It's seven in the morning and family rush hour begins. The teakettle is whistling, the toaster's popping, and the traffic report is the usual bad news.
Enter a whine that will turn your already overbooked day upside down. By reflex
you lay hands on your baby's head. "Oh, no, a fever!" To daycare or not to
daycare, that is the question. Suddenly you realize that it is not so easy to
change jobs at the touch of a forehead.
How sick is enough to miss daycare? This decision affects three parties:
Does your baby feel too sick to attend daycare? Is she contagious to the other
children? How convenient is it for you to take a day off from work? Here are
some practical guidelines on what germs are the most catchy.
Here is one set of germs that all doctors agree are very contagious.
Frequent, watery, mucousy, and sometime bloody diarrhea is a sure indication to
stay home, both for your baby's sake to prevent an outbreak in the center. Add
vomiting – parents call this a double ender – and your baby is certainly too
weak and too upset to leave home. As soon as the vomiting is over, the stools
are no longer explosive and water and your baby feels better, she may return to
daycare. Be prepared for the bowel movements to remain loose and frequent for
weeks, as the intestines are notoriously slow to recover. During this
convalescent stage of diarrhea, your baby is not contagious.
COLDS AND FEVER
While diarrhea illnesses merit quarantine, respiratory and febrile illnesses
are a different bag of germs. Most cold germs do not threaten an outbreak in
the daycare center as much as diarrhea. Children are most contagious a day or
two before they act sick. When you send your two-year-old to daycare with a
cold, this is one time to teach her not to share. Show her how to cover her
nose and mouth with a tissue when she sneezes or coughs and to turn her head
away from others. Two-year-olds may be able to learn this sanitation gesture
but are likely to forget. If your baby have a fever (persistent temperature of
at least 101ºF or 38.3ºC) it is prudent to keep her out of daycare until you ask
your doctor whether she is contagious.
Sore throats, especially those associated with fever and throat spots (for example, herpangina),
are very contagious and are a red light for day-care attendance until the fever and the
throat spots are gone -- usually around five days.
The nose is not the only thing that runs when baby gets a cold.
Eye drainage is often associated with an underlying cold,
especially a sinus infection. These eyes are not contagious, and usually
neither is the rest of the baby. This type of goopy eye drainage does,
however, merit a doctor visit.
Some runny eyes are due to conjunctivitis (often called pinkeye),
a contagious infection that will send day-care providers rushing to
make a come-get-your-baby call. If the eyes are bloodshot in addition
to draining, this is contagious pinkeye, which is quickly treated
and made noncontagious by an antibiotic eye ointment or drops.
The baby may attend daycare as long as treatment has begun.
If the eyes are not bloodshot, this is seldom contagious conjunctivitis,
and your child may still attend daycare.
COLD VERSUS ALLERGIES
Day-care centers often reject a coughing, sneezing child because
of a cold when it's really an allergy that is not contagious to
playmates and is no more than a nuisance to the child. How to tell a
cold from an allergy? Back to the telltale nasal secrections.
Allergic noses are clear and watery, they run and drip, and are accompanied by
other allergic signs: watery eyes, wheezing, a past history of allergies,
and the fact that it's hay fever season. The nasal drainage from a
cold is too thick to run; it dangles. Also, with a cold there are other
signs of infection such as fever. In general, allergic children are noisy
(sneezy and wheezy), yet they don't act sick. They may attend daycare
and are not contagious. Children with colds act sluggish, mopey,
or cranzy and may be contagious.
While most colds end the cough still lingers, keeping babies out
of daycare and parents out of work. But all coughs are not
automatically stay-home illnesses. A dry, hacking cough that
neither awakens baby nor is associated with fever, pain,
difficulty breathing, or other cold signs is not a reason for
quarantine. These nuisance-type coughs linger on for two weeks,
are rarely contagious, and seldom bother the child or her mates,
who themselves may also be coughing. Then there's the baby
who coughs a lot at night but seems well during the day except for
annoying throat-clearing sounds and may have several similar
episodes during the allergy season. This child suffers from
postnasal drip, she is noncontagious, and this seldom is a reason
to stay home from daycare.
Ofcourse, any cough accompanied by fever, chills, and coughing
up of green or yellow mucus warrants medical attention and absence
from daycare. Your baby can return to daycare when the fever
subsides and she feels better (usually in a few days), though
the cough itself may linger for a week or two.
WHEN TO STAY HOME WITH A COLD
If your baby's nasal secrections are clear and watery, and your
baby is happy and playful, pain free, and has only a low-grade
fever (100 degrees F / 37.8 degrees C) there is no need to keep
your baby home from daycare. If the nasal secretions become
thicker, yellow, and green, especially if accompanied by a fever,
an earache, frequent night waking, or a peaked look -- in mother
jargon, a sick-looking-face -- this is a stay-home-and-call-the-doctor
cold. Your baby may have an ear or sinus infection.
Before you jump to change your whole day, here's a nasal secretion
tip: The goop from the nose is always thicker upon awakening in the
morning, since it has had a chance to stagnate during the night.
To help assess the situation, squirt a few saline nose drops into
each of your baby's stuffy nostrils and encourage a gentle nose blow,
or remove the secretions with a nasal aspirator. If the
remaining secretions are clear and your baby breathes better, you can
breathe easier, and it's off to daycare.
The problem with rashes is that the daycare provider sees them
and sends your baby home. But, not all rashes are contagious or
uncomfortable enough for a baby to miss daycare.
A bacterial infection in the skin, impetigo begins as tiny red
spots resembling picked at pimples that enlarge to coin-sized
blisters which rupture and produce oozy, sticky, honey-colored
crust. These circular spots may be as small as a dime or as
large as a quarter. They tend to occur in patches where babies
scratch, such as beneath the nose and on the diaper area, but may
occur anywhere on the skin. Scratching spreads these eruptions.
You can cover the infected areas with the prescribed antibiotic
ointment and a square bandage and send your baby to daycare. More
severe cases may require oral antibiotics and a longer stay-at-home break.
A circular rash with red, raised borders; ringworm is caused by
a fungus and is even less contagious than impetigo. Cover the
area with an over-the-counter antifungal cream (or a prescription
cream iF necessary) and pack your baby off to daycare.
Unlike the rashes just mentioned, chickenpox is one of the most
contagious of all childhood infections and a sure prescription to stay
home. It begins as a flu-like illness (low-grade fever and tiredness),
and the spots usually appear a day later. Initially, they resemble
tiny bites over the back, chest, abdomen and face. I'll frequently
have patients waiting at my office door at 9:00 a.m. wondering if
"these spots" could be early chickenpox. I pronounce them prickly
heat or fleabites and dispatch the spotted baby to daycare.
If you're uncertain about your baby's spots, circle a few with a felt-tipped
pen; in a day, they'll change from pimples to blisters if they're
chickenpox, and new crops will appear. After several days, the
early spots will crust. Baby can return to daycare once all the
spots are scabbed over, about a week after they first appear.
Where there are lots of children in a crowded place, expect
little parasites to tag along. A typical scene: You get a
call at your office or your baby is sent home from daycare
with a note informing you that she has head lice. Your first
reaction is embarrassment ("But my house is so clean!") followed
by incredulity ("She has to miss daycare and I have to miss work
because of a lousy louse?")
What's wrong with this picture? First, head lice are no reflection
on your housekeeping. They live in warm, crowded environments like
classrooms and daycare, where they can easily pass from head
to head as babies snuggle together. Lice don't carry disease
and are more of a nuisance than a medical problem. They
reside deep in the hair, most commonly around the nape of the
neck and around the ears. In return for a warm, fuzzy place to
live, they often don't bother the host, except for an irritating
itch and unnecessary quarantine by the daycare provider.
Lice themselves are difficult to see (they're tiny, light brown,
and may sometimes be seen with a magnifying glass), but you may
find the whitish nits (egg sacs) attached to the base of
individual hairs. You can distinguish nits from dandruff
because nits are round and adhere to the hair shaft, unlike the
flat flakes of dandruff that slide off easily.
If you see nits, you don't have to immediately share your
discovery with your doctor. An over-the-counter lice shampoo
(follow directions on package) and a specially designed
nit-removal comb will suffice for an evening at-home treatment.
Your baby may return to daycare the next morning, but be prepared
for the daycare provider to scan every hair looking for nits -- hence
the term "nit picker" -- and to call for pickup if even one egg is found.
WHO PLAYS NURSE WHEN BABY IS SICK?
For dual-income families; Who stays home when baby can't go to daycare,
mom or dad? Who can most afford to stay home? Who is most needed
at work? Do you and your spouse split the shift or bring in
the reserves? (Sick babies should have their mothers if at all
possible -- mother preference intensifies when baby is sick.)
While there is no better nurse than a caring parent in a child's own
home, this ideal may not be possible, especially for financially
strapped and single parents. Consider these alternatives:
- Try shift work. Mom is nurse in the morning, dad in the
afternoon. Your child gets special TLC from both parents and
both sharpen their sick-child-care skills.
- Take your baby to work. If your baby is not sick enough
to stay home but is not permitted in daycare prepare a "sickroom"
at work if circumstances permit. If you have your own office, set
up camp in the corner, including her favorite books, toys, and blankets.
This scene is also a prime chance for your child to learn about your work.
If the older patient is willing and able, give her some time-occupying
tasks to "help" you at work. Your child will feel important and get
her mind off being sick.
- Have grandmother on call. If blessed with a nearby extended
family, ask grandma to pinch-hit. Grandmothers have time, unlimited
patience, and the price is right.
- Use a sick-child-care center. Explore what facilities for
sick children are available in your community. Some daycare
centers and hospital pediatric wards have get-well rooms,
staffed with sensitive caregivers trained to care for sick
children. However, they are expensive.
- Plan ahead. Before your baby gets sick -- and she will --
devise a family game plan rather than scrambling for on-the-spot
decisions with the first fever. Decide with your spouse who will
stay home. Have backup caregivers on call. Find out your daycare
center's sick-child admission policies. Are there home-care agencies
available, and what is their cost? Find out what's available,
affordable, and what's best for your child.
- Sick-leave benefits. Taking a baby out of daycare may
mean paycheck deductions for working parents, but a day at home
with your sick child can have its compensations too. Being at home with
your sick baby is a chance to rebond. Especially if you have recently
locked horns with your child or she is going through an independence
streak, a day at home may do wonders for your relationship.
Babies go from independent to dependent when sick, as if
clicking into a memory of what "mother" and "father" really means.
Making chicken soup and popsicles, giving back rubs and reading
stories -- a day at home with your baby is a chance for nursing
and parenting skills to shine.