Child Care Centers Too Often Send Kids Home For Minor Illnesses

by Kristin Harmel
August 16, 2010

According to the U.S. Census Bureau’s Survey of Income and Program Participation, there are more than 11 million U.S. children under the age of 5 who are in some sort of child care arrangement. The majority of those not being cared for by a relative are in settings where, unfortunately, germs do run rampant. According to the American Academy of Pediatrics (AAP), the risk of spreading infectious diseases exists in child care settings, especially among infants and toddlers who are most likely to share germs through putting toys in their mouths. In fact, most children in child care and school settings have as many as 8 to 12 colds a year. And when a child gets sick and has to be sent home, it can impact working moms and dads.

According to recent study, child care centers are often too quick to send a child home for minor ailments, such as coughs and colds, even when national guidelines discourage doing so, and these decisions come at a cost for both the children and their working parents.

When should children be sent home?
Led by Dr. Andrew N. Hashikawa, researchers from the Medical College of Wisconsin, the Mayo Clinic, and Cincinnati Children’s Hospital surveyed child care centers in Milwaukee, Wisconsin in order to evaluate whether the national child care guidelines from the AAP and the American Public Health Association (APHA) are being followed when it comes to sending kids home for ailments. In this particular study, more than 300 directors of child care centers from the metro Milwaukee area completed the survey.

Sending kids home by the time they’ve developed conjunctivitis, a mild fever, a cough or a cold may be unnecessary, researchers explain, because at that point, they’ve already been contagious and have potentially infected other kids.

The study, published in the journal Pediatrics, found that 57 percent of the time, child care centers would unnecessarily choose to send children home with minor ailments, such as a mild fever. The researchers found that more than 60 percent of the directors had never heard of the AAP/APHA guidelines (found here). The AAP/APHA guidelines, issued in 1992 and endorsed by many states, were developed to address the high rate of unnecessary exclusions from child care.

“If we sent home every child with a runny nose, we would have no children here during the winter months!” says Claudia Weger, the assistant director of the Ossining Children’s Center in New York, who has had more than 25 years of experience in child care.

Weger also notes that it’s important for children to have routine and structure, so disrupting their routine unnecessarily can be damaging. Plus, for parents, taking off work constantly to pick up sick kids unnecessarily simply isn’t practical.

“Many employers are not very understanding about parents having to take time off from work to care for a sick child, so child care providers should call parents to take the child home only when it’s necessary,” Weger says.

What should parents know about child care and illnesses?
If you have a kid in child care, talk to their care provider about the standards they set for sending kids home, Weger advises. But expect that you’ll be getting calls from the child care center at some point.

“Children in group day care will get sick,” Weger says. “We do everything we can to minimize germs: We wash our hands and the children’s hands frequently; we wash toys in the dishwasher and disinfect them with a solution of bleach and water; but even so, germs spread.”

Make sure your child care provider is aware of AAP/APHA guidelines, which specify that for most common illnesses, unless a child has a temperature that exceeds 100 degrees, there is no reason to automatically send him home. Some states have their own guidelines too; ask your child care provider how they determine what makes a child too sick for child care.

For parents, the AAP recommends keeping your child home if he has:

• Diarrhea or stools that contain blood or mucus;
• An illness that caused vomiting two or more times during the previous 24 hours, unless the vomiting is known to be caused by a condition that’s not contagious;
• Mouth sores with drooling, unless caused by a noncontagious condition;
• Impetigo (a skin infection with erupting sores) until 24 hours after treatment has been started;
• Head lice (until after proper treatment has been given);
• Scabies (an itchy skin condition caused by mites) until after treatment has been given;
• Conditions that suggest the possible presence of a more serious illness, including a fever, sluggishness, persistent crying, irritability, or difficulty breathing.

Click here for more from the AAP, including pertinent questions to ask when selecting child care for your kids.

“Parents need to have a back-up plan, because their child will get sick, especially for the first couple of years he or she is in day care, until they build up some immunity,” Weger says. “Also, if your child has a specific health issue or quirk—such as a child who vomits every time he gets a headache—let the provider know about that. Talk with the staff about how you handle that problem at home. Parents need to work in close partnership with their child care provider.”