CMs - would you exclude for a cold sore?

[ZuleikaD]

Child and her 14m sibling have just been dropped off, and I only noticed after their mother was gone that the child has what appears to be a crusted cold sore on her lip. I have three other children in the setting, including the child's brother and another under-1, and I don't know if I can adequately supervise all day to ensure she doesn't kiss or contact another child. WWYD? Also, the mother isn't returning my phone calls or texts.

HPA guidance is not to exclude

Tricky one

Prob have to accept for now and write into your sickness policy for future?

What does your sickness policy say?

Are you sure it's a cold sore? DS had a crusty scab on his lip this week it was from putting his teeth through his lip in a fall. Could have been mistaken for a cold sore, FWIW nursery didn't mention it and I forgot to say about it.

On the other hand if it is a cold sore it's not something I'd be happy for my child to pick up at childminders.

I've got splinters in my arse from fence sitting

Sometimes children get impetigo around their lips, which should be excluded according to hpa guidance, so you need a diagnosis either way.

I wouldn't be happy for my children to be exposed to cold sores before they are old enough to understand not to touch it.

Really, exclusion for a cold sore?!I would be fuming if I was asked to collect my child for this reason as it is not an excludable illness. Children are exposed to cold sores in all walks of life, visiting friends, nursery, tots groups, soft play etc. Children who are exposed to this in their own family don't necessarily get it when exposed on a regular basis so why exclude from your setting?

I'm not a CM and I'm not usually a fussy mum with contagious diseases, I take the view they're going to catch them sometime.

However, I would want other children excluded for a coldsore (and would keep mine away from others) because once you get one you're stuck with them for life.

If it was me, I wouldn't want my children exposed to catching a cold sore (and I speak as someone who gets them very occasionally and HATES them). However, I don't think you can legitimately exclude a child for this. All you can do is be as vigilant as its realistically possible to be...

If a CM puts in in their policies, then they can exclude for it.

How old is the child? Are they old enough to understand no contact with other children?

Can young children use those patches to cover coldsores? That could be a good compromise. Otherwise I would say that any contagious infection is excludable. It may seem minor to someone who gets them occasionally, but especially the first time they can make people, especially young children very I'll indeed.

Sorry, lots of especiallys! Very ill indeed.

I can't believe you are all so sanguine about this. I would think that this is something you can and should exclude - unlike things like a respiratory virus they are not an inevitable thing to have to to go through, and the infection is permanent. I would be furious if a dc of mine got a cold sore at the CMs.

At the very least I think you need to tell the other parents and give them the choice. If I had to, I would stay at home with my dcs rather than they got coldsores

Can be fatal to newborn babies, I have known of a baby who died in hospital from this. And maternity staff are advices against working with cold sores. But to be honest not sure re toddlers. Do nurseries exclude for this reason?

No, nursery is the same, not excludable, best practice is to follow HPA guidance for infection control and other childcare settings. (There is a downloadable pdf)

If I notice a child had a crusted sore on their face, I contact one of their parents without hesitation (it's happened just once).

My first was/would be impetigo, which is highly contagious and for which children should be excluded. If for no other reason OP, you should ask that a parent collect the child so that impetigo can be ruled out.

The parent I contacted wasn't pleased, and it turned out not to be impetigo - but I insisted that impetigo should be ruled out before the child returned to the setting.

I hadn't considered cold sores as I've never cared for a child with one, and as people say it's not an excludable condition. BUT, having read this thread and gone onto WebMD to check it out, I'm going to add it to the list of conditions I will exclude for - HPA guidance notwithstanding.

The virus that causes cold sores can't be cured - once you've got it, you've got it.

It isn't just a matter of children kissing and touching each other (and you), which of course you can't prevent; the virus can be spread through shared touched items such as eating utensils - and toys.

I wouldn't want other children in my setting put at risk of contracting the virus, and I certainly wouldn't want to contract it myself.

Any parent who was 'fuming' at being asked to collect their child because of a cold sore or any other suspect sore would just have to fume

It can also cause serious complications for a child with eczema. I would want a diagnosis and I would talk very seriously to a non-contactable parent when he or she finally gets in touch. That is absolutely not acceptable and I would want a very good reason for it or I'd consider giving notice.

Cold sores are not transfered on utensils otherwise whole households would be affected which they are not. I would hope that based on this every childcare worker, cm etc would exclude themselves from work Iif they get a cold sore. Hpa guidelines are resesrched andvalidated.

2plus1 -I would consider not working if I had a contagious eruption on my face, yes.

However, as an adult I know I could avoid touching my sore, kissing and dribbling on my charges or putting in my mouth toys and other items which would subsequently almost certainly be sucked by children - so I'd probably work.

If cold sores can't be transferred on such things as shared utensils and other items that touch the mouth, a number of apparently reputable health information websites are giving out incorrect information.

I'm a cm and recently had a cm child with a cold sore. I only cm for one family and my own young children are here. I didn't exclued but was really worried my own young dc would get one, I didn't think it would be a valid reason to exclude and I never thought to write it in my policy to exclude. I think if I went back to the family and said if she gets another one she can't come they would kick off. I was really strict and tbh the little girl probably had a naff time with me that week, as I was forever stopping her hugging her friends and stopping her from touching her face, getting her to wash her hands, but no one else caught it so I was really relieved.

Thanks everyone for your thoughts - really useful. I didn't exclude her but was on her case the whole time to make sure she didn't kiss any of the other children (particularly the babies). I am concerned that I haven't been diligent enough about disinfecting stuff she touched though, especially as the NHS website says it can be contracted through touching a shared toy or something. However, I'll just have to fret until the incubation period is over and see whether any of the others have got it.

I'm not sure if my policies would cover this or not. Mine say that any cuts wounds or sores which might bleed or weep need to be covered, and that if they cannot be covered for whatever reason, the baby/child must stay away until they are fully healed. Would that work for cold sores? I think I have been lucky not to encounter any, but I do know they are highly contagious, so maybe they would be covered in any case by the general exclusion of babies/children with contagious infections?.