Although many illness are most contagious before any symptoms even appear, it is possible to cut down on how much they spread within your child care facility by following these tips.
Illness Policy vs. Symptom Policy
Example of an Illness Policy:
"Children who have the flu must be excluded from care"
Example of a Symptom Policy:
"Children must be excluded from care if they exhibit the following: vomiting, loose stool, or fever greater than 100 degrees"
1. Exclude for the symptoms of illness rather than the illness itself
You may think that there isn't much of a difference between an illness and a symptom, but this can be the key in keeping sickness from spreading in your home daycare. If your policy simply states that children can't attend your daycare if they're sick you're opening the door to allow parents to interpret that however they choose.
However, by creating a Symptom Exclusion Policy, rather than an Illness Exclusion Policy, you may have an easier time shutting down parents who attribute their child's illness to "teething" or "allergies". If they're exhibiting the symptom then they can't stay. Simple as that. The cause of the symptom isn't usually important at all.
Symptoms to Exclude
- Child cannot comfortably participate in group activities
- The symptoms require more care than you can provide without impacting the care of the group
- An acute change in behavior (lethargy, difficulty breathing, persistent crying, uncontrolled coughing, sudden spread of a rash, etc.)
- Child requires medication in order to mask symptoms
- Fever at or above 100° (taken under the arm)
- More than one episode of diarrhea or loose stool that cannot be contained in a diaper
- One episode of vomiting
- Mouth sores with drooling
- Rash with fever and/or behavior change
- Purulent conjunctivitis (red or pink eye)
- Untreated scabies, lice, or any other infestation
- Untreated tuberculosis
- Known contagious diseases while still in the contagious stage (hepatitis A, chicken pox, strep throat, rubella, pertussis, mumps, or measles)
*Feel free to go reasonably above and beyond this list*
2. Create a written policy and stick to it
Having a written symptom policy will help cut down on any confusion when it comes time to exclude a child. This should be part of the Parent Policy Handbook that's given to all of the parents in your daycare. I even went one step further and created a laminated version of my symptom policy with a magnet glued to the top. This way my clients could stick it to their refrigerators and reference it whenever they needed to instead of having to dig through their paperwork.
Make sure that your policy is clear cut and uses language that parents can understand easily. You don't want anything left to interpretation.
Even with an awesome symptom policy in place, it means nothing if you don't follow it. Make sure that you know your own policy from top to bottom and that you're prepared stick to it. I've found that if you allow a child to attend your daycare when they're exhibiting a symptom even one time then parents will expect them to be allowed every single time. Stick to your guns and don't feel bad. You can empathize with the parent's situation, but in the end you still have to do what's best for your group and that means sticking to your policies.
When to Accept a Doctor's Note
In some situations, a doctor's note may be required. In my state, parents can legally return their child to care if they provide a note for the following:
- Mouth sores with drool is deemed noninfectious
- Rash with fever is determined not to be a contagious disease
- Children with tuberculosis must provide a doctor's note for when the child is able to safely return to care
3. Don't ask for doctors notes
There are two main reasons why I advise against requiring doctors notes for children who are showing symptoms of being sick.
The main reason is that you have absolutely no idea what the parent is going to tell their child's doctor in order to get that golden "return to daycare" note. Even though you've experienced massive liquid diaper blowouts several times a day with their little one, it's fairly easy for them to tell the doctor that the child simply ate something that didn't agree with them. The child who had a 101 degree fever while in your care has suddenly been doing some hardcore teething (because that's what the doctor was told is going on). See? Easy peasy. The parent proudly hands over a doctor's note and you're stuck with a child spreading who knows what to the entire group.
The second reason is that some parents will clog the emergency rooms and immediate care clinics in order to get back into care quickly. What they're really doing is receiving a doctors note from a doctor who has never seen their child before and has no history of their health.
The best thing we, as providers, can do is to simply stop requesting doctors notes entirely. They mean almost nothing and you will still end up with a child exhibiting symptoms of illness while in your care. The easiest action to take is to exclude them regardless of the reason behind the symptom and resume care once the symptom clears up.
If you do choose to allow medications or if a child requires a medication for a chronic illness, protect yourself and the child by doing the following:
- Do not allow "as needed" medications. You are not qualified to determine when "as needed" is.
- Check with your state licensing for paperwork requirements
- Have the parent sign a form that states the medication name and dosing requirements
- Document the date, time, reason, and dose every time you administer the medication
- Only allow original, brand new (sealed!) labeled medication bottles
- Prescription bottles must contain doctor's name, dosage, and specific time for administering
4. Do not administer medications to daycare children
The only medications I administered in my home daycare were those that were for chronic illnesses and that could not be administered at home by the parents. These would be medications like inhalers or EpiPens. Even antibiotics that have to be given several times a day can be scheduled so that every dose is taken at home. It was also my policy to not give breathing treatments because I was unable to sit with one child for an extended amount of time and safely care for the entire group.
Over the counter medications, such as pain killer and fever reducers, should not be given to daycare children. In my experience, all these do is mask the symptoms of illness which widens the chance of that illness spreading within your child care. If a child requires a dose of pain medication or fever reducer in order to make it through the day then they are too ill to attend daycare.
I also recommend taking it one step further and never allowing a child who has been given fever or pain reducer before they are dropped off. If they need over the counter medications to make it through the day then they should be home.
5. Hold high hygiene and cleanliness standards
Although I believe that exposure to germs helps build immune systems, in a daycare setting we have to keep our environment as clean as possible. Ways to use proper hygiene and cleanliness to cut the spread of illness in your daycare include:
- Wash everyone's hands frequently. Important times to wash hands are when arriving at daycare, after using the restroom or changing diapers, before and after preparing meals and snacks, before and after meals and snacks, after coming in from playing outside, after helping with a runny nose, after attending to a scrape or cut, after performing any cleaning duties, and any other time you feel you may have touched something or someone that could transmit illness.
- Clean any toy that finds its way to a child's mouth. When a child mouths a toy, make sure the toy gets cleaned properly before you allow any other children to play with it. The easiest way to do this without constantly cleaning toys is to have a dedicated dirty toy bucket that is out of the reach of the children. Throughout the day when you see a toy mouthed or become dirty simply throw it in the bucket. At the end of the day, clean the toys inside the bucket and return them to the daycare area.
- Disinfect the surfaces where the children eat before and after each meal and snack. We have no way of knowing exactly what germs find their way to the tables and high chair trays between eating times. Since little hands undoubtedly find their way into little mouths during meals and snack times it's important that the surfaces they're eating on are clean.
- Disinfect all large daycare surfaces at the end of the day. Surfaces like larger toys, tables, chairs, etc. need to be disinfected at the end of each daycare day. This will help provide a clean environment for the next day.
How to Disinfect Toys
Stop the Spread of Illness
It's inevitable that children in your daycare setting will get sick. By using the tips above, you can easily cut down the spread of illness and prevent problems with parents by developing clear symptom policies. By remembering to strictly adhere to your own policies and to uphold high hygiene standards you can quickly and easily eliminate the spread of illness in your environment.
Do you have experiences with illnesses spreading within your daycare? Let me know in the comments what steps you've taken to help keep your daycare children healthy!
This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.