Vomiting, diarrhoea and the 48 hour rule - CareforKids.com.au®
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Vomiting, diarrhoea & the 48 hour rule

Know when your child can be excluded from child care


Most schools and preschools now have a 48-hour quarantine for vomiting, diarrhoea and some other infectious diseases.

This means that if your child vomits at child care, he or she will be sent home and may not go back for 48 hours until the virus has passed and is unlikely to bring the entire place into a mass of vomiting children.

It can be extremely frustrating when you're a working parent and you need to get back to work. Most children have the odd vomit or upset stomach - either from over-eating, nerves, over-heating or for absolutely no particular reason. There is usually absolutely nothing wrong with them at all.

However, vomiting and diarrhoea are also symptoms of some very infectious diseases, the spread which can be reduced by excluding the infectious child from contact with others who are at risk of catching the infection.

The following are recommended minimum periods of exclusion from school, preschool and child care centres for cases of, and contact with, infectious diseases, based on guidelines issued by the National Health and Medical Research Council in December 2005 and the tenth edition of the Australian Immunisation Handbook.

The need for exclusion depends on:
  • The ease with which the infection can be spread
  • The ability of the infected person to follow hygiene precautions
  • Whether or not the person has some immunity to the infection (either from vaccination or past infection)
  • To a lesser extent, the severity of the disease.
A person who is not excluded may still need to remain at home because they do not feel well.

NB: if a child care worker has gastroenteritis, the exclusion period is for at least 48 hours after the vomiting and/or diarrhoea have ceased.

Exclusion periods

The following table shows the recommended exclusion periods from child care, preschool and school. You’ll most likely never need to know most of these, particularly if your child is vaccinated, but it’s worth having a look for the more common diseases.
Disease or condition Exclusion of case Exclusion of contacts
Amoebiasis (Entamoeba histolytica) Exclude until no diarrhoea for 24 hours Not excluded
Campylobacter infection Exclude until no diarrhoea for 24 hours Not excluded
Chickenpox See Varicella-Zoster Not excluded
Cytomegalovirus infection (CMV) Exclusion is not necessary Not excluded
Conjunctivitis Exclude until discharge from eyes has stopped (unless doctor has diagnosed non-infectious conjunctivitis) Not excluded
Cryptosporidium infection Exclude until no diarrhoea for 24 hours Not excluded
Diarrhoea (no organism identified) Exclude until no diarrhoea for 24 hours Not excluded
Diphtheria Exclude until medical certificate of recovery is received following at least two negative throat swabs, the first not less than 24 hours after finishing a course of antibiotics and the next 48 hours later Exclude contacts living in same house until cleared to return by appropriate health authority
Food poisoning Exclude until well - no vomiting or diarrhoea for 24 hours Not excluded
Giardiasis Exclude until no diarrhoea for 24 hours Not excluded
Glandular fever (infectious mononucleosis, EBV infection) Exclude until no diarrhoea for 24 hours Not excluded
Hand, foot and mouth disease Exclude until all blisters are dry Not excluded
Haemophilus influenzae type b (Hib) Exclude until person has received appropriate antibiotic treatment for at least 4 days Not excluded
Head lice (pediculosis) Exclude until appropriate treatment has commenced Not excluded
Hepatitis A Exclude until medical certificate of recovery is received, and until at least 7 days after onset of jaundice or illness Not excluded
Hepatitis B Exclusion is not necessary Not excluded
Hepatitis C Exclusion is not necessary Not excluded
Herpes simplex (cold sores, fever blisters) Young children and others unable to comply with good hygiene practices should be excluded while lesion is weeping. Lesions should be covered by a dressing where possible Not excluded
Human immunodeficiency virus (HIV/AIDS) Exclusion is not necessary. If the person is severely immuno compromised they will be vulnerable to other people's infections Not excluded
Hydatid disease Exclusion is not necessary Not excluded
Impetigo See School sores  
Influenza and influenza-like illnesses Exclude until well Not excluded
Legionnaires' disease Exclusion is not necessary Not excluded
Leprosy Exclude until approval to return has been given by an appropriate health authority  
Measles Exclude for at least 4 days after the onset of the rash Immunised and immune contacts are not excluded. Non-immunised contacts of a case to be excluded from child care until 14 days after first appearance of rash in last case, unless immunised within 72 hours of first exposure during infectious period with first case. All immuno compromised children should be excluded until 14 days after first day of appearance of rash in last case
Meningitis (bacterial) Exclude until well and has received appropriate antibiotics Not excluded
Meningitis (viral) Exclude until well Not excluded
Meningococcal infection Exclude until appropriate antibiotic treatment completed and until well Not excluded
Molluscum contagiosum Exclusion is not necessary Not excluded
Methicillin resistant Staphylococcus aureus (MRSA) skin infection Exclusion is not necessary unless infected skin lesions on exposed surfaces cannot be completely covered with a dressing. Not excluded
Mumps Exclude for 9 days after onset of swelling Not excluded
Norovirus See Viral gastroenteritis  
Parvovirus infection (Fifth disease, erythema infectiosum, slapped cheek syndrome) erythema infectiosum, slapped cheek syndrome)   Not excluded, but people who are anaemic, immunocompromised, or pregnant should be informed of possible risk of getting infection
Pertussis See Whooping cough Not excluded
Respiratory Syncytial Virus Exclusion is not necessary Not excluded
Ringworm/tinea Exclude until the day after appropriate treatment has commenced Not excluded
Ross River virus Exclusion is not necessary Not excluded
Rotavirus infection Exclude until no diarrhoea for 24 hours  
Rubella (German measles) Exclude until fully recovered or for at least 4 days after the onset of the rash Not excluded
Salmonella infection Exclude until no diarrhoea for 24 hours Not excluded
Scabies Exclude until the day after appropriate treatment has commenced Not excluded
Scarlet fever See Streptococcal sore throat  
School sores (impetigo) Exclude until appropriate treatment has commenced. Any sores on exposed surfaces should be completely covered with a dressing Not excluded
Shigella infection Exclude until no diarrhoea for 24 hours Not excluded
Shingles See Varicella-Zoster  
Streptococcal sore throat (including scarlet fever) Exclude until the person has received appropriate antibiotic treatment for at least 24 hours and feels well Not excluded
Thrush (candidiasis) Exclusion is not necessary Not excluded
Toxoplasmosis Exclusion is not necessary Not excluded
Tuberculosis Exclude until medical certificate is produced from appropriate health authority Not excluded
Typhoid, Paratyphoid Exclude until approval to return has been given by an appropriate health authority Not excluded unless considered necessary by public health authorities
Varicella-Zoster (chickenpox and shingles) Exclude until all blisters have dried (usually 5 days) Any child with an immune deficiency (for example, leukaemia) or receiving chemotherapy should be excluded for their own protection. Otherwise, not excluded
Viral gastroenteritis (viral diarrhoea) Exclude until no diarrhoea for 24 hours Not excluded
Warts (common, flat and plantar) Exclusion is not necessary Not excluded
Whooping cough (pertussis) Exclude from child care, school or workplace and similar settings until 5 days after starting antibiotic treatment, or for 21 days from the onset of coughing Household and child care contacts (in the same child care group) of the case who have received < 3 doses of a pertussis containing vaccine should be excluded from child care for 14 days from the last exposure to the infectious cases, unless they have already completed 5 days of recommended antibiotic treatment, in which case they may return
Worms Exclude if diarrhoea present Not excluded
Yersinia infection Exclude until no diarrhoea for 24 hours Not excluded
If you find that your child is excluded and you need to work click here for our sick day and emergency child care tips on what to do with the kids when you are working?
Sources: National Health and Medical Research Council, Australian Immunisation Handbook 2013, SA Health.
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