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How do I keep my child healthy at daycare?

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    Even at the cleanest daycare centres, kids inevitably put dirty hands and toys in their mouths. As a result, they rub their eyes or otherwise, picking up any number of common "daycare diseases," including:

    • Colds and upper respiratory infections.
    • Pink eye.
    • Gastroenteritis (stomach flu) can come from a variety of viruses and bacteria.
    • Hand, foot and mouth disease, which most often affects children under age 5. Symptoms include fever, rash and mouth sores.

    Young children in daycare often get frequent upper respiratory tract infections, including colds and secondary ear infections. Experts estimate that the average child gets six to eight viral upper respiratory tract infections each year. And since that is the average, some kids are getting more, and some are getting less. It seems likely that the kids in daycare are getting more infections since they tend to be exposed to more people and germs. They can also get one to two episodes of gastroenteritis, including vomiting and diarrhea, each year.

    Fortunately, the longer that kids are in daycare, the fewer infections they usually get. And by the time they start kindergarten, children in daycare seem to get sick much less often than children who weren't in daycare. In other words, your child is likely to get sick a lot at some point in their early life—so if it doesn't happen during the daycare years, then it's expected to occur during kindergarten and first grade.

    FAQs about these daycare diseases

    Do children in daycare get sick more often than other children?

    According to a National Institute of Child Health and Human Development study, kids in daycare get sick more often than kids at home — until age 3. Then infection rates even out. In kindergarten and first grade, infection rates in daycare kids may even drop below the rates of their home-care peers, who may be encountering certain germs for the first time.

    Does exposure to germs at a young age strengthen a child's immune system?

    In theory, yes. Once your child has been exposed to a virus, their immune system programs itself to fight it off next time. So, for example, they develop antibodies to combat that particular virus strain.

    What can parents do to stop kids from getting sick?

    Vaccinations are also important, she says. They won't prevent common viruses, but they can protect from serious illnesses, such as meningitis and some types of pneumonia. In addition, flu vaccines can ward off dreaded influenza. And the rotavirus vaccine can prevent at least one kind of stomach flu.

    When to Keep Your Child Home from Child Care

    ​In today's world of two-income families and single parents, many young children spend a lot of their childcare time. Many school-age children are in before and after school child care programs, as well.

    Common Illnesses in Child Care:

    The viruses responsible for colds or the flu cause the most common illnesses in child care facilities. Even though your child has had immunizations, they can still get viruses causing colds, sore throats, coughs, vomiting, and diarrhea.

    Children of any age will experience a lot of infection in their first year of group child care. However, if the first year of child care is during infancy, a child may have as many as 8 to 12 colds more than a child would have if cared for at home without exposure to siblings or other children. During the second year of child care attendance, the number of respiratory illnesses begins to decrease because exposure to so many germs causes the rapid development of the immune system. Diarrhea occurs once or twice a year in the typical child.

    AAP Child Care Recommendations for Exclusion:

    The primary reasons for exclusion from child care or school are that the condition:

    • It prevents the child from participating comfortably in activities.
    • Results in need for care that is greater than staff members can provide without compromising the health and safety of other children
    • Poses a risk of spread of harmful disease to others (see list of these conditions below)

    Any child with respiratory symptoms (cough, runny nose, or sore throat) and fever should be excluded from their child care program. However, the child can return after the fever associated with these symptoms has resolved (without the use of fever-reducing medicine).

    To reduce the risk of becoming sick with the flu, child care providers and all the children being cared for must receive all recommended immunizations, including the flu vaccine. The single best way to protect against the flu is to get vaccinated each year. This critically important approach puts the health and safety of everyone in the child care setting first. The flu vaccine is recommended for everyone 6 months of age and older, including child care staff.

    Do You Keep Siblings Home When Another Is Sick?

    When the first sign of a stomach bug or severe cold enters your house, it can feel like a ticking time bomb. In a short matter of time, your entire household could succumb to the Illness. From sleepless nights and missed days at work and school, short of buying everyone in your family a hazmat suit, you may wonder if it's safe to send your kids to school when a sibling or parent is fighting off an illness. Do you send the healthy ones to school or keep them home? When is it safe to send your sick child back to school?

    Is it Safe to Send My Healthy Kids to School When Another Is Sick?

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    You may assume that if one child is sick, the Illness has already infiltrated your home. Most often, that's not the case. As long as siblings are not having symptoms and have good hand hygiene, they can generally go to school.

    However, It may not be the case for daycare centres.

    Some daycares require even asymptomatic siblings to stay home, so check their policies. Sometimes, they recommend that siblings of a child with gastrointestinal issues, such as persistent diarrhea and vomiting, stay home from daycare.

    When Is It Safe to Send My Sick Child Back to School?

    If your child has a fever of 101 degrees or higher, has a severe cough, vomiting, diarrhea or appears fairly ill, they should stay home and away from others, even with basic symptoms like a simple cold or pink eye. However, they are safe to return to school after 24 hours of no fever and symptoms. "Once they are acting at their baseline, such as eating and drinking and playing, it is reasonable to send them back to school."

    ​Conditions that require exclusion include:

    • When the child appears to be severely ill, is not responsive, irritable, persistently crying, having difficulty breathing, or having a quickly spreading rash.
    • Fever (temperature above 101°F [38.3°C] by any method) and behaviour change or other signs and symptoms (e.g., sore throat, rash, vomiting, or diarrhea). For infants less than 2 months of age, a health professional should evaluate an unexplained fever. For these infants younger than 2 months, get urgent medical advice for temperature above 100.4°F [38.0°C], whether or not other symptoms are present.
    • Diarrhea—Exclusion is required for all diapered children whose stool is not contained in the diaper and toilet-trained children if the diarrhea is causing "accidents," and for children whose stool frequency exceeds 2 stools above normal per 24-hours for that child while the child is in the program or whose stool contains more than a drop of blood or mucus. Diarrhea is defined by stool occurring more frequently and is less formed in consistency than usual in the child and not associated with diet changes. 
    • Vomiting 2 or more times in the previous 24 hours, unless the vomiting is determined to be caused by a non-communicable/non infectious condition and the child is not in danger of dehydration.
    • Abdominal pain that continues for more than 2 hours or intermittent abdominal pain associated with fever or other signs or symptoms.
    • Mouth sores with drooling that the child cannot control unless the child's primary health care provider or local health department authority states that the child is noninfectious.
    • Rash with fever or behavioural changes until a primary care provider has determined that the Illness is not an infectious disease.
    • Skin sores are weeping fluid and are on an exposed body surface that cannot be covered with a waterproof dressing.

    Other conditions with specific diagnoses are as follows:

    • Streptococcal pharyngitis (i.e., strep throat or other streptococcal infection) until the child has had two doses of a course of an appropriate antibiotic 12 hours apart.
    • Head lice, scabies, ringworm until after the first treatment (Exclusion is not necessary before the end of the program day.) Treatment may occur between the end of the program day and the beginning of the next day—not requiring any exclusion.
    • Chickenpox (varicella) until all lesions have dried or crusted (usually 6 days after onset of rash) and no new lesions have shown for at least 24 hours.
    • Rubella, until 7 days after the rash appears
    • Pertussis, until 5 days of appropriate antibiotic treatment (21 days if untreated)
    • Mumps, until 5 days after onset of parotid gland swelling
    • Measles, until 4 days after onset of rash
    • Hepatitis A virus infection, until 1 week after onset of Illness or jaundice or as directed by the health department ​​

    Distinguishing Daycare Syndrome From an Immune System Problem

    Although parents and pediatricians often get frustrated when a child gets sick over and over, if the child is in daycare and is otherwise growing and developing normally, and if the child hasn't had any serious infections (like pneumonia or other illnesses that required hospitalization), then it isn't very likely that they have any problem with their immune system.

    Warning signs of a primary immunodeficiency can include:

    • 8 or more new ear infections in one year
    • 2 or more serious sinus infections in one year
    • 2 or more months on antibiotics with little effect
    • 2 or more cases of pneumonia within one year
    • Failure of an infant to gain weight or grow normally
    • Recurrent, deep skin or organ abscesses
    • Recurrent thrush in the mouth or elsewhere on the skin after age one
    • Need for intravenous antibiotics to clear infections
    • 2 or more deep-seated infections
    • A family history of primary immunodeficiency

    If you believe that your child does have a primary immunodeficiency, ask your pediatrician about performing tests to look for immune system problems.

    Tips for Avoiding Infections

    Since keeping a child out of daycare isn't a practical option for many parents, some other things to consider to help your child stay as healthy as possible include:

    • Getting your kid a yearly flu vaccination and making sure that your child's other vaccinations are up to date
    • Making sure your child is getting the nutrition they need to help their immune system function normally. This means ensuring that they get enough protein, fibre, and micronutrients (vitamins and minerals) and minimizing sugar and processed foods.
    • Avoiding other day care-type situations, such as a gym daycare or church daycare, so that your child isn't exposed to a lot of different groups of kids who might be sick
    • Discouraging thumb sucking or using a pacifier as your infant gets older, as a contaminated finger, thumb, or pacifier can be a good route for germs 
    • Teaching your child to wash their hands as they get older frequently

    Make Sure You Are Reachable at All Times:

    In many child care programs and public and private schools, parents are contacted right away when their child shows signs of even a mild illness, like a cold. In others, children are allowed to continue the regular program as long as they can participate in most activities and do not have a condition that requires exclusion. Either way, be certain that the school or caregiver has a way to reach you at all times—make your phone numbers at home and work available, as well as your cell phone number.

    ​When It's OK to Stay in Child Care: 

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    Except during outbreaks of influenza, as long as the first two criteria are met, children do not need to be excluded for:

    • Common colds
    • Runny noses (regardless of colour or consistency of nasal discharge)
    • Coughs
    • Yellow, green, white, or watery eye discharge without fever, even if the whites of the eyes are red (pinkeye)
    • Eye pain or eyelid redness
    • Fever in children older than 4 months above 101ºF (38.3ºC) from any site-(axillary, oral or rectal) without any signs or symptoms of illness
    • Rash without fever and behavioral changes
    • Thrush
    • Fifth disease
    • All staphylococcal infections, including Methicillin-resistant Staphylococcus aureus (MRSA) carriers or children with the colonization of MRSA but without an illness that would otherwise require exclusion
    • Molluscum contagiosum
    • Cytomegalovirus infection
    • Hepatitis B virus infection
    • HIV infection
    • Children who have no symptoms but are known to have a germ in their stools that cause disease—except when they have an infection with a Shiga toxin-producing Escherichia coli (STEC), Shigella, or Salmonella serotype Typhi. In these types of bowel infections, follow health department guidelines for return to care.

    Some tips to Prevent Illness:

    • Don't Throw in the Towel

    The best offence to fighting off Illness in your home is a good defence, so don't feel defeated. Here are some tips to help deter the spread of an illness:

    • Wash Hands

    Hand washing is crucial. Nearly 80 per cent of infectious diseases are spread by touch. From eye rubbing to booger picking, kids can be walking viruses. Have your kiddos scrub their hands with antibacterial soap for 20 seconds, the time it takes to sing their ABCs, making sure they scrub between their fingers and on the tops of their hands.

    • Disinfect

    To minimize the number of items you need to keep track of to disinfect, keep your child in one area of the house. Disinfect anything they have touched (i.e., iPads, toilet) twice a day. If your child is old enough, they can help disinfect too.

    • Don't Share

    Don't share food, cups, utensils or even toothpaste. Set aside the sick child's items, so there is no confusion. If they share a bathroom, you may consider having the healthy ones use another.

    Most importantly, understand that frequent infections are very common in the first year or two of daycare and are usually not a cause for concern. Call your pediatrician to figure out the best course of action if and when your child gets sick. Also, try to maintain as much flexibility in your work schedule as possible and hang onto as many sick days as you can since your child may have to stay home sick from daycare a lot.

    But children will get sick at some point. Parents should accept that they cannot protect their kids from every Illness — whether they're in daycare or not. Do what you can to take precautions and be prepared for missed work and school. All parents know that it's bound to happen. When your child shows signs of Illness, set up an appointment with your Banner Health pediatrician and get them back on the path to health right away.

    How to Keep Your Child From Getting Sick at Daycare
    1. Vaccinate. ...
    2. Eat Healthy. ...
    3. Keep Shared Toys Clean. ...
    4. Enforce Regular Hand-Washing. ...
    5. Choose Facilities with Compassionate and Careful Sick Policies.

    Often, a child is not allowed to return to the centre until they've been fever-free (or diarrhea-free) for 24 hours. That means if a daycare worker notices your child is running a temperature at 3 p.m., they won't be allowed to attend care the next day, even if the fever has vanished by morning.

    Young children who are in daycare very often get frequent upper respiratory tract infections, including colds and secondary ear infections. In fact, experts estimate that the average child gets six to eight viral upper respiratory tract infections each year.

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