BACKGROUND: Temporary exclusion of ill children is a complex decision and strategy for mitigating transmission of harmful diseases in school and childcare settings. Anecdotes suggest exclusion decisions are made by individuals without formal training to perform health assessments and may result in unnecessary or prolonged absences. California state guidance standardized approaches for managing COVID-19 in school/childcare settings; analogous guidance for other illnesses has been requested.

METHODS: A literature review and needs assessment were conducted to understand the current landscape for managing children with symptoms of illness in school and childcare settings. A survey was conducted to assess accessibility and utility of existing guidance and determine who within the school/childcare community determines exclusion. An expert panel comprising school nurses, physicians, and public health officials was then convened to draft guidance which will be vetted with state and local health, K-12 education, and childcare partners.

RESULTS: 556 survey responses were received with >1 response from 87% (53) of California’s 61 local health jurisdictions. 67% of respondents noted that school staff without licensed health training make determinations for temporary exclusion for symptomatic children. Nearly three-quarters (299/410; 73%) of respondents rated potential statewide symptom-based guidance as “very” or “extremely useful”. School/childcare lay staff were identified as the primary audience.

CONCLUSIONS/NEXT STEPS: Survey findings demonstrated a need for guidance and clarified the current landscape and target audience. Stakeholder engagement has informed the development process, and work is ongoing to produce guidance that supports the goal of safe, in-person instruction in school and childcare settings.