Stapleton Pediatrics Blog

Daycare Exclusion Secondary to Illness

Welcome back to school and the inevitable dismissals from daycare.

For anyone who has had a child in daycare, it has happened multiple times:  You see that your child’s school is calling.  Your blood pressure and heart rate rise as you feel your stress response activate.  They have been monitoring your child’s temperature and it just turned 100.1.  They are going to be nice enough to watch her in the office until she can be picked up.   Each time this happens to my family, my wife and I bargain to figure out who has to cancel their afternoon.  (Many thanks and sincere apologies if I have ever had to cancel an appointment with you.)

Having a child dismissed from daycare for illness is a significant problem in terms of lost productivity and lost wages for our society.  It is also one of the major reasons families relocate - having family available is a huge advantage when your child is sick.    We see lots of patients who are generally well, but need a note to get back into school.

What are the rules that regulate the decision to exclude a child from their daycare?  

There are actual guidelines produced in association with the American Academy of Pediatrics (, which in my experience, are variably followed.   Each facility has its own usually strict rules, which are sometimes based on medical facts and sometimes on community pressures and ideas of contagiousness and severity of very common diseases.  Daycares play an important role of protecting our kids from both injury and illness, and a better understanding of these guidelines might beneficial for our entire community, especially for parents and pediatricians.  Many times a doctor’s note saying it is ok for the child to return is not helpful.


     When deciding whether to keep your sick child out of child care, the two most important
to think about are:

          1.  Does the child’s illness keep him/her from comfortably taking part in activities? 
          2.  Does the sick child need more care than the staff can give without affecting the health and safety
               of other children? 

     If the answer to either of these questions is yes, then the child should not go to child care or school.
     If he/she is sent to child care or school, then the caregiver or teacher may not let the child stay.

     A third question to ask is:

          1.  Could other children get sick (with a harmful illness) from being near your child?

     Most common illnesses, like a cold, are not really harmful. Other children can catch illnesses
     before, during, or after your child is sick. Making a sick child stay home may not really prevent other
     children from getting sick.

The guidelines cited above reference individual illnesses that do not warrant exclusion (e.g., pink eye, fever in well appearing child, colds) and those that do need to be excluded (see first reference  This can be a difficult decision for both parents and caregivers, e.g. is the belly pain due to nerves or an impending vomiting/diarrheal illness.

Recurrent daycare colds:

Many parents complain of “daycare nose” – the constant waxing and waning goopy nose that we see in most kids throughout their first winter or 2 of daycare.  Children average a cold every 3 weeks during this time. Unfortunately colds often take 2-3 weeks to fully resolve, so a parent usually is pretty happy to see any day(s) of a clear nose.   Colds are expected worsen for the first 2-5 days, then the immune system kills the virus and any fever resolves.  Other cold symptoms gradually improve as the damage to the lining of the nose and throat is repaired.  When should a child with a cold be seen?  We recommend seeing children for colds that are not improving at 10-14 days, signs of ear infection (poor drinking/sleeping), a fever late in the course of a cold, or if the following occurs at any time: dehydration, difficult breathing, significant pain, or the parent is concerned about how the child looks/acts.
The glass half full:

There is an upside to these recurrent illnesses from daycare that help build your child’s immune system.  These daycare children tend to be healthier kindergarteners.  Some studies suggest that all children have experienced approximately the same number of illnesses by third grade.  Also, there are multiple studies that show up to a 30% decrease in the risk of leukemia when a child is in daycare (exposed to numerous illnesses) early.

I hope this helps clear some of the questions surrounding daycare illnesses. We are always here to help and happy to answer your call or see you in the office. 

My best always, 
Dr. Rich
Posted: 6/28/2015 11:28:57 AM by | with 0 comments
Filed under: colds, daycare, illness

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