When a child has a runny nose but is nonetheless perky, most parents would ship him off to school or day care. But day care directors would send that kid home about 60 percent of the time, despite the fact that guidelines from the American Academy of Pediatrics say otherwise.
The day care exclusion guidelines make clear that in most cases, there's no point in keeping kids home once they're symptomatic: Children generally spread germs for a few days before signs of colds or other bugs appear. That's something directors of child care centers are supposed to be up to speed on. Apparently many are not. The new survey, published online in Pediatrics, found that 57 percent of the 307 day care center directors who responded would exclude children from day care with symptoms allowed under the medical guidelines. For instance:
- 8 percent would exclude children with a cold.
- 60 percent exclude children with conjuncitivitis (pinkeye).
- 65 percent exclude children with an upset stomach or mild diarrhea.
- 67 percent exclude children with a mild fever and no other symptoms.
- 84 percent exclude children with ringworm of the scalp, a fungal infection.
Yep, your child can go to day care with all those symptoms, according to the pediatricians. "There's a lot of phobia regarding pinkeye and colds," which isn't justified, says study lead author Andrew Hashikawa, a pediatrician at the Medical College of Wisconsin in Milwaukee. "A lot of these illnesses spread before there are symptoms." As a result, he says, the doctors' guidelines have been shifting away from having parents quarantine kids with mild symptoms. But waving this new study in front of a day care director who is booting out your kid will probably not do much good. Day care directors need better education on the guidelines, he says, and few states offer them training in dealing with contagious illnesses.
Although the stay-or-go verdict is ultimately up to the day care director, the AAP suggests these three tests for deciding if your child is well enough to attend. They put your child's interests first, just like you do:
- Does the child's illness keep him or her from comfortably taking part in activities?
- Does the sick child need more care than the staff can give without affecting the health and safety of other children?
If the answer to either of these questions is "yes," then it's time for a sick day. (I'm writing this at the dining room table while my 6-year-old is home sick, so I feel your pain.)
The third question is trickier:
3. Could other children get sick from being near your child?
The pediatrician's guidelines say children should stay home with an oral fever of 101 degrees or more, and/or if they have a long list of contagious diseases like measles, mumps, and chickenpox. Children with strep throat should stay home for 24 hours after they've started antibiotics. (If my daughter's strep test is positive, she'll have to miss the school field trip to the zoo tomorrow, poor thing.) You can find the whole list of illnesses that should keep a child at home at the AAP's website HealthyChildCare.org.
Ultimately, it's a judgment call. We've all sent kids to day care or school hoping they'd be OK, only to have to come pick them up an hour later. But if more day care centers got up to speed on the reality of kids and germs, perhaps there would be fewer days of work lost for parents, and more days for children to have fun with their friends at day care. Hashikawa urges parents to talk to their center's director about exclusion policies to make sure that everyone is on the same page.