Month 19 Worry: When to Keep a Sick Toddler Home from Daycare

The most common medical concern for parents of children this age

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It’s a consistent question for parents of kids in daycare: “Is it safe to send my child if she has the sniffles? A cough? Pinkeye?” Here’s what our doc has to say about when to keep sick toddlers home.

It’s Monday morning and you are the doctor on call. Odds are that your 7 a.m. page is a frantic, one-foot-out-the-door parent asking, “My child has a runny nose/ a pink eye/ a low-grade fever… should I send him to daycare or keep him home?”

What’s the Issue?

Toddlers’ illness symptoms can come in many varieties and severities (and, well, colors and sounds and …). But with the pressures of getting yourself to work, taking the best possible care of your child, and an infinite combination of potential sickness signs to sort through, it can be a tough call as to whether to send your child into the mix at daycare or keep him home. How can you decide without a call or trip to your doctor’s office?

Consider the Numbers

The average toddler has about one viral infection per month. The average toddler in daycare about doubles that average. Each viral upper respiratory infection lasts seven to 10 days. Doing the math, two of those viral infections per month can make a toddler sick for 20 out of 30 days in a month. And that’s the average! It’s no wonder that it seems your toddler is sick all season long!

What Parents Can Do

Keep your child’s best interests in mind. A sick child is a potential Typhoid Mary at the local daycare. Kids share their toys, their playing spaces, and subsequently their germs. Infections, even in the most compulsively clean of daycare settings, can spread easily. 

But also remember that your sick child who is simply droopy, coughing, and out of sorts could be made more seriously ill with a compounded viral or bacterial exposure. In other words, recovering from a simple cold is easier than recovering from a cold plus the fluor the stomach bug.

Keep in mind the recommendations from the American Academy of Pediatrics (AAP). A toddler should be excluded from daycare if …

  • his illness prevents him from playing comfortably in program activities
  • his illness requires more care than the staff can provide
  • he is feverish (temp greater than 100.5), in which case keep him home until 24 hours after his last fever spike
  • he is lethargic, persistently crying, or having difficulty breathing (signs of more severe illness)
  • he has vomited two or more times in the past 24 hours
  • he has diarrhea, especially with blood or mucus
  • he has a rash with fever or rash with behavioral change (lethargy, pain, or severe itching)
  • he has pink eye with white or yellow discharge. In cases of conjunctivitis which would require daycare exclusion, the eyelids are usually crusted and goopy, especially after sleep
  • he has belly pain lasting more than two hours or associated with fever or signs of dehydration
  • your doctor has diagnosed an infection which requires a long recovery period and medical clearance for return

Check your daycare facility’s policies, because they can vary significantly from the above guidelines and generally take precedence no matter how medically illogical (see below).

What the Docs May Do

Your child has a runny nose and he appropriately scurries off to daycare. Yet a runny, pink eye often gives him an immediate “return to sender” from the daycare provider. What’s the difference? “If noses were anatomically inside out, that is, if all your mucus membranes were visible (like your eye) and not hidden underneath a layer of skin (like your nose), no child would ever attend daycare,” says Dr. Eugene Shapiro, MD, a Yale pediatric infectious disease expert. 

His point is that the same viruses that cause your toddler’s pink eye also cause that perennial runny nose. These are similar symptoms caused by very similar pathogens. But because you can see the eye that much better than the inside of your nose, the same symptoms appear more dramatic. 

The bottom line: Use your good parental instincts and your daycare’s guidelines. If your doctor thinks your toddler is OK to be in the mix after a careful evaluation, ask whether a clearance note can be written.

More 19th Month Help

Even the most confident parent has concerns about her child’s health and wellnessfrom time to time. Learn more about which medical issues are most common at each age, here. (If you have any pressing concerns or questions about your child’s health, please check with her healthcare provider.)

  • What was last month’s most popular health worry?
  • Learn which medical question you might have next month.
  • Here’s what else is happening with your child’s health and development this month.

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