HEALTH HISTORY AND IMMUNIZATION POLICY for children
Resources for Child Care Givers
Provided by All Family Resources

You need to know the health history of, and medical emergency information for, every child in your care. When a child enrolls in your child care facility, you should find out:

• Where parents can be reached--full names and work and home phone numbers and addresses.
• At least 2 people to contact if parents can't be reached--phone numbers and addresses.
• The child's regular health care providers--names, addresses, and phone numbers.
• The hospital that the child's family uses--name, address, and phone number.
• The date of the child's last physical examination. Any child who has not had a well baby or well child examination recently (within the past 6 months for children under 2 years old and within 1 year for those 2 to 6 years old) should be examined within 30 days of entering your child care facility.
• Any special health problems or medical conditions that a child may have and procedures to follow to deal with these conditions. Examples of conditions needing procedures are allergies, asthma, diabetes, epilepsy, and sickle cell anemia. These conditions can cause sudden attacks that may require immediate action. You should know 1) what happens to the child during a crisis related to the condition, 2) how to prevent a crisis, 3) how to deal with a crisis, and 4) whether you need training in a particular emergency procedure.
• The child's vaccination status.
• Whether the child has been evaluated with a TB skin test (using the Mantoux method with tuberculin purified protein derivative (PPD)).

You should require that all children admitted to your care be up to date on their vaccinations. Laws in many states require you to have written proof of each child's up-to-date vaccinations. Children attending child care especially need all of the recommended vaccinations to protect themselves, the other children, the child care provider, and their families. Several diseases that can cause serious problems for children and adults can be prevented by vaccination. These diseases are chicken pox, diphtheria, Haemophilus influenzae meningitis, hepatitis A, hepatitis B, influenza, measles, mumps, polio, rubella (German measles or 3-day measles), tetanus, and whooping cough (pertussis). Many of these diseases are becoming less common because most people have been vaccinated against them. But cases still occur and children in child care are at increased risk for many of these diseases because of the many hours they spend in close contact with other children.

Children who are not up to date on their vaccinations should be taken out of child care (excluded) until they have begun the series of shots needed. In the absence of an outbreak, they may usually continue to attend child care as long as they continue to receive the shots as recommended. Many states require that children whose vaccinations are not up to date be excluded from group care. Each child in your care should have a certificate of up-to-date immunization in your files. In many states this is a legal requirement and blank certificates are supplied by the state. Example certificate is shown on the next page.

The certificate should state that the child is up to date for immunizations, list the date when the next immunization is due (the date the certificate expires), and be signed by the child’s health care provider. As the date when the next immunization is due approaches, you should remind the child’s parents of the pending immunization and request a new immunization certificate. If the child is exempt from vaccination because of a medical condition or religious objection, this should be noted on the immunization certificate and supported in the child’s file with documentation from the physician or religious authority. Many states include the date of each immunization on the immunization certificate. Rapid access to this information can be very useful during an outbreak.

The following table lists the current recommended schedule for routine immunization of infants and children. Because this schedule changes frequently, you should contact your local health department for annual updates.

Recommended Childhood Immunization Schedule United States, July - December 1996 Vaccines are listed under the routinely recommended ages. Bars Indicate range of acceptable ages for vaccination. Shaded bars indicate catch-up vaccination: at 11-12 years of age, hepatitis B vaccine should be administered to children not previously vaccinated, and Varicella Zoster Virus vaccine should be administered to children not previously vaccinated who lack a reliable history of chickenpox.

Approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).