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When to Keep a Sick Child Home

  • Tonia Moore
  • Posted March 11, 2013

How can I tell if my child's too sick for daycare?

It's not always easy. Obviously you don't want your kid to pass a phlegmy cough along to all his pals, but it's a much harder call when he has nothing more than a runny nose.

In general, you shouldn't bring your child to daycare if the illness is contagious and could do anything more than make any youngster a little cranky.

Here are some specific signs that mean your child needs to stay home:

  • A fever. If your child seems unusually irritable, listless, or tearful, be on the alert that he might be coming down with something; take his temperature.
  • Bronchitis, flu, or another upper respiratory sickness. However, if he has only a simple cold and no fever, you don't need to keep him out of daycare.
  • Bacterial conjunctivitis (pinkeye) or yellow eye discharge. Returning to daycare is fine after 24 hours on antibiotics. If it's a case of nonbacterial conjunctivitis and the discharge is watery, antibiotics won't make any difference and your child needn't stay home at all.
  • Signs of strep throat such as red swollen tonsils (possibly with smelly white spots), rough red patches on the roof of the mouth, a whitish tongue, fever, swollen glands, and difficulty swallowing. If it's strep, your child will need only a full day on antibiotics before heading back to daycare, so call your pediatrician promptly.
  • Gastrointestinal trouble. If a bowel problem is anything worse than slightly loose stools, keep your child at home until he's better. Also, if bowel movements have blood or mucus in them, kids should stay home and may need to see the pediatrician; this can indicate a viral or bacterial infection. Vomiting that goes beyond an isolated incident or is accompanied by other symptoms also calls for time at home.
  • Persistent, strong abdominal pain. You'll want your pediatrician to check for appendicitis, especially if it hurts most in the right side of the lower abdomen and feels worse when your child walks or jumps. On the other hand, if your child simply has a mild case of belly cramps that seems to be associated with gas or constipation, he can probably go to daycare.
  • A severe ache such as a bad headache, toothache, or ache in one limb. Your pediatrician will need to evaluate this type of problem, since the seriousness and possible causes vary case by case.
  • A rash that didn't result merely from skin irritation. Rashes can be confusing; to figure out how to respond to one, consider the possible causes. A rash that occurs with a fever or other symptoms of infection, such as swollen glands, calls for keeping your child out of daycare. However, rashes triggered by illness (most often a virus -- as with roseola, for instance) generally don't appear until the most contagious stage has passed. In those cases your child usually won't need to stay home. With fifth disease, a viral infection that may incubate for as long as two weeks before triggering bright red cheeks, your child will be only slightly contagious when the rash shows up; by then, his daycare pals may all have been exposed. Call your pediatrician's office if you're unsure of what to do.

Chicken pox is an exception to the rule on virus-related rashes. Kids who have it shouldn't go back to daycare until the itchy sores have dried out and crusted over or until six days have passed since they appeared. Children with impetigo (another contagious skin disease) should be on antibiotics for 24 hours before rejoining their daycare buddies. Scabies is contagious, but children can return the day after they've been treated.

A rash triggered by the MMR vaccine (for measles, mumps, and rubella) isn't something that other kids can catch. Likewise, if dry skin or a condition like eczema led to the rash, there's no reason your child can't go to daycare. Rashes set off by contact with poison oak or ivy aren't contagious either.

  • Head lice. These stubborn bugs mean you have some work to do. Drugstores sell kits that include special shampoos and combs as well as spray cans to use on the sofa and other places lice hide out; you may also want to wash all the bedding in your home (not just your child's sheets) in hot water. If the problem persists, ask your pediatrician about using a prescription-only shampoo. While many schools and daycare facilities still prohibit children from attending until they are nit-free, the American Academy of Pediatrics (AAP) discourages no-nit policies. According to the AAP, lice are not a health hazard and keeping kids home won't stop the spread of lice.

References

American Academy of Pediatrics. Caring for Your Baby and Young Child: Birth to Age Five. 2009. Bantam Books.

Sears, William and Martha. The Baby Book: Everything You Need to Know About Your Baby From Birth to Age Two. 2003. Little, Brown and Company.

Cleveland Clinic. Scabies. http://my.clevelandclinic.org/disorders/Scabies/hic_Scabies.aspx

Frankowski BL et al. Head Lice. Pediatrics. Vol. 110, No. 3, 638-643. September 2002. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;110/3/638

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