Daycare Dilemma

Lisa Holling

You're at work, an important meeting is about to start and the phone rings. It's your daycare provider telling you that your child needs to go home now. Or, perhaps your child seems to be coming down with something and your caregiver is just letting you know so you can decide whether to make an early pick-up. What do you do? When is it appropriate for you to send your child back after an illness?

These issues will confront every parent with a child in daycare or preschool. Handling such situations is much easier if you understand your care provider's illness policy and if you have a plan in place ahead of time.

Every childcare facility home-based or center has its own policy regarding sick children. These policies should follow criteria established by the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and specific regulations set forth by each state's Department of Public Health and/or Human Services.

While every policy will vary somewhat, it will probably include information such as when your child should not attend, what symptoms will warrant that dreaded mid-day call, how much time you have to pick up your child before penalty fees begin, and instructions for how medicines will be administered.

When You Get That Mid-day Call
Even though your child seemed fine when you dropped her off, she may become sick during the day. Sometimes, your care provider will simply describe the symptoms to you and let you decide whether to wait a few more hours. Other times, you won't be given a choice. Some of the symptoms warranting mid-day pick-up include:
•    Diarrhea (2 or more loose, watery stools in a day)
•    Vomiting (2 or more times in a day)
•    Sore throat and difficulty swallowing
•    Eye discharge that is thick and white or yellow
•    Unusual spots or rashes
•    Yellow skin or eyes
•    Severe coughing
•    Fever (100F under the arm, 101F orally, or 102F rectally)

Don't be offended if your caregiver turns you away the next morning. Many illness policies specify that children may not return for 24 hours after being sent home. Most states also recommend that children remain fever free (without medication) for 24-hours before returning to daycare or preschool. Again, you must be clear about your caregiver's policy to avoid inconvenient surprises.

When To Keep Your Child Home
Several common childhood illnesses require at least a few days of TLC at home. Most are fairly mild in nature. More serious diseases such as meningitis, hepatitis A and B, pertussis (whooping cough), or tuberculosis invoke very stringent requirements. A physician must determine when children with these diseases may return to a group setting.

Once your little one is feeling better, it is usually appropriate for him to go back to daycare. If you think he shouldn't participate in regular activities, discuss this with your caregiver. Smaller, family daycare homes often do not allow children who can't join in all activities because they simply don't have the resources for alternatives. Larger centers, however, usually have enough staff to offer quiet options for some children and more vigorous playtime for others.

What if you absolutely can't take off work? You may have some options. Many communities have sick or mildly-sick childcare programs. Check with your local Child Care Resource and Referral Agency, Department of Health and/or Human Services, or area hospitals for local centers offering such services. Guidelines for these types of facilities are quite different than those covered here, so be sure to check before you need them: know their locations, policies, and costs, and keep their phone numbers handy.

The Common Cold
Infants and preschool age children average 8 to 10 colds per year. That could mean a lot of sick time for you and your child! Fortunately, the CDC and the AAP agree there is little benefit in keeping children with a mild cold at home. Chances are the virus that caused the cold has been spread before symptoms appear.

The Flu
If your child develops a fever with chills, a sore throat, headache, or muscle ache, then he has more than a cold. You may think your child has influenza (the flu). However, most children with these symptoms actually have a virus other than influenza. In this case, you need to keep him home until fever free and feels well enough to return to daycare.

Ear Infections
Ear infections often seem to accompany or follow colds. Regardless of whether your child's ear infection requires antibiotic treatment, you don't need to keep her home if she feels well otherwise.

Respiratory Syncytial Virus
RSV (respiratory syncytial virus) causes most childhood respiratory infections. Nearly all children will contract RSV before their second birthday. This is a bad bug, especially in children under 6 months old. Because children are usually contagious before symptoms appear, there is no reason to keep them home unless they need the extra TLC only a parent can provide.

The virus is spread two ways: in the air when children cough or sneeze and in the stool. Even when apparently well, a child who had RSV can spread the virus for a week or longer. If the daycare has children under one year old or children with lung, heart or immune problems, then a child with RSV should not return until well for a week.

Strep Throat
Strep throat is a highly contagious bacterial infection that requires antibiotic treatment. Children with strep throat should not attend daycare for a full 24 hours after treatment has started. By this time, most children also feel well enough to participate in regular activities.

Chicken Pox
If your child develops this itchy rash of small red blisters, you must keep them home for at least five to six days sufficient time for new blisters to stop appearing and for all lesions to scab over. Once this happens, your child is no longer contagious and may return to daycare.

If your child hasn't been vaccinated against chickenpox and is exposed to the virus at daycare, it's not too late to give him the vaccine.

Cold Sores
Cold sores or fever blisters are painful lesions on the lips or in the mouth. Whether children with cold sores should be excluded from daycare is debatable. As long as your child does not drool uncontrollably or routinely bite and the day care can't provide good infection control measures, then there is probably little benefit in keeping them home. Some doctors believe children under 1 year old should stay home for a week or until the sore has healed. Check with your provider to be sure.

Hand-foot-and-mouth Disease
Hand-foot-and-mouth disease appears as small, fluid filled blisters in or around the mouth, on the palms, fingers, and/or soles of the feet. As awful as the name sounds, it is a very mild, very common childhood ailment. and does not warrant exclusion from daycare. The child is contagious for the few days after the blisters appear. If your child has a fever, then she should stay home until she has a normal temperature for 24 hours.

Conjunctivitis, or pinkeye, is an infection characterized by white or yellowish discharge from the eye and redness, burning, or itching. It may be caused by a virus or bacteria. A child with pinkeye must receive antibiotic eye drops 24-hours before returning to daycare. This requirement of most daycare centers really makes no sense since the virus-caused conjunctivitis, and not the bacterial-caused, is highly contagious. And antibiotic drops do nothing to treat the virus-caused infections.

Head Lice
Head lice are tiny insects that live in the hair and on the scalp. State regulations regarding lice vary widely: some require children to be nit (lice egg) free before returning to school or daycare, while others require only one day of treatment. Again, check your provider's policy.

When Your Child Needs Medicine
If (and when) your child contracts an illness, you may need to send over-the-counter or prescription medication for your caregiver to administer. Always send medicines in their original containers clearly marked with your child's name.

Write out the instructions (dosage, frequency, storage in refrigerator, etc.) on a separate sheet of paper even if they already appear on the label. Provide an appropriate dropper, measuring spoon, or other utensil for administering your child's medicine label this with her name as well. Take the dropper or spoon home with you each day to be sure it is properly cleaned. Most caregivers will also ask you to sign a medication consent form. These extra steps protect your child insist upon them!

Remember, dealing with health issues in your daycare or preschool is much easier if you prepare ahead of time. Plus, understanding and respecting your childcare provider's illness policy is essential, not only for your child's health, but also for your long-term relationship with your caregiver. This way, you can focus on getting your little one well again.

Lisa Holling is a freelance writer specializing in childcare and parenting issues. She is also a licensed family daycare provider and member of several professional childcare associations.
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