Health & Illness

Prevent illness in your child care business

Diseases can spread easily and quickly in child care environments, and children are more susceptible to some illnesses. This is because children have less developed immune systems, may not have received all of their vaccinations, are in close contact with many other children, and are still learning healthy habits. Here is an activity booklet to help children learn to stay healthy.

The Snohomish County Health Department Child Care Health Outreach program helps child care owners and workers with the challenge of preventing illness and maintaining sanitary child care environments. We offer on-site visits and consultations, distance learning classes, and resources.

Immunization Information for Child Care

Illnesses in child care

When to send a child or worker home: Exclusion guidelines

In group settings, illness can spread rapidly. Child care providers are encouraged to call the Child Care Health Outreach program at Snohomish County Health Department to discuss guidelines for observing, responding to, and reporting symptoms of illness. Our qualified staff can:
  • Advise on when a child is too sick to be in care
  • Advise on when a child or staff member can return after an illness
  • Provide sample notification letters for specific illnesses
  • Support and educate staff and families during a communicable disease outbreak

Brochure: Dealing with Illness in child care settings (click to download)

Child Care_Help Stop Spread of Illness Poster_PHSKC Opens in new window
(click thumbnail to download poster)

Telling public health & parents about an illness

Child care providers are required by law to report certain diseases called notifiable conditions to Snohomish County Health Department. If the disease is on the list of notifiable conditions, or if there is a cluster of any illness suggesting a possible outbreak, it should be formally reported to the Communicable Disease program at 425.339.3503.

Although some diseases may not require reporting, child care providers are welcome to call for advice. If the disease is not on the list of reportable conditions, or if you are unsure, call our program line at 425-252-5415. 

Parents must also be notified when their child has been exposed to a communicable disease. 


We provide fact sheets on a variety of illnesses for child care providers to use to notify parents when there is an exposure. The "Keep Me Home If" poster is available in a variety of languages here.

Child care health policies & guidelines

Child care licensing regulations state that every program must have a current, written health policy. We encourage child care and early learning programs to have their health policy signed by a licensed health professional such as a child care nurse consultant. Revising your policies periodically is important to make sure that they remain current with the latest regulations and guidance. We recommend updating your health policy at least every 3 years.

Our Child Care Center and Family Home Health Policies have been updated to reflect the 2019 update to WAC 110-300 and the most recent best practice standards outlined in Caring for Our Children, National Health and Safety Performance Standards, 4th Ed.  The School Age Health Policy has been updated to reflect new school age regulation, WAC 110-301, effective June 2021. You can access the health policies through the links below. After opening the document, you may have to click "View" in the top bar on Microsoft Word and select "Edit Document." This will allow you to fill out and make selections on the form to customize it for your child care or early learning program.

For Snohomish County child care providers, the Child Care Health Outreach program staff will review and sign your health policy at no cost, provided that you use the most current template above. Once you have finished filling in your policy, email the document back to us. We will review it and contact you to set up a time to meet virtually or at your child care and complete the process to ensure that your health policy meets best practices. 

For out of county child care providers or those utilizing a child care health consultant, this document can only be revised (red font removed, changes made, etc) by a registered nurse or other qualified health care professional. Have your child care health consultant contact our program to obtain editing privileges at If you have questions or need assistance with this, please let us know.

In addition to a health policy, you may need some or all of the following supplemental policies and forms.

Health Plans

Many children in child care settings have special health and behavioral needs that require additional attention and resources. Children with special health care needs are defined by the American Academy of Pediatrics (AAP)  as “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” The AAP also supports that these children should have health care plans that are completed by the child’s primary care provider. The Child Care Health Outreach Program supports the best practice of having a health professional complete the necessary plans, and having a child care health consultant involved in the application of the plan to the child care setting. Most of the forms below were developed by ECELS (Early Childhood Education Linkage System), a program offered by the Pennsylvania Chapter of the American Academy of Pediatrics. for more detailed information on how to fill out the special care plan or which forms are needed when, please refer to the Care Plan Instructions sheet. 

Individual Care Plan Forms:

 All three of the following forms should be provided to the primary care provider for completion for any child with special health needs.

Special Care Plans:

Some conditions such as asthma, severe allergies, or behavioral challenges require an additional “special care plan” to provide further guidance. You should include the following plans for these diagnoses:

Medication Forms:

When children require medications to manage their health symptoms, the following forms are also required, as applicable:


Lead is a common metal that has been used in products for hundreds of years. It is a naturally occurring heavy metal that is toxic when it enters our bodies. Although the use of lead in house paint, gasoline, and drinking water pipes has been reduced or eliminated, old and new products containing lead can still be found in our environment. Lead remains a problem in Washington State and Snohomish County. Did you know there is no safe level of lead? For more information see the following brochure Lead Risks in Child Cares Brochure.


Child care providers, teachers, or managers may come in contact with blood or potentially infectious body fluids as part of their work with young children. Illnesses such as hepatitis B, hepatitis C, or HIV can be transmitted through blood or certain body fluids. Child care providers must use Universal Precautions to protect themselves from becoming infected. The Washington State Department of Labor and Industries requires child care providers to have a Bloodborne Pathogen Exposure Control Plan to help protect staff. A model policy is included here.