Now that we are really in the throes of sick season I am often asked about when you should keep your child home from school or day care. I noticed a recent article in one of the pediatric journals on this topic, which emphasized that hand washing and vaccines are still the best way to prevent transmission of infectious diseases. But, with that being said, especially at this time of year when so many upper respiratory tract infections are circulating, when do you need to keep your child home?
The short answer is that most minor illnesses are not a sufficient reason to keep a child home. That includes most colds and coughs. But if your child is running a fever, or seems terribly uncomfortable or is ill enough to “require extra care” by a day care worker or teacher, the child needs to stay home. A day at home for some TLC (tender loving care) is often the best medicine, especially for the first day or two of a viral upper respiratory infection, when a child may have a fever.
I am also asked about GI illnesses and whether a child with diarrhea needs to stay home from day care. It seems that some day care facilities now exclude a child from care if they are having more than three to four loose stools/day, even if they are still playful, fever free and eating and drinking. The recommendation by the CDC does not require a child with diarrhea to stay home, if the stools can be contained within the diaper. This gets back to good hand washing! A child with vomiting is a different story and should not be sent to school or day care.
I am seeing a lot of children with pink eye (conjunctivitis). Pink eye may be caused by both bacteria and viruses. Transmission occurs by direct contact with contaminated secretions from the eye or via respiratory droplets. Unless a child has other symptoms to keep him or her out of day care, the child should be allowed to return to school once appropriate therapy has been started.
Even with good hand washing it is not unusual for children who are crawling and walking to get up to 11 to 12 viral infections in a season! This is often difficult for a family with two working parents, as the decision is made whether a child can attend day care and who will stay home if the child needs to be home. At the same time, young parents will often get several of their children’s viral infections as well; even with good handwashing. What parent has not had their child cough or sneeze directly into their face, and then within several days also become sick! This is a hazard for us pediatricians as well.
Lastly, do not “try” to figure out “who got your child sick.” There are just too many places we all go on a daily basis where we are exposed to viruses and bacteria. Trying to “track down” the exposure for most of the common infectious diseases that children get is a big waste of time. Serious illnesses like meningitis, mumps, measles, etc. are a different story; but, fortunately, because of vaccines this is rarely the case.
So keep up hand washing and hope for the best during this time of year.
(Dr. Sue Hubbard is an award-winning pediatrician, medical editor and media host. “The Kid’s Doctor” TV feature can be seen on more than 90 stations across the U.S. Submit questions at http://www.kidsdr.com. The Kid’s Doctor e-book, “Tattoos to Texting: Parenting Today’s Teen,” is now available from Amazon and other e-book vendors.)
