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Day-care practices of excluding sick kids are much too strict

April 19, 2010 |  9:08 am

One day, many years ago, I was called at work by my 2-year-old daughter's day-care provider and told to come and get her. She probably had an infectious childhood illness called hand, food and mouth disease, the director explained, because of the pinkish cracks in the palms of her hands.

Daycare I was fairly certain my daughter wasn't ill. However, I left work, picked her up and took her to the pediatrician, who glanced at her palms and said she had dry skin. I returned her to the sheepish day-care director and drove back to my office, thinking what a waste of time and money the morning had been for my employer and me. My daughter rather enjoyed the unplanned interlude, but I worried that she'd probably picked up some real illness at the doctor's office and would be vomiting by morning.

This experience, it turns out, is all too common. Despite detailed guidelines on illness from the American Public Health Assn. and the American Academy of Pediatrics, day-care centers routinely exclude children with mild illnesses, according to a study published Monday in the journal Pediatrics. The study polled 305 directors of day-care centers and presented them with scenarios of various illnesses, asking when they would exclude the child from care.

Researchers found that directors would unnecessarily exclude 57% of children with mild illnesses. Here are some of the scenarios in which the majority said they would exclude children but, under guidelines, do not warrant exclusion.

  • Three-year-old, clear, runny nose for five days, dry cough for three days, temperature normal, able to participate in usual activities.
  • Four-year-old, red eyes, clear drainage, temperature normal.
  • Two-year-old, toilet trained, vomited what she ate once and had two loose, watery stools in the toilet. Temperature normal.
  • Three-year-old, felt warm, fever of 101 taken under the arm, no other symptoms and "acting his usual perky self."
  • Four-year-old, circular rash on scalp, hair not growing well at site of rash, temperature normal, acting normally.

Children were more likely to be unnecessarily excluded if they attended smaller centers and centers with less experienced directors. However, children were less likely to be excluded at centers with a higher proportion of single mothers and children on state-assisted tuition.
The findings suggest that all child care directors should have regular and ongoing training to reduce the rate of unnecessary exclusion. In the directors' defense, it is sometimes difficult to know when to exclude a child for illness. Child care personnel have to worry about the transmission of infectious illnesses. On the other hand, there is no excuse for not having the APHA/APA guidelines readily available and referring to them often and carefully. It's hard enough to be a working parent without having to find alternative child care for every running nose.

Child care personnel and parents can find out more about the issue at
the National Resource Center for Health and Safety in Child Care and Early Education.

-- Shari Roan

Photo credit: Carolyn Cole / Los Angeles Times

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Comments (9)

I am a child care director and while I agree with much of what you say, you are missing a major point. I agree that your child should not have been excluded. However, sometimes children simply don't feel well - they may have symptoms without fever. A day in child care (even high quality child care) is not a stroll in the park for children - it is their "work". There are stresses and challenges throughout the day for them - they are often expected to be socially competent when, in fact, many of them are just learning social skills. We have 14 children with two staff members in our preschool room. To have to share your office with 13 other people when you are feeling under the waether is not something any of us should be expected to do. Why do we expect that of children? Sometinmes they are overly tired, have a tummy ache or just feel crappy - and they just want their mommy or daddy. It's too bad that in our pressure cooker society, they sometimes can't be afforded that luxury.

I agree more with the other comment. Accidents will happen, but as someone who worked in the early childhood education field for 10 years and now have a young daughter of my own in child care, I can say it is not as easy as the author makes it sound. We are not medical professional and are being asked to make medical decisions. I knew our public health guidelines backwards and forwards and would google for pictures of certain rashes, pink eye, etc. and sometimes you just have to err on the side of caution. Furthermore, most daycares, child care centers and preschools are places for healthy children. Even if you child is "mildly ill" they may not be fit to be in a group setting with lots of stimulation. And it shouldn't be a child care workers or preschool teachers job to cater to a unwell child; that is a parent's responsibility. If anything, I would be thankful that my child's place of care cared enough to be too careful. My daughter's child care has sent her home two times for things I still think were unnecessary, but I trust them to make decisions about what is best for all the children and teachers; not just my schedule.

The problem is the lack of backup daycare for working parents. We all need a backup facility where we can send sick children so that we don't miss work. Most sick children are better the next day and yet every day care I've used requires them to stay out the next day.

My biggest pet peeve are parents who send their kid to school when they know she is sick, but I understand why they do it when there are no backup options.

As a mother I am happy to see the other comments here. If my child had a runny nose (clear or not), bumped his head or vomited I want to know! I wish I could be a stay at home mom, but that doesn't work for my family, so any time the director calls me I am more than willing to take my child and make the judgement call. Last I checked... he is still my responsibility.

Better safe than sorry. If my 2 year old daughter had a temperature under the arm of 101 degrees under the arm, I'd sure as heck want to be notified of that. That is a fever. Under the arm registers cooler than in the mouth or rectally. Over 100.4 rectally is a fever in a child.

It is not fair to endanger other children by having them exposed to sick children. Nor is it right to ignore symptons in children that could be sick. This article and the advice offered could cause a daycare worker to ignore serious symptons and let a child be harmed.

A Mom in my mom's group picked up her daughter from daycare and her 1 year old had a fever over 103 degrees that the daycare center had failed to recognize. This is the kind of issues that the Times should be following up on instead. Lets make our children safer not give daycare workers an excuse to not do their jobs.

It is precisely the idea that it doesn't matter if children are exposed to the "mild" illnesses of other children that makes some of us shy far, far from daycare. Not all children have "normal" health profiles: those with Type 1 diabetes, for example, can have their blood glucose control impaired from even "mild" colds, leading to health issues for the kids, and sleepless nights for the caregivers who must monitor night blood sugars with increased vigilance. An ounce of prevention is worth a pound of cure, right? Shame on those who choose the convenience of the parents over the health of the kids.

Are you serious? You are certainly not considering the other kids who may be exposed to potential illness. I applaud the teacher for paying attention to the kids and try to prevent major illness from spreading at the school. If you just want to drop your kid off and let someone take care of him/her without worrying him/her getting other kids sick, hire a nanny, not a daycare center.

The APA has done excellent work in producing clear and easily understandable information for parents, which has proved invaluable for me raising my 2 y.o. girl. I will assume they have produced similarly high-quality guides for child care professionals. As such, I think that child care center directors (particularly those who do not have medical training) faced with these decisions ought to put a bit more trust in those guidelines. Being "too careful" is by definition overly careful. While I respect their effort to keep my child healthy, the unnecessary exclusions can become a major (and unnecessary) problem for working parents. There is a balance. Judgment calls benefit not only from experience but on trustworthy, credible data like that of the APA. When in doubt, look to the medical professionals and make the best decision you can for both the child, the school, and the parents. If you dismiss children at the first nasal drip, you're probably overdoing it. Maybe the APA should host workshops for child care providers so they can learn and be more comfortable in the decisions they are obliged to make.

In my opinion what the day care is doing is right things to do. My infant day care center allows kids to stay and even give medicine if parents allow them. Guess what, every time I send my kid to the center he picks somethings.And unlike some parents we can't leave a sick kid in the care. We are really upset and I think every day care should follow strict procedure to not allow sick kids in the center.We finally found a nanny who is coming to our house.Even day care call parents to take their kis for silly reason, I think it's an nice opportunity to spend some time with kids.
But for single parents it's kind of tough


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