoms may remain in care: 1. A child with a temperature of up to one hundred degrees Fahrenheit (100°F) by mouth or ninety-nine degrees Fahrenheit (99°F) under the arm; 2. After an illness has been evaluated by a physician, medication has been prescribed and any period of contagion has passed as determined by a licensed physician; 3. When it has been determined that a child has a common cold unless the director and the parent(s) agree that isolation precautions should be taken; 4. When a child has vomited once with no further vomiting episodes, other symptoms, or both; or 5. When a child has experienced loose stools only one (1) time with no further problems or symptoms. (E) If children exhibit any of the following symptoms, they must be sent home: 1. Diarrhea—more than one (1) abnormally loose stool. If a child has one (1) loose stool, s/he shall be observed for additional loose stools or other symptoms; 2. Severe coughing—if the child gets red or blue in the face or makes high-pitched croupy or whooping sounds after coughing; 3. Difficult or rapid breathing (especially important in infants under six (6) months); 4. Yellowish skin or eyes; 5. Pinkeye—tears, redness of eyelid lining, irritation, followed by swelling or discharge of pus; 6. Unusual spots or rashes; 7. Sore throat or trouble swallowing; 8. An infected skin patch(es)—crusty, bright yellow, dry or gummy areas of the skin; 9. Unusually dark, tea-colored urine; 10. Grey or white stool; 11. Fever over one hundred degrees Fahrenheit (100°F) by mouth or ninety-nine degrees Fahrenheit (99°F) under the arm; 12. Headache and stiff neck; 13. Vomiting more than once; and 14. Severe itching of the body or scalp, or scratching of the scalp. These may be symptoms of lice or scabies. (F) Parental contact and the decision made shall be recorded and filed in the child’s record. (G) The ill child shall be kept isolated from the other children until the parent(s) arrives. (H) The caregiver shall be in close proximity to the child until the parent(s) arrives. Close proximity means that a caregiver is close enough to hear any sounds a child might make that would indicate a need for assistance. (3) Medication. (A) The provider is not required to administer medication but may choose to do so. (B) All medication shall be given to a child only with the dated, written permission of the parent(s) stating the length of time medication may be given. (C) Prescription 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. This may include sample medication provided by a physician. (D) All nonprescription medication shall be in the original container and labeled by the parent(s) with the child’s name, and instructions for administration, including the times and amounts for dosages. (E) All medication shall be stored out of reach of children or in a locked container. (F) Medication shall be returned to storage immediately after use. (G) Medication needing refrigeration shall be kept in the refrigerator in a container separate from food. (H) Medication shall be returned to the parent(s) or disposed of immediately when no longer needed. (I) The date and time(s) of administration, the name of the individual giving the medication and the quantity of any medication given shall be recorded promptly after administration. This information shall be filed in the child’s record after the medication is no longer necessary. (4) Immunizations. (A) No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine-preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration. (B) A child who has not completed all immunizations appropriate for his/her age may enroll, if— 1. Satisfactory evidence is produced that the child has begun the process of immunization (see form at 19 CSR 4061.185). The child may continue to attend as long as the immunization process is being accomplished according to the ACIP/ Missouri Department of Health recommended schedule; or 2. The parent(s) or guardian has signed and placed on file with the day care administrator a statement of exemption which may be either of the following: A. A medical exemption (see form at 19 CSR 40-61.185), by which the child shall be exempted from immunization requirements upon certification by a licensed physician that the immunization would seriously endanger the child’s health or life; or B. A parent or guardian exemption, by which a child shall be exempted from immunization requirements if one (1) parent or guardian files a written objection to immunization with the day care administrator. Exemptions shall be accepted by the day care administrator when the necessary information as determined by the department is filed with the day care administrator by the parent or guardian. Exemption forms shall be provided by the department (see 19 CSR 40-61.185). (C) In the event of an outbreak or suspected outbreak of a vaccine-preventable disease in the facility, the administrator of the facility shall follow the control measures instituted by the local health authority or the department, or both the local health authority and the department. (D) The administrator of each day care facility shall prepare a record of immunization of each child enrolled in or attending the facility. An annual summary report shall be made by January 15 showing the immunization status of each child enrolled, using forms provided by the department (see 19 CSR 4061.185). The immunization records shall be available for review by department personnel upon request. (5) Accidents, Injuries and Emergency Medical Care. (A) In case of accident or injury to a child, the provider shall notify the parent(s) immediately. If the child requires emergency medical care, the provider shall follow the parent’s(s’) written instructions. (B) Information regarding the date and circumstance of any accident or injury shall be noted in the child’s record. (C) When planning for activities away from the facility, the provider shall establish a procedure for handling emergencies. (6) Handwashing. (A) Caregivers shall wash their hands with soap and running water after toileting or assisting a child with toileting, after diapering a child, before food preparation or serving of food and at other times as needed. (B) Caregivers shall teach children to wash their hands before eating and after toileting. AUTHORITY: section 210.221.1(3), RSMo Supp. 1993.* This rule previously filed as 13 CSR 40-62.192 and 19 CSR 40-62.192. Original rule filed March 29, 1991, effective Oct. 31, 1991. Changed to 19 CSR 40-62.192, effective Dec. 9, 1993. Emergency amendment filed Aug. 18, 1993, effective Aug. 28, 1993, expired Dec. 25, 1993. Emergency amendment filed Jan. 4, 1994, effective Jan. 14, 1994, expired May 13, 1994. Amended: Filed Aug. 18, 1993, effective April 9, 1994. Changed to 19 CSR 30-62.192 July 30, 1998. Moved to 5 CSR 25500.192, effective Aug. 30, 2021. *Original authority: 210.221.1(3), RSMo 1949, amended 1955, 1987, 1993.