Child and Adolescent Clinic - When to Exclude Children from Daycare

Ask Dr. Sue

WHEN TO EXCLUDE CHILDREN FROM DAYCARE

Dr. Sue,

I have two children, ages one and three, both in daycare. Every winter we battle the usual number of mild and not-so-mild illnesses. I’m always debating about whether it’s O.K. to take them to daycare or not. It seems like some parents bring their kids there constantly sick, and I wish they would keep them home. Then other parents seem to keep their kids home with the most minor sniffle. My husband and I both work and we don’t have family in the area to help out. There are only so many days we can take off work for sick kids! Can you help me sort out when I should really keep them out of daycare?

Dear Parent,

We are definitely in the midst of the illness season. The peak incidence of viral illnesses lasts from around early November through the spring months, as any parent can tell you. Parents whose children are in daycare are reminded of this fact more often. There is no doubt that young children in daycare are exposed to more illnesses than their at-home counterparts. In general, young children can be expected to have about six to twelve infections each year, most of which are respiratory infections. Respiratory infectious include colds, influenza, sore throat illnesses (most of which are viral), and most illnesses that include coughs, including some severe ones like RSV. About 10-15 % of illnesses will be gastrointestinal, or “stomach flu.” Most minor illnesses are not a reason to keep your kids home from daycare. This is primarily because nearly every illness is contagious before anyone even knows the child is sick (before any symptoms are even present). So even if every child with symptoms was excluded from daycare, the illness rate would probably not change significantly. The 26th Edition of the Red Book (2003), which is the pediatrician’s bible in regard to infectious diseases, lists the following reasons children should be excluded from daycare:

1. Illness that prevents the child from participating comfortably in program activities.

2. Illness that results in a need for care that is greater than the staff can provide without compromising the health and safety of other children.

3. Any of the following conditions suggesting possible severe illness: fever, lethargy, irritability, persistent crying, difficulty breathing, or anything else that suggests severe illness.

4. Diarrhea or stools that contain blood or mucus.

5. Certain bacterial causes of diarrhea (including one type of E. coli or Shigella) until 2 stool cultures are negative for these organisms.

6. Vomiting 2 or more times during the previous 24 hours, unless the vomiting is known not to be caused by a contagious illness AND the child is not in danger of dehydration.

7. Mouth sores associated with drooling, unless the child’s physician or local health department authority states that the child is noninfectious.

8. Rash with fever or behavioral change, until a physician has determined the illness is not a communicable disease.

9. Purulent (pus producing) conjunctivitis, otherwise known as bacterial pink-eye, until examined by a physician and approved for readmission. (Most often children will be allowed to attend daycare after they have been on treatment for 24 hours. If the infection is viral, normally they will not be excluded at all.)

10. Tuberculosis, until the child’s physician or local health department authority states that the child is noninfectious.

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