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When can a sick child return to nursery? The rules parents need

date 27/08/2026
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If your child has had vomiting or diarrhoea, keep them away from nursery for a minimum of 48 hours after the last episode, under UKHSA guidance. That single rule sits at the heart of every nursery sickness policy in the UK. Most mild coughs and colds don’t need exclusion at all, provided your child can join in and has no fever. Before you decide, run this quick “well child” check:

  • Can they take part in normal activities without struggling?
  • Are they free of fever?
  • Do they need medication just to get through the session?

If the answer to that last question is yes, they’re not well enough for nursery yet.

Key Takeaways

A safe return to nursery after illness depends on following the 48-hour rule for sickness bugs, judging your child’s true readiness against a simple ‘well child’ check, and choosing a setting with a clear, written policy.

Point Details
48-hour rule is non-negotiable Keep children off for 48 hours after the last episode of vomiting or diarrhoea.
Use the well child test Check they can join activities, have no fever, and don’t need medicine to get through the day.
Most coughs and colds don’t need exclusion NHS guidance confirms mild symptoms rarely require keeping a child home.
Know the red flags Dehydration signs, persistent high fever, or breathing difficulty mean calling NHS 111 or 999.
Ask to see the written policy Thesunflowernursery shares its sickness and exclusion policy with families at enrolment, alongside daily journal updates.

Table of Contents

Day one actions: what to tell your nursery and what happens next

The moment your child shows symptoms, your nursery needs specific information, not a vague “she’s not feeling herself.” Give the team:

  1. The exact symptoms and when they started (fever from 6am, vomiting once at breakfast, and so on).
  2. Current medication given, including dosage and time, so staff aren’t caught off guard mid session.
  3. Emergency contact details, confirmed and up to date, in case you need to be reached quickly.

Nurseries following the Statutory Framework for the Early Years Foundation Stage must have a procedure for responding to ill or infectious children, agreed with parents in advance. This isn’t paperwork for its own sake. It means staff know exactly when to refuse admission (a child needing constant one-to-one care they can’t provide that day), when to call you mid session because a child has deteriorated, and how to log the incident accurately. Expect a written record of symptoms, time of onset, and any medication administered, kept as part of the child’s file. If your nursery can’t describe this procedure clearly, that’s worth asking about before you sign up.

How long should my child stay off nursery for common illnesses?

Most parents want a simple answer, and for the big one, there is one: diarrhoea and vomiting mean 48 hours off after the last episode, full stop. If your child was sick at 3pm on Monday, they can return after 3pm on Wednesday, provided there’s been no further episode in that window.

Beyond that rule, exclusion periods vary by condition. Gov and nursery-level policies such as Oxford Brookes nursery’s exclusion guide set out the common ones:

  • Chickenpox: usually excluded until all spots have crusted over, typically around 5 days from the rash appearing.
  • Hand, foot and mouth disease: usually no exclusion needed if your child is well enough to take part, despite the spots and mouth ulcers looking alarming.
  • Conjunctivitis: usually no exclusion required, though some settings ask for treatment to have started.
  • Head lice: no exclusion needed. Treat at home and send them in.
  • High temperature or flu-like illness: NHS guidance on when a child is too ill for school suggests keeping them home until the fever has settled without medication.

These are general timelines, not guarantees for every case. Babies under 12 months, children with weakened immune systems, or those with underlying health conditions sometimes need bespoke advice from a GP or health visitor rather than a blanket rule. During a confirmed outbreak of something more serious, such as scarlet fever or a notifiable disease, your nursery may need to follow specific instructions from the local health protection team, which can extend or shorten the usual exclusion period. If you’re ever unsure which category your child’s illness falls into, ring the nursery. A two-minute phone call beats guessing.

When should I call NHS 111 instead of nursery?

Some symptoms need a healthcare professional’s input before you think about nursery at all. Call NHS 111 if your child shows:

  • Signs of dehydration (fewer wet nappies, a sunken look to the eyes, unusual drowsiness).
  • A high fever that isn’t easing with paracetamol or ibuprofen.
  • Severe drowsiness or difficulty waking.
  • Breathing that looks laboured or fast.

Call 999 or go to A&E immediately for convulsions, blue lips, or a rash that doesn’t fade under a glass, as these need emergency assessment.

Pro Tip: Once you’ve spoken to NHS 111 or a GP, pass that advice straight to your nursery. Telling them “111 advised keeping her home until the fever’s gone” gives staff the context they need and avoids repeated phone calls chasing updates.

Can I give my child Calpol and send them to nursery anyway?

Most nurseries ask parents to complete a written consent form before staff administer any medicine, including simple things like paracetamol, and staff will only give what’s written on that form, at the times specified.

There’s a more important principle behind the paperwork, though: fever-reducing medicine masks symptoms, it doesn’t treat the underlying illness. A child dosed with Calpol to get them through the nursery day is often still infectious and still not well enough to be there. NHS guidance on fever in children is clear that a persistent fever needs monitoring, not covering up. Many settings will ask directly, “Have they had anything to bring their temperature down this morning?” and will decline admission if the answer is yes and the fever was significant. When you’re unsure, try: “She’s had a slight cough overnight but no fever since yesterday evening, is that okay to bring her in?” That kind of specific, honest question gets you a clear answer rather than a guessing game at the door.

What does a nursery’s sickness and exclusion policy usually include?

A properly written policy answers the questions parents actually ask, rather than reading like a legal disclaimer. Expect to see:

  1. Notification requirements: how and by when you must tell the nursery about illness.
  2. The 48-hour rule for diarrhoea and vomiting, spelt out with a worked example (symptom-free from 2pm Thursday means return from 2pm Saturday).
  3. Medicine consent procedures, covering what staff will and won’t administer.
  4. Collection expectations: how quickly you’re expected to arrive if called during the day.
  5. A link to EYFS duties, showing the policy isn’t invented on the spot but reflects a statutory requirement.

At Thesunflowernursery’s Ilford and South Woodford settings, parents are asked for up-to-date emergency contacts, GP details, and any relevant medical information at enrolment, then given daily updates through the online journal so nobody is left wondering what happened during the day.

Pro Tip: Ask any nursery you’re considering to show you their written sickness policy before you sign up. A setting with nothing in writing is a setting improvising on the day your child gets sick.

Do nursery staff have their own illness and vaccination rules?

Yes, and it works both ways. A nursery asking parents to keep unwell children at home has little credibility if staff are working through the same symptoms. Reputable settings apply comparable exclusion expectations to their own team: staff experiencing diarrhoea or vomiting stay off for the same 48-hour window, and anyone with a contagious condition such as chickenpox or conjunctivitis follows the same guidance given to families.

Vaccination is a more nuanced area. There’s no single blanket legal requirement forcing early years staff to hold specific vaccinations to work in a UK nursery, though many settings strongly encourage seasonal flu jabs and up-to-date routine immunisations, particularly given how much close contact the role involves with very young children and babies who aren’t yet fully vaccinated themselves. Staff are also expected to disclose relevant health conditions during recruitment and ongoing employment, and settings maintain sickness absence records as part of their wider health and safety obligations.

What matters most to parents in practice is transparency rather than policy documents. A nursery that tells you plainly, “Two of our team are off with a stomach bug this week, so ratios are slightly different today,” is being straightforward about a normal part of running a childcare setting. One that says nothing and hopes you don’t notice is a bigger concern than the illness itself. Ask, when you’re choosing a setting, how staff sickness is managed and whether it ever affects ratios or continuity of key workers.

Do nursery staff have their own illness and vaccination rules? — overview diagram

How do nurseries handle an outbreak of illness?

Staff spraying disinfectant on nursery toys

When several children fall ill with the same thing within a short window, most settings shift from individual case management into outbreak mode. That typically means notifying all parents that a specific illness is circulating, often with the exact condition named (rather than a vague “there’s a bug going round”) so you can watch for symptoms.

Nurseries usually increase cleaning frequency on high-contact surfaces, review whether affected rooms need temporarily separating from the rest of the setting, and check exclusion dates more strictly during the outbreak period than they might for an isolated case. For anything beyond a routine stomach bug, particularly a suspected notifiable disease, gov.uk guidance directs settings to contact their local health protection team, who can advise on extended exclusion periods, additional hygiene measures, or in rare cases wider public health steps.

Communication is what separates a well-run outbreak response from a chaotic one. Parents should hear from the nursery promptly, through whatever channel the setting normally uses (a note at pickup, an app notification, an email), rather than finding out secondhand from another parent at the school gate. A good outbreak update tells you what’s circulating, what symptoms to watch for, and what the nursery is doing about it, so you can make an informed choice about whether your own child’s minor sniffle is something to mention.

What cleaning and hygiene routines actually reduce illness spread?

Handwashing remains the single most effective everyday habit in a nursery setting, and it’s also the cheapest. Staff typically prompt children to wash hands before meals, after using the toilet, after outdoor play, and after nose-wiping, building the habit into the daily rhythm rather than treating it as an occasional reminder.

Beyond hands, settings focus cleaning effort on the surfaces babies and toddlers actually touch and mouth: toys, table surfaces, door handles, and nappy-changing areas. Toys used by babies are typically cleaned daily and immediately if visibly soiled or mouthed by a child later found to be unwell. Nappy-changing areas follow a strict clean-between-every-change routine, with staff using gloves and disposing of waste separately from general rubbish.

None of this eliminates illness entirely, nursery settings bring young immune systems into close daily contact by design, but consistent hygiene routines measurably reduce how far and how fast common bugs spread through a room. It’s worth asking, when you tour a setting, how often toys and surfaces are cleaned and whether that routine changes during a known outbreak.

Do siblings or other household members need to stay home too?

Generally, no, unless the sibling also has symptoms themselves. A nursery sickness policy applies to the child who is unwell, not automatically to their brothers or sisters attending the same or a different setting. If one child in the family has diarrhoea and vomiting, siblings without symptoms can usually continue attending as normal.

There are exceptions worth knowing. During a confirmed outbreak of something more serious, such as a notifiable disease, a local health protection team may advise wider precautions covering the whole household, and your nursery would pass that specific advice on to you rather than applying it as a blanket rule unprompted. If a sibling develops symptoms while another is still within their exclusion window, both then follow their own separate exclusion periods based on when each child’s symptoms started, not a shared countdown.

The practical takeaway: monitor each child individually. A well sibling doesn’t need to be kept home as a precaution just because another child in the house is under the weather, but tell the nursery what’s happening at home anyway. Staff appreciate knowing that a stomach bug is circulating in the family, even if the child in front of them shows no symptoms yet, because it helps them watch for early signs during the day.

What does the law actually require of nursery sickness policies?

Every registered nursery in England operates under the Statutory Framework for the Early Years Foundation Stage, which requires providers to have a clear procedure, agreed with parents, for responding to children who are ill or infectious and for minimising the spread of infection. This isn’t optional guidance a setting can choose to skip. Ofsted inspectors check that a written policy exists and that staff can describe how it works in practice, not just recite it from a folder.

Beyond EYFS, nurseries also draw on public health law when managing notifiable diseases, conditions that must be reported to the local authority or UK Health Security Agency, such as certain forms of meningitis or measles. In those cases, a nursery’s discretion narrows considerably: local health protection teams can direct specific exclusion periods that override a setting’s usual house rules.

For parents, the legal framework translates into a practical right: you’re entitled to see your nursery’s written sickness and exclusion policy before you enrol, and to expect it to be applied consistently rather than at a staff member’s individual discretion. If a nursery can’t produce one, or the rules seem to change depending on who’s on the front desk that day, that’s a fair question to raise before you commit to a place, alongside the wider safety checks worth making when comparing settings.

Handling borderline cases without the drama

A child with a mild cough but bags of energy is rarely a hard call, they usually stay and join in. The trickier moments come after a stomach bug, when a parent is desperately hoping the 48 hours are up a little early. Being upfront about the rule from day one, and explaining the reasoning rather than just enforcing it, avoids most of the tension. Families who trust the daily updates tend to trust the decisions too.

— tariq

How Thesunflowernursery supports families when children are unwell

Choosing a nursery often comes down to trust: will they call you if something’s wrong, and will they be fair rather than overcautious about exclusion? Thesunflowernursery’s settings across Ilford and South Woodford run on a written sickness and exclusion policy shared with every family at enrolment, backed by daily updates through the online journal so you know exactly how your child’s day went, not just whether anything went wrong.

Thesunflowernursery

Every member of staff holds paediatric first aid training, which matters most in exactly the borderline moments this article has covered, spotting the difference between a child who needs collecting now and one who just needs a quiet corner for an hour. If you’re comparing settings and want to see how a clear, consistently applied policy actually looks in practice, book a trial session or ask for the full written policy before you decide.

Official pages parents should check for full details

  • Gov sets out condition-specific exclusion rules for childcare settings.
  • NHS: is my child too ill for school? gives symptom-by-symptom advice and red-flag signs.
  • If an outbreak is confirmed at your nursery, ask staff whether the local health protection team has issued any specific guidance beyond the usual rules.

This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.

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