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.
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.
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.
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.
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.