When to Keep Junior Home From Day Care

Nov. 22, 2005 --- When is a child too sick to go to day care? Does a kid's runny nose mean he should stay at home? How about wheezing or constant crying?

Parents and day care providers don't always agree on those decisions. So, what's the bottom line?

National guidelines on the topic were updated three years ago. But many people don't seem to know about those guidelines, a new study shows.

The researchers included Kristen Copeland, MD, a pediatrician at Cincinnati Children's Hospital Medical Center.

Guidelines? What Guidelines?

The guidelines studied by Copeland and colleagues aren't law. They were designed by health experts to simplify decisions about excluding kids from day care for health reasons.

Copeland's team gave surveys about the guidelines to 80 day care providers, 142 parents, and 36 pediatricians in Baltimore.

Most weren't very familiar with the guidelines, the surveys showed. Each of the three groups didn't know how the guidelines addressed four out of 10 children's common health conditions.

The guidelines come from the American Academy of Pediatrics, the American Public Health Association, the Maternal and Child Health Bureau, and the National Resource Center for Health and Safety in Child Care.

Could You Pass the Test?

Try your hand at these questions, adapted from Copeland's survey. Read each scenario and decide if the child could attend day care, according to the guidelines.

• Your child has a thick green or yellow discharge from the nose for 5 days but no fever.
• Your child has a new rash, but he or she is behaving normally and doesn't have a fever.
• Your child is crying persistently.
• Your child is wheezing or coughing uncontrollably.
• Your child has a fever and isn't acting like they usually do.
• Your child shows signs of illness that prevent participation in normal activity.

The answers:

• The children in the first 2 scenarios can attend day care.
• The next 3 children can't, unless they have a doctor's approval.
• The last child may also be excluded from day care.

The Full List

The guidelines list these conditions for the temporary exclusion of kids from day care.

• Too ill to comfortably participate in activities, as determined by the child care provider
• Too ill for the day care staff to handle without compromising the health and safety of other children
• Fever, accompanied by other behavior changes or other symptoms
• Lethargy beyond expected tiredness
• Uncontrolled coughing
• Inexplicable irritability or persistent crying
• Difficulty breathing
• Wheezing
• Diarrhea
• Blood in stools not explainable by dietary change, medication, or hard stools
• Vomiting (2 or more episodes in the previous 24 hours)
• Persistent abdominal pain that continues for more than 2 hours
• Mouth sores with drooling
• Rash with fever or behavior change
• Purulent conjunctivitis ("pink eye" with thick discharge from the eye), until after treatment has started
• Head lice, until after the first treatment
• Scabies, until treatment has been completed
• Tuberculosis, until a doctor states that the child is on appropriate therapy and can attend day care
• Impetigo, (a bacterial skin infection) until 24 hours after treatment starts
• Strep throat or other streptococcal infection, until 24 hours after starting antibiotics and fever has ended
• Chicken pox, until all sores have dried and crusted (usually 6 days)
• Whooping cough (pertussis), until 5 days of antibiotic treatment has been completed.
• Mumps, until 9 days after onset of swelling of the parotid gland
• Hepatitis A virus, until one week after onset of illness, jaundice, or as directed by the health department when preventive measures have been given to other children and staff members at the day care facility
• Measles, until 4 days after onset of rash
• Rubella, until 6 days after onset of rash
• Shingles (herpes zoster)
• Herpes simplex
• Unspecified respiratory tract illness

Doctors may provide an exception in some cases, such as fever, tiredness, irritability, uncontrolled coughing, and other possible signs of severe illness.

Parents must tell their day care provider within 24 hours if the child has strep throat or related conditions, the guidelines state.

SOURCES: Copeland, K. Ambulatory Pediatrics, November-December 2005; vol 5. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care, "Caring for our Children." News release, Cincinnati Children's Hospital Medical Center.