Sick Children in the Daycare Setting

Dr. Greene's Answer

This is a very complex and important question. It concerns the care of millions of kids in the United States alone — over 50 percent of preschool-age children are in group day care settings. Day care can be a wonderful experience for children. It can provide freedom for parents to pursue their goals. But it can also provide a setting where germs spread easily.

Most kids who are in day care are there because the adults they live with work outside the home. These parents sign contracts with you agreeing that while they are at their workplaces, you will care for their children in exchange for monetary payment. You agree to take the best possible care of these growing, learning, energetic tots. So far, so good. But what happens when (not if, but when) one of the children in your care gets sick? Let’s look at it from a few different angles.

Child Care Provider — You get to be with these wonderful (sometimes challenging) kids during their most productive hours five days out of every week. You learn to read their moods. Often, you are there to see those precious “firsts.” You grow attached to the children. You want the best for each child in your care.

When one child gets sick, you are not only concerned for that child, but for all the others who are being exposed to the illness while that child is in your care. You are not equipped to care for sick children, you don’t have time to give special attention to a sick child, and you are responsible for protecting the other children.

Employer — In order for a business to run, it must generate enough money to pay all the bills. Of course most employers would like to actually show a profit, but even if they can’t, they must at least cover expenses. So whether a business is doing well or barely making it, employers want and need to keep productivity up.

All other things being equal, parents with young children can be less productive than those who do not have such responsibilities. Nine to five just isn’t enough in most jobs. It is not unusual for employees, especially those in management, to come in early and leave late. Yet parents often come in late and rush out in time to pick their children up before 6 p.m., when child care is no longer available.

When one of the workers needs to leave suddenly to take care of a sick child, the employers are usually less than thrilled. If the worker plays a vital role, other workers will need to shuffle responsibilities to cover. If the worker is involved in a project with a deadline, his or her absence could throw everything off. Regardless of the specific job, the employer wouldn’t be paying the employee unless he or she was needed.

Parent — Most parents I know feel stress over leaving their children to go back to work. Often I walk into a 2-month physical to find a mom (still post-partum) in tears because her maternity leave is ending. These parents shop for a wonderful place to entrust their precious children. They want what is best for their child. For many, this means group child care. It is an honor to be chosen to play this vital role.

As time goes by, many parents become comfortable with the arrangement, yet they still feel torn. They are parents first, but they feel pressure from their jobs to work more. The parents’ employers have specific expectations of them. These employers often provide some vacation time, a few paid holidays, and a limited number of sick days. Those parents who are self-employed often find themselves in even tougher circumstances.

When parents get a call that they need to leave work, and quite likely not come back for several days, they are put in a tough spot. They don’t want to use their vacation to stay home with a miserable child (that’s no vacation!), they have limited sick leave, and they don’t have anyone else to care for the child. At the same time, they care about their child’s health. Their best hope is that you, the child care provider, are overreacting.

Child — Learning to leave mom and dad is hard for most kids. The adjustment period can be tough on everyone, but the kids learn to be happy with you. They are stimulated in your care. They make friends. These friends carry germs. These friends share germs. These kids get sick. And no matter how much they grow attached to you, there is no one like mom and dad when you don’t feel well!

On the other hand, there are times when a child is contagious, but he or she doesn’t feel particularly bad. Recently, my youngest son had a post-vaccine case of chicken pox. He had a total of four very small pox and he appeared to feel fine. In fact he had lots of energy!

There are several things that can be done to make this situation as easy on everyone as possible:

As the child care provider, you should provide a brief, written outline stating your objective criteria for determining when a child is sick. Here are some issues to consider including:

• Fever — While a high fever is worrisome, a child may have a slightly elevated temperature due to teething or a recent vaccine. In these situations you will want to inform the parent at the end of the day, but you do not need to require that the child be immediately taken home.
• Rash — Common, non-communicable rashes, such as baby acne or eczema , do not require children to be separated from each other. On the other hand, rash associated with a fever would be a reason to send a child home. Chicken pox for example, is highly contagious.
• Vomiting — One episode following active play may not be a problem. One episode a day for several days needs to be looked into. Multiple episodes on the same day or vomiting accompanied by general discomfort would necessitate calling parents to take the child home.
• Diarrhea – Children who have diarrhea especially associated with fever should be kept at home. Children with diarrhea containing blood or mucous should be seen by their doctor before returning to school.
• Pink eye – A child with a red, irritated eye associated with fever or with an eye discharge, should be sent home and seen by a doctor before returning to school.
• Lice & Scabies — There’s no way around this one! When kids are infested they need to be removed from the group setting as quickly as possible.

New research comes out frequently that changes how childhood diseases are handled. The condition you asked about, Fifth Disease, is a case in point. Until recently, it was routine practice to confine children with the Fifth Disease (also known as Slapped Cheek ) rash. Now we understand that this is not necessary. As with Roseola, when the rash appears, the child is no longer contagious! By keeping up with the latest infection-control guidelines you can prevent unnecessary hardship on parents.

You are wise to require parents to sign a contract that requires them to take care of their children when they are sick. Even better, have them sign a plan describing how they are going to do so.

• Perhaps there is a grandparent or close family friend with a more flexible schedule than either of the parents’. Arrangements can often be made to call upon them to step in when the child gets sick. It’s almost always easier to follow up on a plan than to improvise on the spot.
• New child care companies are being developed in many communities that are on-call specifically to take care of sick children. They are typically very expensive, but they can be cheaper than losing a day at the office or, worse yet, jeopardizing a job.
• If mom or dad (or a combination of both) are going to be personally responsible, instruct them to talk with their employers when they sign the child up for day care. This can make a big difference when the time comes for mom or dad to leave work suddenly.

Parents are often the ones who lose the most when their children are sick — they may face angry employers, they spend valuable time off nurturing children who aren’t very fun to be with, they may have their paychecks docked for missed work, and they still have to pay you to take care of their children. From a parent’s point of view, this just doesn’t seem fair. Of course your fixed expenses must be paid even when a child is out, but most parents feel like this is adding insult to injury — especially when they don’t agree with your assessment of the child’s need to stay away from the group.

The question of requiring full payment for sick days does not have an easy solution, but alternative payment plans can be explored. Consider raising your monthly fees in exchange for a discount for days missed. The bookkeeping on this would be bothersome, but some parents would feel better if their fees were reduced when their child is sick, even if it meant paying more on a regular basis. Even if this approach doesn’t work in your setting, you can get a lot of valuable information by asking parents for input. In the process, they might begin to understand your point of view.

C.E., I believe the keys to a successful relationship are mutual respect, open communication , and a willingness to try new solutions. As you treat each other with respect, talk with each other about the difficulties having a sick child can cause, and look for new ways to solve the problem. I believe you will become even stronger allies in the process of caring for the greatest treasures in the world.