Sickness policy going against NHS guidance

[Sickofoursmellybins]

I asked to see our nursery’s illness policy today after I heard from another parent that they were asked to keep their child at home until all their spots cleared.
The policy states that with HFM they may ask parents to keep children off nursery despite the NHS guidance saying the may attend if they are not too unwell. It seems unreasonable to me that they may not allow a child with HFM to attend for 1-2 weeks when the NHS has concluded that doing so is pointless. Where do I go from here? Do I have grounds to complain?

Are you sure it's not scabbed over rather than gone? I always thought that was the guidance. As an ex childminder I always set my own policies, it's up to the parents to read them and sign if they agree, if they don't, they find someone else.

I’ve never known any childcare setting accept children with HFM spots. I know what the NHS guidance says, but every setting I know insists children are off until spots have healed. To be fair, it can be quite a nasty virus and DD has had fevers with it in the past so I can see the logic.

I agree. It’s so contagious too.

HFM is incredibly contagious and usually horrifically painful. I caught it twice as an adult off my kids when they were at nursery. All three off us were poorly but it was the pain that was the worst. I would be incredibly concerned if a nursery ALLOWED kids with HFM in.

I used to work in a nursery that let children with HFM in. My dc preschool wouldn't let them in with HFM or if they had been in close contact with chicken pox. My 2nd son ended up having 4 weeks off preschool with chicken pox, 2 while waiting to catch it from his brother and 2 when he got it himself. There were some vulnerable children at that preschool including a child with Edwards syndrome so they had to be particularly careful.

My nursery wouldn’t allow it, same as PP have said.
Even though he caught it from there 😂

Their “sickness policies” are ignored by all and sundry. We had every bug and ailment going it was literally almost every week.

I took him out in end. Childminder has different rules, mostly take it as a case by case depending on the situation

NHS guidance is just that...a guide. Different settings can decide their own policy so there are no grounds to complain or challenge

Personally having had my 18 month old with HFM last year I'm grateful my nursery have a policy of spots faded before returning. It is by far the worst thing he's ever had and so so contagious!

Even if the spots are scabbed over, there may be the odd blister still weeping as the spots came in waves. We all know toddlers pick and are unclean so any chance of skin touching and it'll spread like wildfire.

I'd be grateful they're taking extra precautions to be honest.

Their “sickness policies” are ignored by all and sundry. We had every bug and ailment going it was literally almost every week.

Same at our nursery. So frustrating. We once had a child pull out of a Sunday party last minute as they'd come down with a sickness bug...but they were at nursery on Monday and lo and behold-a vomiting virus took down most of the class that week!!

Nurseries don’t have to follow NHS guidance. They do, however, have to follow the guidance published by Public Health England (or whatever it’s called now), which states that children with HFM can’t be excluded from nursery for any period of time.

I mean, I’m sure some nurseries do exclude, but they could theoretically lose their funding if a parent turned nasty and kicked up a fuss with the local authority. It’s an Ofsted requirement to follow the PHE guidance, therefore the LA would consider it a breach not to.

Ours allows them in with HFM in line with the public guidance here (NI), it's a mixed bag locally I think.

My understanding is that the public health guidance is because it's mainly contagious before symptoms, so once the first child comes out in spots they all probably have it anyway.

It's a frustrating policy OP, but AFAIK it's up to each nursery to set its own policies so you probably have to suck it up.

The government guidelines for UK Health Security Agency does not say that a child cannot be excluded. It merely says as a guide that exclusion isn't necessary but in some cases may be required. PHE may have said something different but now dissolved.

I get that it's frustrating and PP is right that the incubation period is something like 5 days so by the time spots come out they may have already been contagious but my DS felt unwell for 2 days before spots appeared so I absolutely would have sent him in during that period where he would have just passed it all around

But honestly he felt so fucking ill be could barely eat anything so I think nursery was the last thing he wanted poor chap.

You all make excellent points. I think I have focused on the wrong issue here. After reading your answers and reflecting on this I think what I find frustrating is the fact that they don’t have a detail illness policy. Their policy is a very vague list of 4 bullet points with questions like “is my child feeling very unwell?”. What I said about HFM was written by the manager in the body of an email. I don’t mind a rule that says “children with X must stay at home for Y days or until Z symptom is gone”, but I don’t like having to take emergency leave and cancel 3 meetings last minute because I didn’t know whether my child could come in until I showed up at drop off at 8am ask them. Surely parents have a right to know what their policy is?

YANBU about that OP, that's shit.

Ours takes them with HFM as long as they're well enough in themselves - we've had it a few times over the years and sometimes they've been in an awful state, others absolutely fine. Always frustrating when you have to keep a well child home.

You're right OP, that's super frustrating and means if they come down with something over the weekend then you have to wait til Monday or know if they can attend (if they feel well enough)

We have a very detailed policy and some general rules (48 hours exclusion after any D or V) and then a list of illnesses that says whether we need to notify them and what their exclusion policy it's

It's super clear and I'd expect any childcare setting to be able to provide this. That point definitely is worth raising!

And I'm slightly laughing at all the NHS guidance and other official docs saying it is a 'mild illness'. I honestly don't know anyone whose child has had it who hasn't said it's one of the worst things they've been ill with!

@JimandPam DD went to a different nursery last year and they also had something like that. It was a 2 page document. A long table with all the common nursery illnesses and an exclusion period for each one. As you said, it meant we could plan accordingly and were not nervous about having to persuade someone at the door on Monday morning, when neither the carers or myself are doctors. How can I be sure that every member of staff is going to follow the same criteria over time across all children when there’s no clear policy? I had someone tell me that DD, who had a mild case of conjunctivitis, couldn’t go back until she had the drops. She had a swab and it was viral!
I need to organise my thoughts and write a good email to challenge this point…

@JimandPam yep that happened to us as well. Wiped us all out, I was livid 😂 twice in 3 months it happened!
I have a rampant fear of sick bugs which didn’t help.
The staff were all off with it as well so there was talk of closing… Shambles.

In the end I developed such anxiety and I was having to take unpaid leave AND still pay even though he was banished.
I was on a warning at work for being sick too much 🤦🏼‍♀️

I removed him, we have a childminder now. Life changing it was and that’s no exaggeration

Like PP said though, their sickness policy was very specific it listed pretty much every eventuality.

The issue was people ignored it, sent them in regardless and by the time anyone noticed and sent the poor dabs home that was it, it’s already spread

Ah kids aye, it’s all fun and games

It says ‘none’ under exclusion period, unless the local health team is involved and considers it necessary:

https://www.gov.uk/government/publications/health-protection-in-schools-and-other-childcare-facilities/children-and-young-people-settings-tools-and-resources

As a nursery owner, it’s not something I would be willing to risk losing my funding over.

@User8646382 Thank you for your insight. Does it say anywhere that nurseries must follow the advice in the link you shared? They could tell me that’s just guidance and they can set their own policy.

I think it's all just guidance.

Even state schools don't always follow those timelines in the link - some say 24 hours for D&V for example (because they're worried about attendance figures). So I imagine a private business like a nursery can choose not to follow it.

They don't have to follow the guidelines- they're just that; guidelines, not a legal requirement. If their policy states that they can't go in then so be it.I don't allow them.in at my setting.
HFM can be extremely painful- one of my little ones had it two weeks ago. His mouth was full of blisters and he didn't eat for 4 days. He spent a lot of his time crying. To allow a child to attend a setting whilst suffering from it, and pass it on to others is just ridiculous and inconsiderate.

@hookiewookie29 I am not trying to create a public health hazard. I know it’s painful. I know it’s contagious. I know it’s cruel to send a poorly child with HFM to nursery. However, having a policy that says children cannot come back until all their spots have cleared can potentially force parents to keep a child at home who for weeks after their symptoms have improved and they feel fine and this will not stop HFM from spreading, because it has been shown HFM is most contagious before children show symptoms and the first 5 days after symptoms start.

They should leave public health related decisions to public health experts. If UKHSA thinks an exclusion period is ineffective, a nursery does not have the expertise to override that recommendation, in my opinion.

They should leave public health related decisions to public health experts. If UKHSA thinks an exclusion period is ineffective, a nursery does not have the expertise to override that recommendation, in my opinion

But the guidance is very top level blanket guidance. Your annoyance seems to be that there appears to be some flexibility ie they MAY exclude them for this period, it doesn't mean they will. It might be the case that as it's so contagious it's pointless excluding which is why the guidance is what it is; but it's also possible that for some children the scabs are painful and peeling, and it leaves the nursery the chance to assess on an individual basis - which is far more flexible. Appreciate it's a nightmare juggling work and poorly children, but yes it'd be wild to complain about a policy that you haven't even had to deal with.

I agree with pp that you are fixated on the wrong issue. You would be wild to complain about this. Those of us who have had HFM in our household are telling you what an awful disease it is and nobody really knows when the 5 days starts from (mine for example were not unwell and just suddenly got spots and nose dived) so it's better to be safe than have an outbreak

In my experience 'spots gone' generally means when all are scabbed and healing has started. Once they scab over they heal up quite quickly but leave dry skin that will often peel off

I think most nurseries take a practical approach that if the child is feeling much better, spots are scabbed and starting to drop off then they can return. Both of mine have had HFM and were off for a week

You would not be wrong to chase up the full policy though

I suppose you could argue that the UK Health Agency ‘guidance’ isn’t mandatory. However, my experience is that Ofsted expect to see that ‘guidance’ on the parent notice board when they inspect and that if it’s not there and being practiced, you are penalised for it. I remember once being told by an Ofsted inspector that if I had the ‘exclusion poster’ (which was at the time published by PHE) on the board by the end of the inspection, she would turn a blind eye to the fact that it wasn’t there at the beginning. They expect you to follow it.

I’m honestly not sure what the repercussions would be of a nursery ignoring the guidance if a really nasty parent decided to complain that their child was ‘excluded’ and ‘discriminated against’. If the parent was determined enough, I think the local authority would side with them and that could jeopardise the nursery’s funding. There’s no way I’d risk it. It’s far easier to follow the ‘guidance’.

It's not just your own poorly child though, nor just the other children. Nursery staff aren't immune from HFM, D&V, etc etc so they need policies to try and keep their staff well too so that they can actually open to look after your child.

I've never been as sick as I have been when working with young children and it is so frustrating when kids are sent in and they are clearly not well, or have been told to lie by their parents because they have to go to work. How would you feel if someone with a contagious illness came into your office and coughed in your face, licked you, sneezed on you all day or wanted to come and just be close to you because they weren't feeling well and had been vomiting.