Thank you so much for this article! What other service industry has non medical professionals that can send people home they believe to be sick? And still require them to pay for a service they are not receiving? My child has been sent home 'sick' 7 times in two years. Only one of those times was he actually sick. We've started to take him to his doctor to prove that he is not sick, and he indeed is not. But the Director still does not care and nor does she have to. There are no protections in place for parents. The result, as this article says, is loss of income for parents, paying for a service they don't receive and emotional stress of having unreliable care. None of which falls on the daycare or the state. And to top it off, the policies are ineffective, as stated in the article and experienced firsthand. We continue to have outbreaks at least every month.
As the director of an early childhood program I found your article both intriguing and offensive. I love reading content that challenges me to be better at my job, but the blaming and dismissing tone is discouraging.
I don't want to play doctor. I wear a billion hats in my role as an early childhood educator and it's sad that playing doctor is one of them. Like everyone else I am doing the best I can to support children to thrive and unlike a doctor I see children in large groups.
There is a lack of respect and mutuality between the medical field and the early childhood field. I think if we could tear down that huge barrier we could learn from one another and better serve families.
I have a couple of requests for any future writing. Day Care has a negative connotation, please choose a less politically charged term. Child care is an easy substitute but most professionals like myself prefer to be called an early childhood educator and prefer the term preschool or child development center. As early childhood educators battle for recognition, equal pay, and basic human respect I'd like to see the NYT at least keep pace with respectful terminology.
Also if you would reach out to an educator (I'd be happy to comment) to get their take it would make for a more balance and whole picture. You may have discovered that these sick policies are often mandated by our licensing organizations.
Lastly, please keep writing children need all of us to advocate for them! Thanks!
1
It is a sad day for children (and parents) who have to send their sick kids to daycare.
Conjunctivitis, diarrhea, fever, excessive cough, and especially vomiting are reasons to keep your child home from school so they can recuperate comfortably at home and limit spreading the illness to others.
It is so sad that some parents may not have a choice and have to send miserably feeling kids to school.
1
As a mother who lost a child to a severe adverse reaction (DRESS Syndrome) to an unnecessary antibiotic, I appreciate that this article highlights the dangers of overprescribing. While reactions this severe are not extremely common, they do happen. Antibiotics are not a fix all for every ailment and can do more harm than good. As your preschoolers grow into their teens, they will be offered antibiotics for benign conditions like acne. I would encourage every parent to consider the risk versus benefit each and every time your child is prescribed an antibiotic, and absolutely be educated on which conditions are viral versus bacterial.
3
As a preschool teacher for 15 years and a mom of 4 children who attend daycare, I am offended by this article and some of the comments. Currently I am home caring for my sick child with diarrhea and vomiting. His illness was contracted from a child who's parent sends to daycare sick and refuses to keep home. She will not pick him up when called & feels we are picking on her child. As I am doing the right thing by keeping my infectious child home, I am losing out on money, and I'll remind everyone that being an educator does not pay well. This is not the 1st and most certainly will not be the last time I am to stay home with my sick child, but as I chose to become a mother it is my responsibility to care for my child regardless of the consequences. Daycare providers are not only caregivers, we are teachers, nurses, cooks, maids, and we are essentially your childs 2nd mother and father (shout out to all male daycare providers!) Daycare workers are some of the most underpayed and underappreciated, but have such big hearts they choose to love and care for your children when you cannot. It is our responsibility to keep all "our" children healthy and safe and the best way to do this is to keep sick children out of daycare. Daycare policy is not that your child must be put on antibiotics, as that is your and your child's pediatricians decision. However, it is daycare policy and best practice that your contagious child stay home until the infection is completely gone.
5
@Ali Courtois
Certainly, if a child is vomiting & suffering from diarrhea,he or she needs to stay at home.
But this article said that.
The question is whether a child with a drippy nose, or he feels a bit warm
needs to stay home.
Nursry school teachers who try to
make these decisions just don't
have the needed knowledge.
Too often,they call parents at work
to say: "you must come & pick
up your chld."
I
I am responding as a school nurse who works as a childcare "health consultant" on the side. For those who commented inquiring about "medical directors" for daycare,"health consultants" are the daycare center equivalent (most often RNs and APRNs, but some MDs DOs). While it may be easy to blame daycare directors, the issues are complicated and multifaceted. Directors must balance state regulation (sometimes outdated) with best practice guidelines, and recommendations from their nurse (health consultant), which at times conflict with each other. Directors must recruit health consultants, pay them ($0-$100/hr)and rely on them for quality, up to date recommendations. While some health consultants are very good, others may be casually serving in the role and not invested to provide high quality consultation. There isn't necessarily formal training, quality measures, or a databases to find health consultants; and while most states require them, funding is not there for private childcare programs. Conversely (in my state) public and private pre-K-12 schools do receive funding and resources for health and safety. Therefore, childcare center directors are often asked to accomplish the impossible. It's a kin to saying "Here, follow these strict health and safety guidelines, we aren't going to give you any support, good luck." This has huge implications for working parents as well, which I think were well explained in the article.
1
I worked in daycare for some time teaching toddlers. I agree that we need better sick leave policies and parental leave. At the same time, no one has mentioned the problem of parents playing doctor. As daycare employees, we are not allowed to give over the counter medicine without a doctors note. That is state law. Company policy is to send home children with fever over 100 F, also vomiting and diarrhea. Parents know the child has fever over 100, give tylenol and send child in. After a few hours, it wears off. Child is unable to participate in activities like playground time. We can't leave a 1 year old to nap in the classroom when everyone else is outside. The child has diarrhea and needs a diaper change every 20 minutes, or vomits on the floor, requiring us to clean up and sanitize a large area while keeping the others out of the way. Often the parents know perfectly well the child is sick enough they should be kept home and are irritated when we insist that a vomiting child or one with a fever, unable to participate, must go home. It's not even about contagion. A sick child requires extra care and attention and can mean that I am not able to properly monitor and engage the others in learning activities. Daycare teachers are not trying to be difficult--our jobs are very challenging. If a child can't participate, they need to go home.
5
My child attends a child development center (pre-school) at a local community college. They are partially funded by tax dollars (since they are a lab school) but seem to go rogue when it comes to their sick policy. One rule- posted on every exit/entrance and published in the monthly newsletter- children with a constant running nose cannot attend, and parents will be called to pick up children. We live in the Midwest, and winter months can be tough. Imagine explaining to a co-worker you have to pick your kid up due to a runny nose. But... the place is affordable (given the tax dollars that off set the cost), the facility is nice, the teachers are great. And so I deal with the January-March fear of the call with reports of sniffles, and subsequent required pick up.
1
@Helen
This is exctly the problem my adult
children have experienced with a
day-care center in NYC.
The problem seemed to be that
"helicopter parents" complained if
they saw a child with a drippy nose
at their child's daycare.
They didn't seem to realize that once your child begins mixing with & playing with other children, they will
inevitably pick up many colds. In the
process, they will develop resistance.
Better to have this happen when they are 3 rather when they are 6.
My grown chldren chose to take their
children out of a day-care center that
callled them at work over every sniffle,and found a better one, where their children thrived.
With all we now know about bacteria becoming antibiotic-resistant, it's appalling that they are still being requested and prescribed when not necessary! Antibiotics should be a last resort. They are also harmful to the gut flora, which especially for children can have life-long consequences to their immune systems. Yesterday I took my son to an urgent care clinic for an infected toe. The doctor suggested he take an oral antibiotic for one week. When I balked, he gave us a prescription ointment instead. Twenty-four hours later the affected area is clearly on its way to being healed, proving the antibiotic was unnecessary. As I think about it I feel that the immediate suggestion of an antibiotic for a small infection has more to do with doctors protecting themselves against liability, than with good medicine.
3
State laws against practicing medicine without a license need to be more aggressively enforced.
I have been affiliated with day care centers with these kind of foolish policies, and almost all promulgated by people with low- to no- medical training.
A particular nefarious tiptoe around medicine in the daycare setting is the refusal of many centers to properly apply sunblock.
“But that’s a medication!” I hear consistently from these woefully under-informed personnel. “We could be sued!”
What is a parent to do, I wonder.
2
@Max How would such a law eliminate this argument? My daycare is in my home and while I will never tell a parent they have to take their child to the doctor I also choose what I allow and what risks I’m willing to take with myself, my family and the other children in my care. That should be respected. Also, as a state registered provider, we do have to have parents fill out a form anytime we give medications. Sunscreen and diaper rash ointment are on that list. So maybe before calling others woefully under-informed, you should make sure you’re educated about the things you speak of.
1
The term pink eye should be avoided. It is a non-specific term that creates confusion as many things can cause the eye to become inflamed (“pink”) that are not viral or bacterial conjunctivitis.
Infectious conjunctivitis is accompanied by a large amount of discharge that is particularly noticeable upon awakening. If the eye has little or no discharge you are dealing with another condition: most commonly allergic conjunctivitis or dry eyes.
If an inflamed eye is accompanied by pain and/or loss of vision the child needs to be referred to an ophthalmologist ASAP as you are likely dealing with a more serious condition.
More serious conditions I have seen misdiagnosed as “pink eye” include: perforation of the cornea with a pencil lead (delaying surgical closure for 3 days), herpes simplex corneal infection, bacterial corneal ulcer, uveitis (eye inflammation) due to intra-ocular parasitic infections (toxocara and toxoplasmosis), and many others.
The author is correct about not treating conjunctivitis with antibiotics. But, it is worth stressing again that conjunctivitis can spread like wildfire in daycare settings. The affected children need to be sent home until their symptoms resolve as it unrealistic to expect toddlers not to touch their eyes and spread the virus to their classmates and teachers.
17
Anyone who is sick is better off at home. Sick children don’t stay home for the same reason that sick adults often don’t stay home, because the almighty dollar is considered more important than the health of a human being.
In 2020, vote for a president and candidates in every other office who will support:
1. Paid parental leave (no parent should be forced to work during the first year of their child’s life, this improves the health of both child and parent at a critical time)
2. Paid sick/family care leave
3. Free child care
4. Increased funding for high quality education beginning in early childhood
5. Universal health care
These can ALL be paid for by eliminating corporate welfare and tax loopholes that allow corporations and many individuals to make millions or billions of dollars in our country without paying their fair share of the costs to keep our children and adult citizens healthy.
Health is a right, not a privilege for the wealthy. Any country is stronger when its citizens are healthy.
17
@Teresa
But right now, most parents in the U.S. don't have paid parental leave.
As a voter, I agree that we should
fight for this.
But, in the meantime, we all must recognize that working
parents can't just walk out of work in
the middle of the day to pick up a child who is not vomiting, not experiencing diarrhea & is not running a high fever, but just has a cold.
Makes me remember the wonderful time my daughter’s eyes were red and a neighborhood mom chastised me at the playground for bringing her there and hustled her kids away. So glad those years are over. Makes you hate people.
6
Hahaha it’s all very silly when you think ahead to high school where absences are frowned upon and missing a day is a big deal. To get sent home you have to be vomiting or passed out.
3
Heck, even in middle school my kid is allowed 3 absences with a note. That’s it. This new-ish policy began around the time that the district started shutting down the schools for at least a week each school year due to such a high amount of sick teachers & students. It’s funny how they don’t see the correlation.
1
I’m a high school student. I have friends who go to school sick all the time because because it’s so hard to get caught up. Heck I even had to go to school the day of my grandfather’s funeral because I couldn’t afford to miss class. No wonder people my age are so stressed, depressed, and frustrated.
11
@Jeanine High school kids are also able (or should be) to more effectively keep their germs to themselves for the most part than infants and toddlers who are sharing the same space and toys.
When my daughter was in daycare I spent hours filling out forms with our doctors and medical insurance but when an emergency did happen (she suffered a rectal prolapse) they left her on the potty - alone and called me to come down.
I wasn’t even sure what I saw. I washed my hands, pressed on her bottom and all went back - then we drove to the doctor. Day care did nothing and they were on a VA property with doctors and EMTs. She was sitting all alone
4
I worked in a day care in the mid eighties. Was responsible for 2 year olds. 12 of them. That was the ratio then. Had 5 in diapers. Between the diaper kids and the rest, I washed my hands so many times per shift. Those with running noses, that was challenging. Clean up one nose, scrub hands, on to the next one. 2 years have the runniest noses! "My" kids were as clean as I could keep them.
Taught/showed them "how" to wash their hands. I was only working there for just short of 5 months, did not have a case of pink eye in the group, nor were there any viruses that hindered their attendance.I was lucky
2
Best cure for pink eye? Breast milk. Any wise mother knows this. Too bad daycare workers don’t.
1
@Colleen Goidel Wait a second, what if mom doesn’t breastfeed? What if she can barely pump enough just to feed the child? Should I just not feed the child that ounce that I put in their eyes and let them be hungry? Or what if the child is 3? Should I take breast milk from another child and use it to treat the older child? The idea of the last two scenarios makes me a little sick, but I’m trying to understand what you are expecting If a parent brought me extra and asked me to do it I would be glad to. But again, it’s the parent’s responsibility to choose the method of treatment and to treat the child, not mine. You make it sound like early childcare workers are unintelligent when all I am doing is saying ‘your child is possibly ill and I’m giving the responsibility and the choices about what happens next back to you’. No one that I know says you have to put them on antibiotics. I’m as holistic as they come. But then they do need to remain at home as long as they’re contagious. Sorry if that puts a parent in a tough spot, but not my kid, not my job to care for them when they’re sick. I have multiple other families and kids to consider as well as my own.
3
So.... did I read this correctly? A child can get sick going to the doctor, but if that same child is sick, spreading it in day care/school is better? How about we get better sick leave policies for adults that allow parents to take more time off work when their child is sick rather than putting the onus on the child to stay in school "unless he is too sick to participate." Which begs the question participate a what level. As a preschool teacher, I guess I will be using a ton more sick days when I get sick myself because all the sick children stay at school! Just hear the parents complain when they kids don't have a teacher for awhile do to sub shortage. Also when children with compromised immune systems are exposed to germs, that can be dangerous for them. It seems these policies don't matter.... It must have been a long time since this writer has had a fever and then asked to do multiple high cognitive load assignments without taking OTC medicine (which schools are not able to give out). Yet another way to push societal problems on to the backs of students and teachers. Anxiety levels are rising among children and now apparently they aren't even allowed to take a sick day.
11
These issues get worse in regular public school. My 4th grade daughter had a minor knee sprain. I got her a fabric knee brace and told her to skip gym and stairs and we'll see if it gets better. The school sent her home and insisted I get a doctor's note to let her come back to school. The doctor visit cost $155. The doctor looked at her knee and said 'put a fabric knee brace on it and tell her to skip gym and stairs and we'll see if she gets better'.
My other daughter was out of school for a few days because of a cold/fever. They made us get a doctor's note. Another $155. The doctor confirmed that they don't recommend us to come in for few days of cold/fever. Etc.
15
The policies are in each state's constitution. Centers uphold and enforce these policies because they have to or their license will be taken away.
2
As a retired School Nurse, I am deeply suspicious this article was written after the Professor was called to pick up his child from daycare and he and/or the child's mother had to decide who was going to have to ask for leave to care for the child. The article is contradictory. In the first instance the Professor posits that daycare staff should not make medical decisions then he chides this staff for referring the student to the appropriate healthcare providers. School and daycare staff are not advocates for parents' employers, they are advocates for children. When a little one is presented to school or daycare with signs and symptoms that are not consistent with normal health it is always in the best interest of both the individual child and the health of her/his classmates to refer the child to an appropriate healthcare provider for diagnosis and appropriate treatment not withstanding the parents' inconvenience.
29
@Deborah Bennett RN
If the family is upper middle class or beyond, perhaps "inconvenience" is an almost appropriate word. You might have noticed the article puts the issue in the context of families for whom the added expenses (for conditions that do not require a doctor's attention) are much much more than just an inconvenience. "Signs and symptoms not consistent with normal health" is tremendously vague and must cover huge swaths of stuff that by no means whatsoever needs evaluation by a healthcare provider. The AAP guidelines are a good starting point if you want to make an effort to make more judicious choices.
3
@Henry K.No one says they have to take them to a doctor. I’m middle class and I have to pay for insurance. I’d be better off in my state to make less and get state provided insurance for $20/month
@Deborah Bennett RN
First, let me suggest that the Dr. who wrote this article could afford to have
someone pick up a child, bring her home, and care for her.
He is not writing about his problems, but the average parents' problems.
For those parents,we are not talking about "inconvenience."
My daughter is a 1st-grade teacher in NYC with 29 students.
If she walked out, in the middle of the day, this would create chaos for
other teachers (who would have to divide up her class) and their 6-year-old students.
My son is an attorney. If he was in
court, in the middle of a trial, representing a client, could he explain to the judge: I have to leave because the day-care center says my son has a sore throat or a temp. of
100?
Of course, if their child fell & broke an arm, was hit by a car, or was in a true medical emergency, they would leave.
But if a school nurse or a day-care worker sees "signs and symptoms that are not consistent with normal
health" they could not walk out on their responsibilites.
If possibe, they would call the school or center & find out what was going on, but would not leave their sudents or client except in a true emergency.
By the time the child has pink eye, the other kids are already exposed, and have been for a while.
Most are caused by viruses, often with concurrent upper respiratory symptoms. As any adult should know, that virus spread at the first sneeze.
Kids are germ bombs.
Viruses which run rampant include the summer fever of enteroviruses (like Coxsackie); cold viruses like rhinoviruses, and the more potent adenovirus which often causes pinkeye; flu; and norovirus which causes the "stomach flu." Many of these, such as noro and enterovirus are wildly contagious; they are pretty hard to contain as any cruise line will tell you.
Kid with fevers should be sent home. Kids with pinkeye, active cough and sneeze? No kid would ever be in school or daycare the first few years of life.
And nobody should EVER demand antibiotics as a condition of return. Antibiotics are not benign causing a disruption to the natural biome of your body, and their efficacy is ruined by overuse. They should be reserved for when the doctor feels they are necessary.
14
I disagree. If a child is sent home when the signs of conjunctivitis are first present an outbreak can be prevented. Conjunctivitis, particularly that caused by certain types of adenoviruses, is not always a trivial disease. It can persists for weeks and sometimes progress to a keratitis that can be disabling. Every effort to prevent its spread should be undertaken. In my office potential conjunctivitis cases are seen in a room set aside for this purpose. And every item touched by the patient from the front door of our building to the exam chair is thoroughly disinfected after the patient departs.
6
@Cathy I’ve had a daycare in my home for 15 years and can solidly say that we go for long periods of time with no coughs and no runny noses because of the illness policy I have in place and the respect my families have for it. My parents take very few sick days overall because sick kids are kept home, therefore it doesn’t get spread back and forth and mutating into something requiring a visit to the doctor.
@Cathy
Thank you for just a well-informed reply.
You are right, of course, by the time
symptoms are apparent, other kids have already been exposed to a virus.
Sending the sneezing, coughing child with a drippy nose home will not protect them.
And, as you say, small children should not be given antibiotic unless absolutelty necessary. We don't want them to build up resistance to antibotics that they may need in the future.
I used to work in a day care and as a nanny. Some children have weaker immune systems and pick up every bug you can think of. Others manage to go through a whole year with nothing more than a light cold. Not all children benefit from group care and would do so much better staying at home with a nanny. I would include in that group very young children and infants. Infants are most likely to pick up illnesses and the parents get called out of work multiple times to come and pick up their sick child. This despite the parents having no PTO left from using it for maternity leave (a subject for another discussion), and also despite the infant not really needing a visit to the doctor- just a couple of days home to rest. But the problem is that the day care policies (often NOT set by the day care directors or the teachers) apply blanket rules to every illness. The day cares are NOT playing doctor- actually it’s the opposite. They’re essentially telling you “we don’t know what this rash is, please take your child to a doctor to confirm.”
6
As a Nursery School Director/Teacher of 39 years I feel incredibly annoyed by this article. The amount of generalizations here is enough to make your head swim. When parents checked in with me about their child's Illness the first words out of my mouth were generally, “Have you checked with your pediatrician? What did she/he say? Believe me, we have plenty to do in our programs without trying to play doctor. We received our information about childhood illness and disease best practices from our public health office. Our concern is to help keep the children in our programs happy, healthy and engaged in discovery. As one reviewer already said, we are not in these jobs to make money and certainly not to bilk parents. I think the New York Times should be able to find articles that are better researched and not full of blanket accusations for which no proof is shown.
42
@Moira Murphy
I found the article very well reasearched. "Have you checked with your pediatrician?" is as you suggest, probably very reasonable if the parent is asking you to act as a medical professional. But it is not at all the most helpful route for the majority of the colds and viruses kids have that do not require medical evaluation which the article discusses.
3
If you want daycare providers to stop sending children home with things like pink eye, fevers and other illnesses then you need to go to your state legislature and have guidelines changed. We as providers don’t just decide child has to be medically treated it is in our minimum standards. We are following the law as it is written.
28
@Jms if you want daycare providers to stop sending children home with things like pink eye etc stop sending them to daycare with things like pink eye etc
1
This story brought back memories of my three year old getting her only bout of conjunctivitis. I was working nights to be with her during the day and she didn’t have much exposure to other children. I took her her for a ‘routine’ physical and immunizations. The waiting room had many tempting toys and she couldn’t resist playing with them. She was healthy when she went in and developed purulent conjunctivitis in a couple of days. Health care offices and hospitals are also sources of infections. And of course I learned not to let her touch anything in the waiting room after that!
10
The institutional response to illness is often inappropriate. Even though I was just 6 at the time, I remember my first day at my new grade school. I developed a very bad headache and went to the school nurse who suggested as it was nearing the end of school I could just wait it out.
By later that afternoon that headache had bloomed into meningitis ultimately leading to hospitalization for polio. A few days later, Mrs. Langthorne, RN, called my mother to ask why I had not been to school. She was horrified to learn of my diagnosis and for the next week any child who even walked past the nurse's office was sent home.
Extra credit fact: polio is spread by oral-fecal contamination and no one was at risk unless hand washing stopped. (I was the only symptomatic case in our town that entire year.)
8
Unfortunate summary: YOU CANT HAVE IT ALL. Children require care and a job requires commitment.
12
@greatnfi
Here's another summary: Unless born to family wealth, most of us need a job in order to provide for a child's care.
35
@greatnfi Thanks for that very illustrative comment! Who doesn't need to work?
9
@DW. Then don’t have children.
8
Childcare workers do not play doctor. You have to remember most childcare providers follow the same sick policies as schools. Parents need to understand that if their child is in a daycare program that it isn’t just their child. Providers have other children in their care too as well as their on family sometimes. If they have sometching that’s contagious, like pink eye that’s mentioned, they need to stay home. Kids wipe their eyes and spread germs like wild fire. Same if they have a fever, diarrhea, and etc. I never tell a parent they need go to the doctors and get an antibiotic. That’s the doctors job. A doctor is not going to give one just because the provider says they need that. If they get prescribed an antibiotic the child is most likely sick, right?
Daycare can be expensive, yes. But parents need to realize that we are not raking in the money. We don’t get rich. Most of the money earned from daycare barely pays our bills and buys the stuff needed for daycare activities.
Does the author of this article even have any children? Have you worked with children?
19
@Amber the author is a professor of pediatrics. That means he knows so much about providing medical care to children that he teaches others. So yes, he has worked with children.
13
@Aussie
Being a professor of pediatrics is certainly evidence that he has worked with children, but I'd wager he's never worked long-term in a childcare environment. That's a good deal different, and trying to keep everyone healthy simply by being preventative is a lost cause. Just sayin'.
11
@Leslie but the point is that many of the requirements imposed aren’t actually helpful in curing the child or preventing the spread of diseases, like antibiotics for viral diseases
12
Nowhere is the stupidity of school administrators and daycare operators playing doctor more evident than with "no nit" policies for lice. It has been at least a decade since official policies of pediatric and school nurse organizations have said no to the nit-witted policies that do nothing meaningful for health but keep kids needlessly out of school and expose them repeatedly to pesticides that no longer work. I also take exception to "no sick absence is excused without a doctor's note", especially when the doctors office answering machine says STAY AWAY UNLESS ... during a flu epidemic. We had a vice principal on one of our schools who I was ready to take legal action against for bullying students who sensibly stayed home sick during a flu epidemic - and taking actions not specified in the district policy. I shouldn't need a lawyer to tell an administrator that they need to stop pretending to be a doctor.
13
Wow. Read a good sampling of these comments. To me the issues are this - as usual with child care-related issues:
1) Parents need more time off - preferably a year-long parental leave when a child is born, and more generous paid time off later, too. And more flexible schedules.
2) Child care workers need to be paid better and to be better respected in society (then it might not be so hard to keep centers well staffed, find substitutes when needed, etc.).
3) Tying medicine to "patient satisfaction" has had some unintended bad consequences, such as the overprescription of antibiotics, leading to a vicious circle where child carers demand it because they know the doc will prescribe it, and docs prescribe it because they know day care demands it and therefore parents will go to a different doc if they won't prescribe it. Oy
4) Health literacy is low in this country. Too many people don't even understand that antibiotics don't work for viral illnesses.
5) Handwashing campaigns are a pretty loopy suggestion when we're talking about preschoolers. Staff can wash their hands all day long but it's not going to stop kids sneezing all over each other and all over the staff.
45
I find the tone of the article very annoying, almost offensive, and most of the arguments are not logical.
Childcare workers and directors are not playing doctor, they write responsible policies based on best practices and experience. I have worked in childcare for many years and very often, parents would bring in their children with a fever or a severe cold. Also, pink eyes are not minor ailments, they are very contagious. Of course, there are paying for the childcare, but so are the parents of the healthy children, who might get infected. Also, for the childcare workers, sick and contagious children are problematic as they can get infected and often have very limited sick days. The policies are based on what works best for the community around the facility.
Yes, daycare is pricey, but that is not the fault of the directors, but a political problem.
Also, the article sounds like the parents are victims of cruel daycare directors who make the children take antibiotics against the parents will. It is the doctors who prescribe antibiotics, not the preschool directors, and I know of many doctors who prescribe antibiotics against viral illnesses.
I also think for pediatrician, the author has a really cold-hearted look on children and it appears as if parents just want to get rid of them. We adults do not go to work when we feel sick, why would you send your tiny child to daycare when it is sick?
26
@Bernadette I agree with everything you wrote!
3
@Bernadette
You should stop seeing any doctor who is prescribing antibiotics against a known viral illness.
10
Let's not say that this is the case everywhere. The daycare that my daughter full-time attends is immaculate. The kids wash their hands several times each day. She has never had any communicable diseases. The only times that she has had common colds have been after returning home from vacations. It is entirely possible to minimize infectious diseases among even the youngest of children. Clean, clean, clean and wash hands. That's all it takes.
5
@india that doesn't help for respiratory diseases which are spread by airborne germs, not by dirty toys.
12
Parents push other parents to go to the doctor.
The day care is just the messenger.
7
I suspect they are afraid of lawyers who will say they knew or should have known (love that all encompassing phrase) that the child would be a hazard to other children. Our litigious society strikes again.
5
To: New Parents
From: Grandma
Dear New Parents, your children will have snow days and sick days. Young kids do get sick, some children more than others. The children need to be kept home until they feel well enough to participate in the school or child-care day. Dads, hello there, this means that you take time off of work to care for sick kids too. Actually, you will grow to value the time at home with your children. Got it, parenting 101. On a side note, I don’t know how young parents manage to work full time and raise your children. But, you do. And, you are doing it well.
32
My heart goes out to any family be it single working parents or working couples that require day care to stay a float. After years of the rat race and schedule juggling of duel careers and commuting in and out of NYC we were burnt out and miserable. Yes, daycare did eat up about 2/3’s of one of our salaries. Had we stayed in that smaller house closer to the city we could have swung it with only one of us working and with a shorter commute to boot. It all worked out in the end, but there were a few years of a marginal quality of life due to the mindset that we both needed to work in order to self validate.
4
No no no. I have done daycare in my home for 15 years, have been a parent for 19 and this article was offensive to say the least. None of us say they have to be medicated, we are simply saying we don’t have to be exposed. Many of us have policies stating the child cannot return until the symptoms are gone or until they have been on antibiotics for 24 hours...it’s the parent’s choice whether to allow the child to ride the illness out at home or ask for antibiotics. It isn’t the parent’s choice to make all of the other children, myself or my family ill and it’s RIDICULOUS to expect that to be the case. You’re going to have days off when you have kids, accept it or don’t have them. But I bet when I take a day off because your child shared their ‘allergies’ with me I bet most parents don’t feel bad they’re taking my pay away. I feel like I do as much as most doctors do, take a look at them and make a ‘diagnosis’ based on what I’ve seen in the past. Also, we spend more awake hours with most kids than parents do, we know when they’re off. It’s comical, however, that we aren’t supposed to diagnose but when a parent was expected to provide a doctor’s note for a rash (this allowing the doctor to diagnose) that’s wrong too. Providers are just expected to take them all, no matter what condition but we are also shamed if a healthy child picks up an illness from our home. Sounds like we can’t win no matter what we do.
25
@Brandee The point is giving antibiotics for 24 hours is not going to change the course of the illness or its infectivity. Giving antibiotics for a viral illness gives the adults a false sense of comfort but doesn't help the actual illness at all.
10
@Jess you are completely correct. That is in my policy as a way to allow people who DO have the medical degrees to determine whether or not this is viral or bacterial. It’s between the doctor and the parents to determine how often a child has an antibiotic. But just because the illness doesn’t require an antibiotic does not mean it should be shared with anyone else.
9
@Brandee if, as you say" Many of us have policies stating the child cannot return until the symptoms are gone or until they have been on antibiotics for 24 hours...it’s the parent’s choice whether to allow the child to ride the illness out at home or ask for antibiotics." the end results is the parent insists on antibiotics at the doctor, receives it, and then sends their child back to school the next day. Same reason why every adult who goes to the doctor with a cough goes home with a z-pack. The incentive for the doctor is to keep the patient/parent happy, to allow the parent to return to work, and to allow a child who never should have been banned in the first place to return. The American Academy of Pediatrics explicitly states that pink eye, whether viral or bacterial, should not be an automatic exclusion reason from school and daycare. This article cites the source https://nrckids.org/files/CFOC3
5
I belong to a physician's humor/satire group, and one of the most liked memes they've had, paraphrased, was "Childcare worker's diagnosis of bacterial conjunctivitis requiring antibiotics overrules actual informed medical opinion of viral infection by child's board certified pediatrician mother," likely because it has a significant kernel of truth.
12
@Durham MD I have a (somewhat) opposing anecdote. My little boy had several bouts of conjunctivitis. Each were quickly cleared with antibiotics. Our primary care pediatrician had us see a pediatric opthomologist told me in a very haughty way "this is viral, I know." I said "it looks exactly like every other bacterial infection that has been cleared with antibiotics." She then told me (a PhD by the way, "in science") that she doesn't like treating parents rather than treating children. She gave me the Rx and required me to check in a week later. I told her (truthfully) that the infection had quickly cleared.
3
@Donna Gresh We had two families in a class and all members of both of the families kept getting conjunctivitis. They both finally went to opthomologists who tested them. One family was diagnosed with viral conjunctivitis and the second family with bacterial. It did not seem that just by looking at their eyes that a correct diagnosis and treatment had been made by their pediatricians.
Ummm, but if you have a science ph d surely you recognize that the fact that the child took antibiotics and got better does not prove the infection was bacterial? Because the child might have gotten better without antibiotics as well. You don’t know unless you just watch. That’s why a good doctor these days isn’t going to give you antibiotics for say, sinusitis, until you’ve been sick for 10 days or have some specific indicator of bacterial rather than viral infection.
2
I once felt like an overreacting parent for taking my daughter to get antibiotics for suspected pink eye... until a coworker told me she was partially blind in one eye because of untreated pink eye. Not worth the risk!
9
I got the call to get my then 2-year old from day care for "a rash." I took one look at him and said, "That's dry skin." But the staff told me I still needed to bring him to the doctor, he wouldn't be admitted back without a note. So I take him to the doctor, costing me a doctor's visit as well as time off from work. Doctor tells me he has dry skin. When I returned my son (a pasty white Irish boy) to the staff of mostly Black and Hispanic women, I patiently explained that's what dry skin looks on pasty white Irish people. They weren't amused, but neither was I.
12
I had to get a doctor's note explaining that 2-year-old's poison ivy was not contagious so that he could return to his classroom. Same son also got diarrhea the week he stopped wearing diapers and started using the child care center's tiny toilets - it was going around. And he was one ear infection away from tubes before he finally stopped getting one every time he caught a cold.
Nevertheless we loved the place, and so did he. They had their hands full but the caregivers loved the children and taught them a lot.
I don't remember ever being required to use antibiotics as a condition for his returning from an illness.
3
Why does the article cite that "About 30 percent to 40 percent of working mothers pay for child care outside the home." Are working fathers not responsible for paying for child care, too?
45
Yes! This! In 2019, why is it on the mother to bear the burden of being the parent whose career made child care necessary, and from whose salary it should be paid? The content of the article is full of problematic issues, but this particular sentence is a glaring oversight which points to persistent assuptions about shared responsibility which do not apply to many families.
1
The term child care, as opposed to day care, is universally recognized as more appropriate when referring to working with young children. It more clearly describes the work being done. We ask a lot of the professionals doing this work. We should properly label what they do. Words do matter. Thank you.
7
@Karen: I'm curious ... I've heard the terms used interchangably. I would happily choose one over the other if I knew why "child care" was preferred over "day care".
I don't think anyone attends to offend the people of doing the very important work of caring for children before they go to school.
Sometimes an explanation helps people understand why people who do a job prefer one term of the other (such as the sexism of using "mailmen" before we switched to "letter carrier").
4
@Rose Child care is preferred because in the past there was a distinction between nursery school and daycare. The assumption was that nursery schools were better than daycares. The Early childhood profession now thinks of it as part day and full day child care with the same nurturing and developmentally appropriate programs in both time frames.
2
As a child care center director for over 30 years, I respectfully disagree . I think the author is missing the mark.
The article insinuates that directors are recommending medical treatment , such as antibiotic, when in fact center exclusion polices state when children can return to the center. While child on antibiotics or eye drops, might be able to return after 24 hours. However, if a child has a viral illness, only the illness running its course will be the cure. This is often
Exclusion policies are key in maintaining a heathy environment in a group setting. Parents have more of an issue , or struggle rather , with keeping their ill children home than with child care director suggesting medication.
In a group setting the program has to set forth health guidelines, which are agreed upon at enrollment. These policies are sometimes more stringent than individual pediatrician recommendation as directors must consider that care they can give to the whole group of children .
Child care center exclusion and healthy policies are based on guidelines set forth by overseeing licensing agencies such as NYSOCFS and/or health department.
It is conflicting to say for instance , all children must be immunized , but sick children with a fever or eye discharge can attend. Imagine keeping 5 toddlers from touching each other all day.
Most importantly a child deserves to receive appropriate care and rest and recuperate. This is a working parents dilemma in our society.
24
I have worked in daycares.for 20 years. The sick policy is not a silly rule put in place to annoy parents, licensing makes these rules.
If these rules.were.not in place, parents would be bringing exhausted, vomiting children to daycare. We are not doctors, but we are not nurses either. We cannot supervise ill children.
As the wages and.working conditions of Early Childhood Educators are fairly poor, recruitment of substitutes is difficult.
As a.result, when your sick child comes.to.daycare, the staff get sick.
They often have.to.work.when sick.
You don't want to take a day off because your child is.sick?
Neither do I.
45
Companies need to give more sick benefits so parents can stay home with sick kids.
28
@MIMA
Yes. And relax policies that specify you can only use a sick day to care for a member of your immediate family. There are many working, full-time custodial grandparents, aunts and uncles etc.
4
People need to stop typing "I know it's inconvenient, but you have to stay with your sick child" as if loving parents want to send their sick child to day care. People do it for one reason: because they are terrified. Because we live in a vicious capitalist society where there are no protections from summary dismissal and then that child might not have adequate resources. So the least we can do is stop putting parents in this situation if it's just a runny nose. And yes I've been a parent and done child care and been in all the situations. They're all terrible, like everything we do in this country.
34
@Justice guess what, providers are often afraid to take a sick day too. We worry that parents will be upset that they have to parent or provide backup and will leave, thus firing the provider.
6
@Justice
Lots of parents prioritize their own money making / careers and personal interest over caring for a sick child. My wife has taught for 30 years and has had countless bouts of illnesses because a parent had an important meeting and sent their sick child to school. She was exposed to chicken pox while newly pregnant with our first child and had to take 10 days off of work to ensure that she did not contract Fifth's disease - this was workers' comp time, not sick time, so it was unpaid until workers' comp approved it months later and it caused an outbreak in the school. Just one example of a time that parents prioritized work over their sick child (they knew about the chicken pox) - if an employer disciplined over time off for something like that, you can bet there would be a human rights complaint of discrimination based on family status.
It's a vicious capitalist society that keeps electing people who will keep that as the status quo until they are replaced by others who will prioritize something other than profits and money.
9
A Plan B or back up plan for childcare is a fine idea. All parents need that. Daycare providers need days off here & there and they, too, get sick.
Hand, foot, and mouth disease was the daycare ban that drove me the most bonkers. Our kid never had any symptoms beyond a few small blisters on the backs of his hands that didn’t bother him at all. Nonetheless, he was banned each time from the very place he contracted the darn virus in the first place. Our pediatrician said banning him was silly but what can you do? I probably lost two weeks of work to it.
5
My son was always sick at daycare. I find daycares (even though fancy ones that offer French and Mandarin immersion and organic food) rarely clean and disinfect as they should, or enforce proper hygiene with the children. I would drop off my son (at our daycare that costs more than my college tuition did) to see the yellow mucus pouring out of some child’s nose, and watch the educator wipe all the kids faces with the same cloth after snack. They’d ignore children not washing hands after using the toilet because it’s too hard to monitor and a pain to walk a child back the sink to wash up.
The workers are over worked, under paid, and some uninformed at how crucial hygiene and cleanliness is. The daycare directors don’t make it a priority. And since we don’t value child care as we should, no one invests in supporting or informing them.
Meanwhile, my child gets the infections, is miserable, we juggle time off from jobs, and we Only used ~70% of the days we pay for.
4
@Nlinden. If parents don’t bring illness to daycare it’s impossible for kids to get sick from the same daycare...I clean and disinfect daily, but when kids are playing with the same toys it isn’t possible to stop every illness
3
@Brandee This comment shows the lack of understanding among some childcare provider which this article addresses. Yes, it is completely possible and in fact, definitely GOING to happen that kids will pass along illnesses in the same daycare, no matter what. This is because the incubation period of most illnesses is such that many kids are infectious (and, in fact, may be the MOST infectious) before they ever look or feel ill, or have any symptoms at all. The only way for parents to not bring illness to the daycare is to not bring any kids, ever, to the daycare.
10
@Nlinden are you going to put kids in a space suit? Respiratory viruses like colds and flu are spread through the air, not through dirty toys.
1
@joinparis
I don't know about your local schools, but where I live the schools have health aides they freely (and incorrectly) refer to as "nurses". They are not. Same with medical offices - they've all gone to medical assistants and call them "nurses".
2
It’s weird. People are adamantly against vaccines, but overuse antibiotics?
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@Aristotle
Probably not the same people.
4
As a parent and former Daycare Director - both in home and private- you are missing an important point and manage a patriarchal mansplaining tone along the way. I wonder if you have ever had the children of other people under your charge. ??
We have 12 children and their health, family, siblings to consider, not just your child. We are mandated to undergo health and wellness training along with pediatric cpr and first aid. No, we do not purport yo be doctors, but we know conjuctivitis and Coxsackie ,among other viruses, when we see them.
So yes, make sure your child has no communicable diseases. Thank you.
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@Amy Egan
I'm glad you can recognize Pink eye (conjunctivitis), it's not that difficult. But can you recognize the difference between viral (most common), from bacterial (least common), from allergic, from traumatic? Only one of those types needs antibiotics and only one of them "might" be an emergency requiring same day care. Otherwise, send a note home with the child at the end of the day.
I'm also glad you can recognize Hand, Foot, and Mouth disease but can you recognize Herpangina? Same bug, just as contagious but no rash. How about Erythema Infectiosum (5th disease), or Roseola? If you can then you must also know that 100% of the population will get sick with these illnesses ONCE, that there is no treatment and no risk from the illness. Additionally, I'm sure you know that the child was most infectious for the 3-4 days BEFORE you decided the child had to stay home so your entire daycare has already been exposed and keeping the child home is pointless.
4
Ummm, he’s a pediatrician at a major academic medical center. He’s the one who probably spent a good fraction of his 20s pulling 80 hour weeks as a resident with the lives of critically ill children in the hospital in his hands. Btw I’m as feminist as they come (and female) and I don’t see any mansplaining in this piece. He’s citing accepted medical guidelines and actual facts and figures.
1
Pre-school age children average 8-10 viral respiratory illnesses and 2-3 viral diarrheal illnesses a year (with some overlap such as in adenoviruses that cause both types of symptoms). Each may be symptomatic (and theoretically contagious)up to 10-14 days. This adds up to ~100 days of illness a year, give or take. Let’s figure about 70 of those are weekdays.
I don’t know of any jobs that grant 70 sick days a year. And that’s just for one child.
Look, no one likes to be sick, and we should all do what’s possible to stop the spread of communicable diseases. And yes, we shouldn’t be sending really sick kids to school (thus the AAP recs). And YES daycare workers are underpaid. But it’s not selfish for parents to send their children to daycare when they’re still “contagious”. It’s just math. It’s just reality. And to send them on a wild goose chase for unnecessary doctor’s notes for self-limited illnesses is just a waste of everyone’s time.
13
@inquiring minds So it's selfish for the daycare provider to want you to care for your own sick child? You do understand that by sending the sick child you run the risk of not only spreading it to the other children but to the provider herself. If your child is sick and has to stay home one day, you, and only you miss one day of work. If the provider gets sick, you and every other parent will miss work.
13
@Wendy
But it’s not one day, that’s my point. I would, in fact, have to miss 70 days of work to never expose anyone at daycare to my child’s illnesses. And that’s not possible. And I absolutely never said the daycare provider is selfish, not sure where you got that.
Do parents sometimes send kids to school when they shouldn’t? I’m sure they do, and that’s not right. I think the aap guidelines are decent ones for when to keep kids home. But the point of the article that I think people are not understanding is that these policies meant to reduce contagion are actually not evidence based and not in line with how infectious diseases work, so they actually don’t help keep kids and child care providers healthier, but they do produce an extra burden to parents. As a physician, I see this all the time. That’s all I’m trying to point out.
6
@Wendy
Nobody needs to resuscitate their child that is running around playing with a cold 🤦🏼♀️
Or an ear infection
Or a rash
... I could go on.
These are well kids.
They can go to daycare. Period.
4
Our daycare's policy on illness seems reasonable, and is in line with the author's recommendation here: minor sniffles, runny noses etc. in an otherwise-happy child are fine, but fevers and/or any inability to participate normally due to feeling poorly warrant a call for pickup. All the kids (and typically us parents) get every little cold that comes through, but worse ailments tend to get nipped in the bud.
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@Jessica
This is the most sound comment on here from a daycare provider.
3
@Jessica
As a pediatrician, what drives me crazy is HOW schools define a "fever". Medically, an oral or temporal temperature over 100.4 is considered fever that is concerning for illness. 100.4 and below are considered normal elevated temperatures. Yet I see children in my practice several times per week sent home for a 99 or 100 degree elevated temperature, with no other symptoms of illness! When the child reaches our office, they have a normal temp (even without receiving antipyretics). The parent gets a return to school note and a bill for an un-necessary clinic visit.
We had this situation with lice.
I emailed the Director/owner the CDC guidelines and our State guidelines that early dismissal was more harmful than letting her stay the day, but the owner held steadfast to her internet searching, and I had to pick up my child early ...
After 5 years and thousands of dollars, I am thrilled to be done with private daycare and into public school, which does follow CDC guidelines for lice.
6
There really is no substitute for having a parent actually raise the children - either parent, or possibly the grandparent or aunt/uncle. That way, if the kid is sick, they can stay home from day care, preschool, or school/kindergarten - allowing time to heal and not exposing the other children to a communicable ailment.
I (shock and horror) stayed home with our children until they were sturdy enough to flourish on their own and the pre-school and school actually thanked us for not sending infectious kids to make the others sick.
12
@Sara, what constitutes, "actually" raising a child? Having one parent stay home or having a relative on stand-by 24/7 just in case the child gets sick are not feasible for many families. We can find better solutions to the exorbitant cost of raising a child without looking down on parents who aren't as lucky as you were.
22
@Sara
On point.
@Sara, it would nice if everyone could afford to be a stay at home mom, but most can't. And some people are fortunate enough to have willing and appropriate relatives who can jump in and assist when necessary. But frankly most grandparents are working into their 70s to get by.
My gaughter and her husband were fortunate to have two working grandmothers who can fill in by using our sick leave to supplement their sick leave. Many, many if not most, young parents cannot with the increased cost of living.
Best to never mom shame those who can't.
16
The author seems to insinuate that directors are puling the standards out of a hat. Licensed preschools are required to have written policies that indicate when a child should stay home and when the parent will be called to pick the child. These policies are written to the standards set by the state licensing agencies. Centers are required to have a medical professional such as a doctor or a pediatric nurse, sign off on these policies. We ask teachers to administer CPR, First Aid, Epi-pens and other over the counter and prescription medications. Full time nurses are not financially feasible based on how we currently finance child care. It is precisely because the teachers are not health professionals that parents are asked to take their child to the doctor to see what their symptoms require. We do not know what a fever, rash or pink-eye may mean. We are just trying to err on the side of caution. Many centers in the United States are now accredited by the National Association for the Education of Young Children. There are many health and safety standards which are covered in the accreditation process. The standards for hand washing are extensive as are the daily sanitizing of doorknobs, tables for eating and the correct ratio for mixing bleach and water on a daily basis. Aaron if you want to make a difference get involved in meaningful support through NAEYC instead of putting the blame on the most underpaid profession in our country.
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@Laura Linton
perfectly stated, Laura.
1
I’m surprised that there is no mention of another problem arising from inappropriate medical treatment, which is that few treatments (if any) are risk free. Ever hear of antibiotic resistance, for instance?
10
We follow CDC guidelines. We NEVER recommend specific care, that would be illegal and unethical - but we definitely follow CDC guidelines on when people and children should return to work or school. If you are finding fault about fevers keeping children home, maybe you should discuss it with the medical professionals whose advice most of us follow.
19
The "playing doctor" angle to this story is overdone. Day care operators are not purposely playing doctor. They have inadequate medical knowledge but they see plenty of children with pink eye who receive antibiotics. Then, the pink eye clears. It would have cleared without antibiotics. Day care operators connect the clearing with antibiotics, erroneously. They are concerned about other issues too, such as threats to their local or state license to operate and the reputation of their business in the community as well as the difficult parents who threaten to sue them for having children on site who infected their child.
14
A few years ago my son fell at preschool and scraped his eye with a stick. This happens for active 4 year olds. It was still very red, and uncomfortable, several hours later when they decided to let me know about it. "But don't worry," the school's secretary told me, "he doesn't have a corneal abrasion."
"Really," I asked. "Did you examine him with fluorescein and a Woods lamp?" They forgot that I am a physician in another field. Unlike the school secretary, I'm aware of what I don't know about children's eyes, including when it's time for them to be seen.
Yes, this is minor, but it's time for the pediatrician to look at it. There was a big laceration in the cornea, one which needed diagnosis and treatment. From someone who knows what they're doing (not mom, either!).
My children currently attend a school that has good boundaries around what a school can and cannot diagnose and treat. What a relief.
32
@Alice . Any eye injury should be seen my a a doctor.
1
Hand washing is great, but it seems what we really need is more guarantees of sick time/job protection for parents (and really all workers!). I am fortunate to have a job with paid sick leave, and a boss who is understanding about having an ill kid, so if I have to keep my child home I can work remotely while he naps and use up a few less hours of my annual sick leave allotment. Our daycare is also very on top of handwashing and hygiene and our son does seem to get sick much less often than some of our friends kids. But even with a healthy kid and a good/understanding work situation, I use up all of my sick leave every year (some of it for more routine doctors visits also) and definitely sometimes have to consider if I can "afford" to keep my kid home in a case where my own SAHM probably would have erred on the side of caution because she didn't have obligations outside the home. I know also that I sometimes go into work while feeling ill because I'm down to my last couple of sick days, and I see co-workers come in sneezing and clearly in discomfort at times. I can't imagine what it would be like to have less sick leave than I currently do, as I could definitely (honestly) use a couple more days each year.
34
this is a great article. as a pediatrician I see numerous visits throughout the day for doctors notes to return to school or daycare, and often with the demand that the child be given antibiotics for pink eye. or that the child get a note when they are visibly fine and had just thrown up the day before after something they ate and the issue is resolved. these kinds of visits result in more medical waste and higher expense in billing public and private insurance for these visits. I have stopped giving the antibiotics for pink eye - and started telling parents that the daycare does not get to play doctor. I give them a note saying they may attend without medicine.
46
@md. Do you tell the parents that Mild bacterial conjunctivitis may get better without antibiotic treatment and without causing any complications. It often improves in 2 to 5 days without treatment but can take 2 weeks to go away completely. So choose not to give a child an antibiotic. They just can’t come in to school until it goes away completely.
4
Are you assuming the antibiotic makes it go away faster? Bc that may not be the case
@MD This is why early educare policies are now being written to include a physician's note AND director approval for an ill child to return to school. Its simply not up to doctor to decide the attendance of a private business. Doctors have no training in early care and education and group management, thus have no position as decision maker. A physician's note is simply advisement.
1
It's time for all employers to allow more "personal days" so that parents (usually mothers) are able to stay home with their sick children without fearing the loss of pay or even their jobs. I'm sure the cost could be covered by lessening the compensation paid to highly overpaid executives. More and more, workers are getting less pay and fewer benefits than they deserve. And it goes without saying that health care will be better and less expensive with a national single-payer insurance program. Other civilized countries have plenty of benefits that help parents to deal with the distinct challenges of raising children. We should learn from them.
21
The author fails to mention the fact that, in many states, day care is subject to state licensing regulations. The decisions that he criticizes the directors for making may be those they are required to make, or risk jeopardizing their license.
31
@Kris K Very true. I for one agree that there's too much hysteria over things like pink eye or even lice, BUT if you're a licensed center, you have to play by the rules.
3
Over the course of several years the RN at our local school had me take my disabled child to the doctor. The first was for "two infected ears". The doctor pronounced them just fine. The second was when the nurse was sure my child needed glasses. Due to my child's disability I had to seek out a pediatric ophthalmologist who was not on our health plan and led me to pay an additional $200. That doctor pronounced my child's vision "perfect". And this nurse is a medical professional!
11
This is ridiculous.
If your child has parasites or any communicable diseases, keep them home. If you are sick stay home. The world at large ought not to suffer because you can't afford to miss work to take care of yourself or your child. Taking care of your children when they are ill is part of being a parent, not a "tax on being a parent". Being a parent requires sacrificing time, money, and effort. Being a decent person requires that you and yours stay home when you have an illness you can spread to others.
28
@Alice
A common cold is a communicable disease. Do you stay home every time you have a cold? You know that some people don’t have a lot of sick days or they don’t get paid if they don’t work? You are asking people to forgo pay so others in the same work place reduce their risk? By the way, the common cold is already contagious before symptoms manifest.
15
@Alice the article says nothing about not keeping sick children home - it just argues that children should not be forced onto unnecessary drugs or doctors' visits. Way not to read.
12
@Alice, the world at large ought not to suffer because employers have barely raised wages while medical costs have skyrocketed over the past several decades. This isn't happening because suddenly no one is a decent person anymore. C'mon.
13
Not to mention the children who are allergic to some antibiotics... My one-year-old son is allergic to penicillin and got sent home last week with hives because he presumably swapped slobber with the other baby in his class that was sick and on penicillin. True story. We should also dig deeper into the societal structure that requires us to send our one-year-olds to daycare 50 hours a week, even when they are sick, just so we can stay afloat.
28
It sort of sounds like day care centers put the onus on the kids and their parents instead of taking responsibility to keep everything clean and sanitized. And they should not be allowed to give medical advice without relevant training and a license to do so!
4
@Laume . actually if day care centers are responsible for the care and safety of your child on a daily basis, they should hopefully be good judges of when your child isn't feeling well. Proper hygiene is key in maintaining a healthy environment, but children will contract a number of illnesses throughout their childhood. Parents and their caregivers need to work together. Healthy polices of childcare centers are regulated by the overseeing licensing agency, and the article author negates to mention this.
3
Perhaps medical recommendations are not indicated, but pink eye, diarrhea and productive respiratory illnesses are contagious. Day care staff is justified in requiring the children to be absent until they are well, for the benefit of the other children and staff.
42
@MDMD
I'm no expert, but I'm pretty sure diarrhea is not contagious. It's usually a symptom of something else that may or may not be contagious. A kid could eat spoiled food and get diarrhea. Not contagious.
8
@RW
Norovirus (usually diarrhea with vomiting) is highly contagious
8
@MDMD
Shigella too. Per the CDC: "Exclude any child with diarrhea from the childcare setting until the diarrhea has stopped. Children who recently recovered from shigellosis can be grouped together in one classroom to reduce spreading Shigella germs to children who were not sick, depending on local health regulations."
3
The bigger issue is that we don’t value caregiving or provide support systems for caregivers. It is arduous work whether for young children or the elderly. Exposure to bodily fluids, infections, physically and emotionally demanding—yet we pay day care workers minimum wage and expect parents to drop everything at work to care for ill children. Of course this burden falls mostly on women—whether full time caregivers, day care workers or full time employees.
38
Back in the 1960’s I was president of a graduate student honorary society that negotiated successfully and without protests or even heated arguments to establish a day care center on the campus of one of Harvard’s several graduate schools.
After extensive due diligence and number-crunching the numbers clearly revealed that, even with free classroom space, free maintenance and utilities, and free oversight of the day care center, it could not possibly break even financially due to the many health and other regulations imposed by state and other governmental authorities. As a result, all those involved mutually agreed to drop the plans for the center.
I still do not understand how day care centers can make money, much less break even. (I do believe that considerable regulation and oversight of day care facilities is warranted.)
I also believe that one or more of the pediatric medicine associations, perhaps with input from the companies that insure day care centers, should develop best-practice guidelines to help center directors understand and comply with the many constraints and requirements of their work.
12
I am a pediatrician in NYC and I applaud this article! The daycares and schools in my neighborhood insist on doctor visits for the absolute mildest of eye complaints - slight redness, slight discharge, essentially "colds of the eye" that will resolve without any intervention. While word seems to be out that regular colds do not necessarily need a doctor's visit, the second there is the slightest discharge from the eye there is a mass panic and suddenly a doctor's note and antibiotics are deemed essential. This is a waste of the parents' time, a waste of healthcare dollars, and unnecessary missed school for the kids. I understand that the schools and daycares do not want pink eye to spread amongst their attendees, but I wish they would keep in mind 1) "Pink eye" is no more infectious that a runny nose and should not be treated as such and 2) Viral pink eye (which include most pink eyes in the setting of colds) is not going to get better any sooner with antibiotics so there is no point forcing parents to get a doctors note and prescription for every slightly red or discharging eye. If you want to ban the kids while their eyes are a bit red and discharging, fine - but don't make them all go get antibiotics to return to school and better start banning kids with colds too to be consistent!
22
@Jess we do ask children who are ill with colds to stay home. Rest and parental care . Often times when pink eye or other illness are going around, some children's symptoms are questioned to early. Please consider that numerous parents push their very young children , because they have to work. Sometimes centers request doctors notes because they want a child to be seen by a doctor due to concerns they aren't receiving proper attention.
2
I work in as a school administrator, my wife is a teacher, my mom has been a day care director for 30 years. Want to know why the policies are so strict? Because of the amount of parents who stuff their kids full of medicine and send them in, where they infect dozens of others - including staff that rarely get time off during the school year.
The amount of kids who say they threw up at home but parents sent them in anyway is shocking. The child shows up dehydrated and dazed and pukes in class exposing 30 others in the process
78
@Steve it's the' number'of kids not amount....and 3 professionals in your family...
6
@Steve being strict about sending sick kids home is perfectly fine. Requiring specific drug treatments is not.
20
I found this article exhausting. I have been a teacher for 25 years and I am a mother of 3. The teachers and other adults in the day cares and preschools are human, and many of us are moms. When we get pink eye, lice and stomach bugs because people don’t keep their own children home it effects our families and our lives. We end up unwell and needing to take time off to recover from all the unwanted germs brought in by people sending their sick children to school. We practice
Constant hand washing and are vigilant with regard to cleanliness of the rooms and materials but we cannot do it alone. Sometimes
These inconveniences protect the community from an outbreak, these rules are in place to keep people healthy. The author may have enjoyed belittling day care directors, but I imagine he never had a whopping case of pink eye or a classroom full of lice.
111
Seriously. I’d also like to point the author in the direction of the series of articles the Times wrote specifically on how little daycare workers get paid and what the overhead of these programs are. Often, daycare teachers don’t get benefits, so if we send a kid home it’s for the good of EVERYONE — so we can keep doing our jobs.
44
@Teachermom
He wasn’t belittling anyone. He literally just shared scientific evidence that antibiotics aren’t indicated for every instance of diarrhea or presentation of conjunctivitis. If what is going to help is better hand washing and keeping kids home (what pediatricians recommend) why give antibiotics that won’t work and let the kids back in daycare?
17
@LRD thanks for explaining to me that I wasn't being belittled.
20
Basic rule - if it's not your child and you aren't a trained medical professional, you have no right to touch a child in need of medical assistance.
Any questions about that?
3
@dog lover
Basic rule #1 - if your child has a communicable disease in any fashion - keep them home.
Addendum to Basic Rule #1 - if you choose not to keep them home then we reserve the right to send them home.
Basic principle: don't put large populations at risk because you consulted Dr. Google and he said it was fine before sending your child to day care or preschool.
24
@dog lover
No one is touching anyone. This article is about parents sending their sick children to schools and daycare.
Basic rule - If your child is ill and potentially contagious, keep him home until he is well. If you are ill and potentially contagious, stay home until you are well.
15
"About 30 percent to 40 percent of working mothers pay for childcare outside the home."
While the cited study specifically highlights "mothers" as being the ones paying for childcare, that doesn't mean the NY Times has to repeat the sexism embedded in the study. It's not only mothers who pay for childcare. Many fathers pay for it, too. Every man and woman I work with who has small children pays for childcare. Do better, NY Times.
83
Came to say the same thing. Ridiculous!
17
Something that this article fails to point out is that a lot of these regulations come from the licensing agencies. Speaking for my experience with the Department of Health in NYC, there are very specific rules we must follow regarding illness and symptoms. We even have to conduct a daily health check as children come in.
I’m a director for a small residential program, a group family daycare. If a child is contagious and potentially gets staff sick, we may have to close the program until everyone is healthy enough to work. This obviously is a huge inconvenience to everyone involved.
That being said, there is room for common sense. If a child has an irritated eye but no discharge, we may ask the family if there are any other symptoms. Allergies, soap in their eye, etc. as a general rule, we ask that if a child has a couch or runny nose that inhibits them from participating fully, they stay home.
The NYC DOH also has stringent regulations on fevers, upset stomachs, and rashes. Trust me, I do not want to be a stand in for a doctor or inconvenience families- which is what this article wants you to believe.
32
@JPM, thank you for your reply. Day care centers are not making up arbitrary rules regarding illness, they are mandated from the State. The State is mandated from the Federal government. So, if people have problem with the current practices they should call their federal representative and ask for changes.
13
Thank you for an enlightening article. In Michigan, there are policies for child care program to follow regarding when to exclude children from care, so program directors do not have to act as experts. Child care programs are not required to take into consideration the spread of illness at a clinic. That should be the concern of the clinic administration. If a child cannot go to a clinic for diagnosis and treatment, where should they go?
I do not believe it is unreasonable for a child care program to ask children to stay home until they are no longer contagious, however that can be difficult for parents when trying to balance costs and work schedules. One university subsidizes the use of home health aides for their faculty, staff and students to care for children until they are well enough to return to care.
5
My daughter's preschool's policy was if they vomited in the last 24 hours they could not attend school. My daughter had allergies that caused drainage that made her throw up almost every morning. I had to tell her to not tell teachers about this almost daily occurrence or she would never be in school.
10
But, but, don't vaccinations take care of everything? Isn't that what we have been repeatedly assured?
There are no vaccines for pink eye
17
@Cloudy
Vaccinations can prevent some of the more serious viruses but we are all exposed to hundreds every year. We don’t vaccinate against all of them because. Most are self limited.
8
They sure help with serious communicable diseases! No need to be silly and pretend vaccines should be developed for pink eye and the common cold, which, while annoying and resulting in lost productivity, are rarely dangerous.
22
This article makes a good point - some policies are needlessly restrictive. Our daycare had a "no nit" policy for lice, against the recommendations of the AAP and other organizations, which meant I had to keep my daughter home for 3 days even after dousing her head with chemicals. They also made all parents wash their children's clothes and sheets daily in hot water for two weeks - a real hardship for families who didn't have a washer / dryer at home.
That said, there were some parents during the lice episode that wanted to shut the daycare center down completely until all children were nit free! Daycare directors are trying to juggle their responsibilities to children with the desires of families who often don't agree with each other, and who rarely think rationally when their children's health and safety are at hand.
One local daycare has a sick room for kids who are feeling under the weather or getting over a cold / fever. Seems like a step in the right direction.
12
@Ellen
Talk about a nitpicking comment . . .
@Ellen
I would imagine having a "sick room" raises all kinds of other issues. If the daycare advertises that they have a sick room, wouldn't it have to have a nurse or other qualified healthcare professional on hand? You'd be raising parental expectations in a way that might not be advisable, or even legal.
1
While we're on the subject of daycares and schools giving medical recommendations, can we discuss the inappropriateness of schools and teachers telling parents that their children should be on ADHD medications? Expressing concern about a student's mental health is one thing. I'd expect that of any teacher. But some of them go *way* beyond appropriate boundaries. I've had parents in my office say that the school told them, "Maybe he/she should try Focalin (or Ritalin or whatever)." Some schools have demanded that a child be put on medication before they're even evaluated for any classroom accommodations. I've told some parents they can actually sue the school system if this happens.
17
@Liz
Yes! I pulled my perfectly normal kindergartner - yes kindergartner - out of school because they were recommending Ritalin and required a letter from our doctor that we had discussed Ritalin for my son.
He is now a perfectly normal, well educated, eleventh grade student earning college credit - homeschooled all the way through.
5
@Liz
As a teacher we have been told to never make such a recommendation. For one thing if the school brings it up, I have been told, then the school may have to fund the exam. At any rate teachers are not qualified . The districts have psychologists and psychometrists and it is a long process of observation and testing before ADHD comes up for discussion.
6
Why don't daycare centers have a medical director, someone who can review medical policies like these? Probably because that's an extra expense for the daycare center and they don't want to pay. But just as I had to have a dietician to plan the menus in a halfway house I ran, daycare centers should have to have a medical person to make medical decisions.
1
Sure, that can be a requirement for daycares. But then the cost will continue to rise, becoming a further burden to families.
12
@Barbara They do. It is the child’s personal doctor.
10
@Eileen L
Not the same. A medical director, who would only consult once a year or so, adding little cost, sets standards for the entire center, unlike a child's personal doctor.
3
For all those who are complaining about unnecessary antibiotics for something like conjunctivitis there is another option. It takes up to two weeks for conjunctivitis to fully go away. Don’t give your child antibiotics keep them out of their daycare/school for two weeks. The same for strep throat. You don’t have to give your child antibiotics. You can keep your child out of a community setting for that 10 days two weeks it takes for the strep to go away. You believe in or don’t believe in something? Take responsibility. Take the time off and spend it with your child until they are not contagious anymore. Your choice. It’s other parents choice along with the daycare/school not to have the infection there.
5
@Robin Wow, and here I went through all the trouble to go to seven years of medical school and pediatrics residency to learn the difference between viral and bacterial (not to mention, allergic) conjuctivitis, but hey, apparently commentators on the internet and people who run daycares and schools can make decisions about when antibiotics are really necessary, instead of people like me! We really live in a post-scientific utopia where knowledge really doesn't matter, and everyone's opinion, no matter how uninformed, is equal.
Hey, on a unrelated note, do you guys have any black Sharpies I can borrow?
64
@Durham MD Thank you
7
@Robin It is irresponsible to advise against antibiotics when strep throat is diagnosed. Untreated strep throat (or scarlet fever) can lead to rheumatic fever or other serious complications. Untreated rheumatic fever can cause permanent heart damage.
16
No mention of lice, but there is another situation that has no adverse health outcomes but because it’s icky, schools want kids to stay home for many days missing their education.
5
Lice isn’t just “icky “ . It takes a lot of time and money to get rid of it. Not to mention exposure to chemicals needed.
2
@Sharon, yes lice is “icky” AND it is highly communicable so it is important to treat affected kids immediately before they share the “icky” creatures with their classmates. We have endured several lice outbreaks at my kids’ school. Due to my kids’ thick curly hair, it is a 2 hour process (per kid) to do the initial treatment and another hour (per kid) to do the daily combing for the following 2 weeks. Dealing with lice eats up time that could be better spent on family activities and causes me to miss work. It makes me crazy to think that there are parents who wouldn’t think twice about sending their kids to school with lice or criticizing schools that send kids home once it’s discovered that they have an active infestation. Please consider the other kids and parents who will spend hours on treatment and combing. Maybe you just consider lice to be “icky” but many of us think that lice is both icky and also needs to be eradicated from our kids’ hair once discovered.
2
My child's day care wouldn't allow him to attend when he had poison ivy, under the incorrect rationale that he could spread it to others.
7
@REB64 My kid's preschool would not allow my kid to read a book during rest time because "it's a choking hazard."
5
How do we build up our immune systems? It is from exposure to illness. To minimize your healthy child from getting routine childhood illnesses, only have one child and make sure that child is never around other children. Otherwise, understand that frequent illnesses are the fate of those children, particularly under 5. And don't get upset if your child picks up something from another child at day care. Next time it may be your child spreading the illness.
9
Our family is still in the convulsive years of dealing with daycare and illnesses. After six years of this what I'm seeing is a very unstable and ineffective system with many challenges:
- Daycare workers are underpaid. We would often pick up our children at the end of the day to hear a worker needing to go to a second job just to make ends meet.
- Daycare services are expensive for parents despite the low pay.
- Parents need to work, having limited to no paid time off.
- Children inevitably get sick.
- Daycare centers can't afford to provide sick care to children.
What I see the nation ultimately needing to do is extend the K-12 education system down to infancy. Daycare workers would get a professional training and wages. Daycare centers would be able to afford medical services to tend to sick children. Parents would be able to work and afford childcare. Society simply needs to accept that we have to expand the tax burden to provide these universal services down to infancy, instead of the current awful system that serves no one well.
61
You don't have to be able to make a medical diagnosis to recognize that a child has symptoms -- fever, diarrhea, vomiting, etc. -- that usually denote contagious diseases. I cannot imagine that a child exhibiting theses symptoms (and many others) doesn't require "more attention than they [centers] can provide", especially given how thin the coverage already is in most centers. Would you really expect a child with diarrhea or who is vomiting to participate in activities? It is both expensive and inconvenient for parents to miss work, and it likely affects work success. This is another case of balancing the needs of one (sick child's family) against the needs of the community (other children in center). Having children is expensive. Would a larger deduction for child care and/or a sick child sitting service help? Families with young children need help.
15
My daughter went through this in senior kg. Her teacher kept saying she's got pink eye. I ran to the doc who kept prescribing antibiotics. Back and forth
I finally got so frustrated that I stopped sending her to school and did some research. She had typical allergic conjunctivitis.
Got some otc allergy saline drops and she was all cleared up and went to school the next day. Changed my doctor. Neither the doctor or teacher had the intelligence to suspect the simplest cause &solution. She gets this every year during pollen season. The allergy drops work every time.
Sometimes the experts in medicine and child care leave you wanting.....
15
@RS: for what it is worth....I have this too and I'm a senior adult. Every pollen season...miserable red weepy eyes. And I use allergy eye drops, plus a "moisture eye gel" (ophthalmologic benadryl ointment would work too). No meds, no antibiotics. Yeesh.
5
I feel that the tone of this article is one of frustration, but plays a bit loose with the facts. Day care directors are not "playing doctor," they are following doctors' guidelines.
Generally those making the decisions about exclusion in day care centers have been educated by attending workshops and seminars by the state in which they operate in which guidelines are spoken or even given out in writing about how to handle common challenges such as conjunctivitis, lice, strep throat, etc. Rarely are people making policies without having the impression or being explicitly told to follow certain procedures regarding those situations. Here are guidelines from the states of California (see pages 82 and 83 for eye discharge) and Washington (see page 28).
https://cchp.ucsf.edu/sites/g/files/tkssra181/f/idc2book.pdf
https://www.k12.wa.us/sites/default/files/public/healthservices/pubdocs/infectiousdiseasecontrolguide.pdf
I've been working in and with schools, day care centers, and other educational settings for over 37 years and while it is certainly possible that some heads of those organizations are making up the exclusion rules, in my experience the rules are made because some health care authority stated or wrote down guidelines that became part of the policy.
50 states = 50 sets of guidelines. It would be interesting to look at them all, but even just these two examples show that what is stated in the article as policies are based upon written guidelines.
37
@EML
Thirty years ago when my daughter was in daycare, they called me at 4:00 PM one day to tell me to come straight and pick her up. I could not wait to get off work at 5:00. She had a fever and these were state regs that they dared not fall afoul of. So I believe you.
(As it happened, she had pneumonia.)
10
I wanted to add that this sentence from the article:
"Day care centers seem concerned that children could spread disease to other children in their facilities, but not nearly as concerned that they could spread illnesses to other children in a clinic."
Seems a bit absurd to me. Perhaps I misunderstand it and I welcome the author to clarify. Is the author implying that sick children should stay at daycare in order to avoid getting the children at the doctor's office waiting room sick?
28
@EML
I also scratched my head when I read that. I shouldn’t go to the doctor if I think that what I have may be contagious?
6
No amount of hand-washing will keep toddlers from spreading germs, if not directly onto one another, then certainly to toys and equipment they are touching every moment (and especially after they've just touched their nose, mouth or eyes). The real issue is the lack of affordable child care and of coherent policies. People with sick children can't afford to stay home. Depending on their employer, they may be putting their jobs at risk. So small wonder they are eager to overuse doctors and antibiotics. They're tolerant of their own sick child (after all, they "know" when their child is "really sick") but all that goes to the wayside if it's someone else's child. You can't blame the parent or the child care facility. It's our willingness to ignore companies that do nothing to support employees with small children, and a lack of policy. If you work outside the home and you have small children, it's the Wild West out there, and it's not helpful to pit the child care community against the medical community against the parents. Talk about a circular firing squad ...
30
I was surprised at the virulence of this writer’s accusation that daycare center are “playing doctor” by imposing certain health requirements on the children in their care. Daycares do not require a child to be on antibiotics for minor illnesses, they require that parents not send their kids to school when they are sick, and desire that they keep them home until they are well. I am sure that if parents want to keep their child home to recover from pink eye using warm compresses the daycare won’t care- just keep the child home for the 4-7 days it takes to get over the virus. Also a child in diapers can have contagious diarrhea without feeling particularly sick, but still does not belong in daycare potentially infecting others. Daycares have obviously learned thru experience that parents will often do what is expedient for them- including sending a sick child to daycare.
The writer points out the daycare directors are not doctors and hence the illness guidelines perhaps will send home some not-so-sick kids. On the other hand, my daughter caught a common childhood virus from her two year old daughter when she was pregnant. No one remembers any particular illness other than the typical little fevers or cold- like symptoms that a two year old my get. My grandson was born deaf and with other health problems caused by CMV (cytomegalovirus)- the most common cause of birth defects that most people have never heard of and virtually always contracted thru daycares.
32
People who work with children may not be medical experts, but can have a wide practical knowledge base that balances the needs of the individual child with those of the community. Parents depend on daycare and nursery schools to keep their young children healthy.
While requiring unnecessary antibiotics is never a good policy, sick children should stay home when they are contagious.
17
@Neil but as the article notes in many cases children are contagious BEFORE they begin to show symptoms.
10
This article is precisely why I resigned from being a preschool teacher after several years. Parents fail to realize that sending their children to school (or daycare) with a preventable, yet viral, illness costs so much more than them a day of work. The illness spreads amongst all the children, and ultimately the teacher. If you have a child, take care of them! If that means you have to stay home, so be it! Teachers are meant to have everyone’s best interests at heart, and we love our students, but I was sick SEVEN times last year with viral illnesses that could have been prevented. Parents, your livelihood is not more important than the teachers, and your children are YOUR priority first. This arrogance is out of hand.
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@AreYouKiddingMe
Uh huh. And are you going to be the one who tells the parent's employer that they're being a meanie for firing the parent if the daycare demands the child be picked up 7 days in a 2 month period?
What was that about arrogance?
Are viral illnesses preventable? Sure, but there is no way on God's green earth that they can be completely avoided. Not unless we all live in plastic bubbles.
I'm a pediatrician. I got sick 3-4 times a year for my first two years of residency. After that my immune system toughened up, and now it's maybe 1-2 days of a stuffy nose every winter. You were a daycare worker, being around small children 6-7 hours a day. What did you expect would happen?
28
@Liz No kidding. I also am a pediatric subspecialist specialist and work with kids daily. I have a lowered immune system and get sick generally still 3-4 times a year, even 15 years into my career. Guess what? If you don't like driving, don't be a truck driver. If you don't like bad smells, don't be a garbage collector. And if you don't like germs, really, really, don't spend long periods of time around young children. It's called an occupational hazard.
27
@AreYouKiddingMe I was a graduate student for far too long. For a number of years, you could set a watch to count the hours until I caught a cold at the beginning of each semester as students came back from the far corners of the globe. After a few years, nothing, no more colds; I figure I'd been exposed to everything out there by then. (Or that my immune system had gotten enough practice.)
6
My personal favorite-
I arrive at the preschool front desk after being called and told our son was sick.
I'm greeted with '[name] has a rotavirus. he needs to go home.' I didn't want to create an issue, but, as one who's worked in health care, I know when, and when not, to make/deliver a diagnosis.
Preschools should not deliver diagnoses unless qualified...additionally, they should be more flexible regarding return to school. Preschool staffs are often not expert in the ailments they face.
I do appreciate the pressure they're under to keep their charges healthy all the time.
9
One argument that this writer missed — the main argument against forced antibiotics in my mind — is the cost in health rather than the cost in dollars of forcing kids to take unnecessary antibiotics. The development of drug-resistant pathogens, the havoc that antibiotics wreak on our microbiome and gut health as well as the inherent dangers of drug reactions (yes they happen, even with antibiotics) all argue against going along with school or daycare policies mandating antibiotics when they are inappropriate.
36
Speaking as an underpaid daycare worker - who caught staph & many other diseases from my charges, causing ME to lose my minimum wage hourly pay (not to mention my out-of-pocket medical costs) - there are lots of medical casualties in a daycare setting, both child and adult. It’s just a fact. But prescribing “better hygiene” is an absurd solution for a roomful of 12-24 month-old toddlers. These babies and young children are still learning to walk smoothly and not to hit! Trying to teach them to cough into their shoulder every single time has approximately ZERO CHANCE of being successful. And do any of the commenters even REMEMBER how itchy pink eye is? That’s why it’s so contagious! Few adults have the presence of mind and self-control not to touch their infected eyes; children too young to understand germ theory will absolutely rub their eyes - and nonstop.
151
@Public Health Worker
better hygiene means washing hands before touching the next child, or after diaper changes, etc.. For your sake it should also include washing hands before you eat or touch your face. Pink eye may be itchy, but there is little data to support that anyone gets better significantly quicker with eye drops. I know these are facts that disagree with your base of knowledge, but they are facts nevertheless.
10
@Public Health Worker Pink eye is contagious before the eye becomes itchy, oozy and red. You have been exposed to the virus way before you notice the child is sick. Labor intensive and inconvenient, better hygiene for babies and kids pays off. They don't cough in their shoulders but you can wash their hands and toys.
Of course, it's not your fault that daycare owners, for one reason or another, hire the bare minimum number of workers, pay minimum wage and rent the smallest space possible, and all of that contributes to the spread of disease.
14
The solution to your problem is NOT to demand that parents give their children unnecessary and potentially dangerous medications. It’s to recognize that large groups of small children are going to get sick, period, and that adults need to be as responsible as possible about keeping their hands clean. Because otherwise the only way to avoid spreading germs is to eliminate daycare altogether, which won’t happen.
15
Amen!!! I'm glad someone is finally saying this. I've had too many uncomfortable conversations with daycare directors applying outdated policies to exclude kids from school - all while chiding parents for taking kids out for a family outing ("It's disruptive to the learning process when kids miss school.")
And the endless guilt-trips and chastisement heaped on us for not immediately rushing our kid to the doctor for every sniffle. Ugh!
(Fortunately, we're at a better daycare now that applies common sense to child illness. Much improved!!)
16
They do this with non-contagious "diseases" too: minor sniffles, temperatures of 99.5 F (sometimes I thought they had the children run around to raise their temperatures so they could send them home).
This is what happens when poorly paid people in low status jobs get power. It's why the post office clerk makes sure that you wait, the Amtrak ticket agent asks prying personal questions and threatens to call the conductor to bar you from the train when you don't answer them...
9
@Jonathan Katz well paid people in high status jobs also abuse power.
20
I’m just too curious and trying to imagine: what sort of personal questions do Amtrack conductors ask passengers?
10
Having worked in day care for a few years, in my experience day cares tend to have these policies because a lot of parents will send their children to school regardless of how sick or contagious they are, which can impact the health of kids in their classroom, as well as in others - especially those with babies and young toddlers. A day care I used to work for had a written policy saying kids couldn't come in within 24 hours of having a fever - we rarely enforced it, but frequently encountered situations where a parent swore a fever broke over night, when in actuality the parent had given them tylenol in the morning to mask it. Inevitably the fever would suddenly spike around lunch or nap time, and the teachers would be left to take care of an extremely ill child while also tending to 15 or 20 other kids. And if the kid was sick with something contagious and an outbreak occurred, parents would blame the teachers. I agree that suggesting antibiotics for diarrhea is an overstep and not medically sound, but written health policies are not just about schools playing doctor. Usually day cares understand that parents have to make difficult choices. But they also have to take into consideration the needs of all the children and parents who could be impacted by an outbreak of an infectious disease.
91
Exactly, and parents should themselves stay home from work (including not going to restaurants or stores) if they are sick. Too often if one child or one parent would stay home it would avoid numerous others from getting ill, which is much more costly.
13
@J Your letter illustrates exactly the problem pointed out in the article: making up policies that have no sound medical basis for preventing the spread of infections is not a way to address the problem.
Many laypeople think that antibiotics "may help but they can't hurt" whereas unnecessary antibiotics, besides being expensive, can cause diarrhea, potential allergic reactions, and antibiotic resistance.
Healthcare providers resent having to follow nonsensical policies and prescribe unnecessary treatments.
Handwashing and disinfecting surfaces that children touch is the best way to address the problem of infections (which are usually viruses, except for the occasional case of strep throat, which is not as contagious as viruses).
Because effective prevention is labor intensive, day care centers take the easy way out and develop these policies, which shift the burden to parents.
8
@Stephanie. Regulated child care centers are required to disinfect surfaces and enforce frequent hand washing. Laziness is not the issue. The issue is that some illnesses are airborne, which no amount of cleaning will affect and it is impossible to disinfect each toy all day long. It's not fair to the staff or the other children to send in a sick child -- and for every parent who wants their ill child to school, there is another who wants sick kids to stay out for 3 days after they're symptom free!
16
The policies are about legal liability not about practicing medicine. Daycare providers are responsible for the health and safety of children who are on the premises of the care facility. It is negligent to allow visibly ill children to come in contact with assumed healthy children (ask any parent who drops off a healthy child and the child gets pink eye from another kid at the daycare). The length of time a child must be home is to ensure that whatever caused the illness is not contagious to other children once the child has returned. It has little to nothing to do with making sure the ill child gets well/stays healthy. Daycare providers are protecting children by preventing the spread of illness to the herd.
Raising children is costly. Within the constraints of those costs, parents still have choices: pay for doctor visits and antibiotics to short time out of work caring for an ill child, pay for it via lost wages due to staying home with antibiotic free ill children, hire someone else to stay home with antibiotic free child, form a co-op of parents who rotate time off to stay home to keep kids antibiotic free. If a child is fortunate enough to have two parents/caregivers active in their upbringing, the parents can tag-team time off to care for the antibiotic free child. (The parents at the bottom socioeconomic rung will likely opt for antibiotics and less missed work or opt for half of potential income because one parent stays home full time).
Phase of life.
12
@AGC All you say seems sensible, but you are attributing magical powers to antibiotics. In the article it's very clearly explained that the majority of infectious illnesses in day care centers are viral in nature.
Parents are not going to sue the day care center if their child catches a cold there.
Children in this age group may have colds as frequently as 8 times a year.
The day care center has to do the hard work of disinfecting surfaces, including toilets, handles, and toys; as well as taking the time to make sure the children wash their hands with soap and water frequently. The staff should be doing the same.
Alternately, to compensate for their overly strict policies, day care centers might consider only charging for days the child is in the center, if they insist on having only well children with dry noses.
8
@AGC
Most of what they are requiring antibiotics for does not respond to antibiotics so taking the antibiotics will not shorten the time before the child is better. It may give parents and the daycare a false belief the child, who likely has a virus that can't respond to antibiotics because it's a virus, is not contagious.
6
@JJ I think daycare providers want a document they can point to that says kid has clean bill of health. Totally true what you say.
As a working mother who had in home service for her children, I understand that the daycare workers have a responsibility to all the children not just yours which is why I had a in home nanny.
Then I could control the situation.
Daycare is the only option for some, but you have to understand that these workers are just trying to stop anything from spreading to the whole group.
They are not medically trained and are given a list of guidelines to be used.
Do you really want your child to be exposed to another child with a potential illness?
You say that your child only has a runny nose or slight eye discharge, but what about the other children if you are wrong?
34
I have no problem with keeping contagious kids away from other kids.
The issue here are daycares that are insisting on parents giving antibiotics to kids that don’t necessarily need them. Antibiotics are harmful in a variety of ways and should be reserved for cases where they are truly needed, not used casually every time a kid is sick. Doctors should be the ones making that call in coordination with parents, not teachers at daycare.
15
This article did not limits its excoriation to unnecessary antibiotics. It chastised well-reasoned and well-meaning policies based on narrow potential misuse of one relatively rare policy.
13
@marie
Except for the fact that a lot of these illnesses are spread when the child is asymptomatic. So the guidelines a lot of day cares are using 'to protect children' aren't really protecting anyone.
7
Just this morning I was negotiating with our in-home daycare provider about a rash. My son gets a rash every single time he has any infection. A common cold gives him a rash. We have now gone multiple times to the doctor to verify that yes, the rash is not contagious. It's a quirk his body does. We get a note, the kid can go back to daycare. Every time. And kids get sick a lot.
Today I learned that apparently he shouldn't be allowed in with a rash even with a doctor's note saying that it's not contagious. Per state regulations she shouldn't have him in with ANY rash at all. It could be a full week for the little dots to go away!
14
@Natasha
Not allowed in daycare with any rash--do you think you might have the anti-vaxxers to thank for this?
10
As cynical as this sounds, I used to believe that some of my son's day care teachers would call to have me pick him up because it would reduce their class size for the day. One time, I rushed out of work because the teacher said that he was erupting in hives all over his body. When I got to the center, she pointed out a mosquito bite on my son's back. No hives - just a mosquito bite. Later that same week, she called and said that he'd had a loose stool, but was otherwise perfectly healthy and active.
I finally complained to the daycare director and told her that I'd be switching my son to another center if I kept getting called out of work for anything other than a true illness, the calls to pick him up stopped.
20
My son's pediatrician prescribes OTC eye drops for pink eye; they contain something homeopathic + saline, so basically they are saline and we can tell the preschool he is on meds and cleared to return. :)
17
A perhaps even more and deadly cost for unnecessary treatment - super bugs...which can kill us all.
10
In my area there is a unique alternative. An emergency nanny service, staffed with real nurses. It's pricey as all heck, but your child is home with a nurse / nanny, the daycare doesn't have to deal with contagion, and the parents can go to work. And even though it's pricey, it's generally not necessary for more than a few days per year.
6
@Chip
It's actually ridiculous that a slightly ill child has to be monitored by a nurse for 8 hours so parents can go to work. It's an extravagance for the wealthy who probably also have generous paid time off, the ability to bring a sick child to work, etc.
14
Nurses doing nanny work ! Maybe next we will have paediatric physicians offering their care as Super nannies for the sick children of the ultra wealthy so they can keep doing their ‘important jobs ‘ such as selling real estate or attending another Bank meeting.
7
@Matt
I'm a child Psychiatrist. I'd certainly do a super nanny job if it pays better than my current one.
Ha! As a family doc I went through this a few hundred or thousand times. The parent would come in with a kid with a viral pinkeye saying the daycare required an antibiotic. No. These visits ended with appropriate medical care but, alas, a sometimes suboptimal patient satisfaction score. You can't please everybody.
If you think that's bad, how about nursing home and adult living center patients? I have seen dozens of nursing home patients sent to the emergency room because appetite seemed to be down a little at breakfast. Of course by lunch in the emergency department the appetite was back.
I started practice in 1989. It's always been this way.
19
@vbering
Well that's nice. My dear friend developed a UTI in a nursing home and was kept there, despite his begging them to call the doctor, until he was septic, and spent a month in ICU while the doctors and nurses struggled to save his life. When the nursing home "nurse" called to tell me he was in the hospital she had the same tone I read in your comment as she told me he wasn't in real distress; they only "let" him go to the hospital to get him to stop complaining.
Ha! indeed.
11
@vbering Families who take care of elderly patients often have them admitted around Christmas time. Expensive respite care!
3
@Laura What he said is true. ER's know exactly which nursing homes are good for sending patients to the ER on Friday so they can have a lower patient census for the weekend, while the hospital admits the patient and runs some tests, then discharges them on Monday. Your friend's situation was unfortunate, but he was in one of the OTHER kind of problematic nursing homes.
6
The author has stated at the end "The idea is to protect children.." and this is where the child care school policies come in effect. If your child is healthy and as a parent you see your child playing with his/her friend who has runny nose, coughing or sneezing, I would love to know your reaction to the other child. When a parent is called to pick up their child if she had more than 3-4 diarrhea with an hour or so and feeling very week even to get up, the first thing they ask "Do you have any other child who is sick in her class? If yes why is that child allowed to come to the school?" As teachers they get to take care of the sick child and give extra attention (in the meantime there maybe 10 other children in the classroom as per state ratio). It is a thankless job where the teachers get to hear from both sides. Most of the school's Safety and Health policies are required to adhere to the Department of Children and Families guidelines and if it is not followed properly, the child care centers are held accountable and are in noncompliance.
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@Rammi
I knew that everyone was going to get that cold whether or not some were sent home. It's not a big deal.
It's not smallpox, or even chickenpox (against which children are immunized, so don't worry).
5
The statement that "Day Care Directors aren't medical professionals" cuts both ways. Sending them home AND specifying the treatment is excessive; but NOT sending them home and NOT requiring a physician to sign off on the status of the child is not the right response.
One can imagine the cross-examination of a Day Care Director who saw some symptom (fever, lethargy, nausea) but didn't insist on a physician follow-up in the rare case when the problem is actually serious (kid had a life threatening disease, maybe some harm occurred). Maybe the Director explains that a fever isn't a big deal, and the lawyer will then ask what their medical training is that supports that assessment.
Similar issues could occur if a child has something transmittable, and the Day Care takes no action to protect the herd (the rest of the class).
Perhaps a specific issue would be to have physicians sign off on the kid not being transmittable (kid looks bad, but other kids are not at risk) rather than specifying treatment. But the rationale for calling the parents and taking the kid out of class is driven by the liability of not doing so.
The system won't change until the incentives change.
15
My daughter went to a lovely infant care center right in the building I worked in. They contacted me several times a week to tell me to come and get her because she had diarrhea.
I believe she was the only breast fed baby there, all breast fed babies have loose stools. Fortunately I could walk to the pediatrician, she would write another note , and they would take the baby back, I would return to work. The day care staff claimed State Health Department requirement.
17
The reasons day care centers operate the way they do are perfectly obvious.
If managers made medical decisions for their students, they would be sued if anything went wrong. They would be written up in articles like this one, along the lines of why are they making medical decisions without medical training?
Perhaps 19 out of 20 children don’t need to go to a doctor or be kept home. But that twentieth kid who should have and now has infected other students (or worse, is dead) will bankrupt the center.
In today’s litigious society, I completely understand why “better safe than sorry” is any company’s policy.
27
@ReadingLips The day care center is never going to be held liable for not making a medical judgement. All they have to do is call up the parent and tell them what's happening, and advise the parent to take them home. They have no more expertise in knowing if a doctor is necessary than the parents have--which is why it's the parent's call.
6
@Stephanie
All it takes is them deciding not to send the kid with a snotty nose home and if that kid has anything go wrong they will have a multi million dollar lawsuit on their hands, and because we don't have a loser pays legal system that will destroy them.
The thing that really irritates me about this story is not so much that the daycare center tells the parent that the child cannot attend until they are well (fair enough) but that the center diagnoses the problem and recommends (demands?) a specific medical treatment for the condition. The diagnosis and recommended treatment should come only from a trained medical person. Someone needs to be educated - either the center of the regulatory agency. The policy, as described, sounds pretty close to practing medicine without a license, doing harm all the while. I have no quarrel with sending a sick child home. Yes, that is one of the stressors a parent of a small child can experience - one of many. Parenting can be a very stressful job. Friends, community, and society in general can make it easier, but this medical "playing doctor" policy is not the way.
19
@Sue R . Yes! I had this happen with my daughter - they had me get her evaluated for speech! She wasn't in the same room as the speech evaluator for more than 3 minutes when the evaluator is like: "what's the problem?"
Daycare employees are under-appreciated and underpaid, but the frustration often lands on the parents who are already paying a vast some to send their children to child care.
8
I feel like the author has very little practical experience with daycare centers. Daycare centers provide healthy and developmentally appropriate care and activities for a classroom full of healthy toddlers. They are not trained or equipped to provide medical care or even TLC for sick children. It is unrealistic and unfair to expect daycare teachers to care for multiple sick children at once - one with pink eye, another with a hacking cough, another lethargic and lying on the ground, and another with his nose draining down his chin all day. All of them irritable and prone to tantrums because they're not feeling well. It disrupts the entire classroom and activities. If you want to put responsibility for taking care of sick children on daycares, then you need to staff the daycare rooms with nurses. Bottom line: Although inconvenient, parents need to stay home with sick children. Period. (And I say this as a parent who groaned loudly every time I got the call from daycare to pick up my child.)
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@Confused
A runny nose isn't "sick". As an adult, my nose runs much of the time. Sometimes it is a cold, sometimes spicy food, sometimes the weather.
23
@Confused
Another example of someone who hasn't really read the article. The article clearly stated (and this is repeated in AAP exclusion guidelines) that children should be sent home if a) they cannot participate in activities and b) they are an undue burden to staff. So your example of sick children lying in heaps around the center would not apply.
Please everyone read the article and these guidelines before posting any more comments in favor of antiquated exclusion policies: https://nrckids.org/CFOC/Database/3.6.1.1
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@Confused
Thank you for your logical and cogent response. I for one get it. Parents do expect daycare workers to care for their sick children. It happens all the time. And anyone who has actually spent time raising children themselves clearly recognizes that noses running down the chin is NOT something to be ignored---daycare workers are not doctors and cannot tell if that runny nose is a virus, a sinus infection, or allergies, nor should they be required to. And pink I that has progressed to pus is clearly another infection---and quite common as little children with burning eyes are constantly touching them with germy hands, thus the secondary infection. It's very clear you read the article, and many parents will agree with you. Parents need to stay home with their sick and/or contagious children. Period.
31
Carroll writes: "Being overprotective has costs, though. Visits to the doctor aren’t free, nor are drugs. Parents have to skip work to take their children to the doctor. They already pay a lot for day care, and this is a forced expense that often lacks value."
Unfortunately, Carroll can't bring himself to advocate for the big reforms we need: National healthcare, which in every country in which it's implemented, costs half or less than American healthcare; a national formulary with prices negotiated by the federal government, which, again, is dramatically cheaper in countries which have it; paid family and medical leave, which would eliminate the cost factor in parents' taking off work to keep sick kids home; and government-run and regulated child care, which in every developed nation is high-quality and far cheaper than in America.
The big question is why The Upshot refuses to acknowledge the big problems besetting us, and instead simply nibbles around the edges.
Antibiotics are not the problem- the lack of national healthcare, paid sick leave, and government-provided child care are.
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@Sean, Dr. Carroll writes articles about improving healthcare access on the Upshot, on his Youtube channel Healthcare Triage, and at his blog as well.
However, it is ridiculous to complain that this article does not discuss national healthcare. Even if we had cheap, affordable, easily accessible universal healthcare, the issues discussed in this article would still exist. The point of the article is that these kids shouldn't need doctors appointments or antibiotics, and parents shouldn't have to take off work, regardless of the cost to them.
And antibiotics are definitely part of the problem - misuse of antibiotics is known to contributes to worsening antibiotic resistance, and also alters the gut microbiome, which ongoing research suggests is important for overall health.
It makes no sense to make the important issues discussed in this column into an excuse to complain about how you feel about the Upshot's healthcare coverage.
Also, the other countries discussed in this article have national healthcare, but still have the same daycare problems we Americans have. So national healthcare is not necessarily the solution to this problem.
17
@Sean, Healthcare for all is a good idea. Not sure there would be money to pay for government-paid childcare after that. If there were money left, it might not enough to pay for elderly care that is weighing down middle-aged working Americans who may or may not have children.
2
@JY And yet, the countries of Europe- all of them- manage to pull it off. And they do it by spending dramatically less on universal healthcare than we do in the United States, which leaves more than 30 million people uncovered.
It is certainly doable. Just look at the examples overseas.
3
When you cluster children together in a preschool or day care center, they expose each other and the staff to whatever they have. I've heard that workers in such facilities go through a period of catching many colds before their immune system learns to recognize many more strains.
The current policy seems to be moving towards "let them be exposed, to toughen up their immune systems". That might be inevitable because there is no way to know when they are contagious, or when they stop being contagious after the onset of symptoms. You can't tell, which is why colds and flu spread so rapidly. To stop the spread, you'd have to keep them in some sort of quarantine until you're sure they're no longer contagious. That is not practical, and might not even be possible.
So the policy is to let the germs spread, with clusters of children as the vector. It's the philosophy that what doesn't kill you makes you stronger.
5
I am a medical professional and if the daycare centers did not adhere to policies to keep childre
I don't think you can have one blanket policy for pinkeye. In one child, there may be some mild pink color that you have to look hard to see. In another child, her eyes may be gummy and glue shut during nap time, and be constantly leaking (infectious) tears down her face. Some common sense has to come in here.
8
If my kids were still in day care I would be saying "So what are you trying to tell me?"
3
What all day care centers should require is VACCINATIONS. Since they are not medical experts, they should not require any other medical treatment aside from a visit to a real doctor who then decides whether treatment is warranted or not. On the pink eye issue, kids with pink eye or diarrhea or fever should not attend daycare till they are better, period.
13
And then, of course, there's the skyrocketing rate of resistant bacteria, a direct result of excessive/inappropriate prescription of antibiotics . . .
17
Where is personnel responsibility, you made the choice to have this child. I was a working mother, I know how it is but ultimately you made the choice to live your life that way. My own children grew up and because of our life experience, they made sure they were in a good financial position and married to people that held the same goals and values before kids came along. Everyone wants to push their responsibility off on someone else, then have everyone else pay for it because it is "too" hard for me (the parent).
6
Although antibiotics maybe over prescribed, it is unfair to blame preschool staff for this problem. The author states preschool Directors call parents to pick up children for symptoms of pink eye. The author goes further alluding that the Preschool Director "sometimes says the child cannot come back until they are on antibiotics". Really? I doubt it. As a Director for 35 years, I did make these calls because the child was uncomfortable and showed symptoms of illness, to prevent spread of pink eye, and because state licensing required it. However, I never made a diagnosis or prescribed antibiotics. I always asked parents to see a doctor and provide a note by a medical professional telling me the child's treatment plan. This is standard school policy and to do otherwise would be illegal because I would be prescribing "medical treatment without a license". If any preschool Director is making medical diagnosis and prescription, they should be reported to state licensing. However, I believe, the Director is most likely requiring the child show proof of antibiotics because a medical doctor prescribed the treatment. So let's lay the blame where it belongs.
25
In my experience as a pediatrician, the daycares give parents a choice: either keep their child out of school for the 3-5 days until the eye symptoms are resolved (and then get a doctor's note attesting to the fact that the eyes are now normal and not contagious) OR start on antibiotic eye drops and return to school the next day, regardless of whether the eyes are clinically improved (keep in mind that a viral pink eye will still be infectious, like a runny nose, even with antibiotics on board). The end result? Kids are given unnecessary antibiotics, they transmit their minor illnesses anyway, and healthcare dollars are wasted.
Fortunately my kids are way beyond this, but I remember dealing with my son being sent home with the slightest sniffle and thinking ‘why am I paying for this?’
6
Of course, handwashing is important. Good luck trying to enforce that with a roomful of two year olds!
While a trip to the doctor may not be indicated, it seems humane to let the feverish kid go home to rest. Perhaps the problem is with employers' inflexibility.
Not to mention that it isn't fair to expect already-overburdened day care workers to clean up after a kid with a GI bug on top of their other duties.
53
Licensed day care providers and preschools usually have health care related policies and regulations that derived from some authoritative source. Often they come from the agency that regulates the facility itself, or from a source recommended by that agency. Changes in protocol usually have to come down from on high, or at least be suggested from on high.
27
What is best for the child? The parents appear to be unable to keep the child home while they recover. The day care centers prefer not to deal with an ill child when they have plenty to do keeping the healthy ones busy and in line. The child is bobbled between parent, day care and doctor's office. What good does any of that do for the child?
20
@Carole Goldberg exactly. Where do you want to be when you don’t feel well? In a room full of loud people or in your own home?
4
Interesting article. I wonder if the author is aware that many preschools are required by regulation to have certain health care policies and procedures. Or that most private preschools, unlike public schools, are not funded to have a health care professional (i.e. a nurse) on site. This is especially true for small, community based programs, that are largely underfunded by government to serve low income families.
While a family may be inconvenienced by being called for an early pickup of their child, other families may perceive programs allowing attendance of children with even minor illnesses as not being safe or healthy for their children who aren't ill but who may be affected by unchecked contagion.
The issue is more complicated than meets the eye. If the author hasn't had a chancer to spend time at a good community based preschool, I would encourage him to do so. It will be eye opening and informative, I guarantee!
10
Children should not be asked to go to school when they feel sick. Sitting there with a fever and trying to do work would not be pleasant at all.
If someone has an irritated red eye and feels terrible, why make them sit in a class and try to act like they feel fine? They need to be home on the couch resting and taking it easy. This article upset me a little bit in that it did not convey sympathy for someone who feels lousy and needs some TLC at home.
19
@Curiousgirl The author specifically stated that the child *should* stay home if he is unable to actively participate in the daily activities. As a school nurse, I always tell parents to judge how the child feels, to determine when to return to school, in the absence of an obvious communicable condition.
7
And one wonders why there is increasing antibiotic resistence? Our old family doctor used to tell my parents when my siblings and I were sick, "Without antibiotics the flu will go away in 7 days; with antibiotics it will take just 1 week." It was a joke, but he was deadly right.
Antibiotic stewardship and preventing/delaying antibiotic resistence requires prudent and especially limitied use of antibiotics. Most ailments benefit absolutely zero from antibiotic use, and most common ailments including pink eye are self-limiting. In fact, antibiotics may even be harmful by selecting for resistant microbes that cause serious infections in future or immune compromised individuals.
72
@David Many years ago, my children's pediatrician told me the same thing about pink eye. "With treatment, 7 days. Without, a week."
My grand daughter recently started a week of antibiotics for a bite by another child in child care--it was "preventative" in case the bite (which did break the skin) got infected. Two days in, my daughter told me she wished she's never started my grand daughter on the antibiotics. The stomach upset, diarrhea and damage it did to her gastrointestinal flora didn't outweigh a potential maybe.
13
@MaryP
to this layman, that sounds like a case for topical antibiotic ointment.
6
If day care staff lack medical training as this article states, then of course they are going to err on the side of caution.
While pink eye is pretty obvious, rashes, vomiting, or diarrhea can be symptoms of many different conditions and the staff isn't the entity to sort that out, an MD, DO or other medical professional is.
That however is a separate issue from the staff setting a specific remedy for the illness they are not qualified to diagnose.
31
@B Dawson
Except that the AAP publishes pretty clear guidelines to help child care centers to determine when exclusion is necessary. Unfortunately, most centers don't follow them. (As was also stated in the article.)
4
Again, an article about group child care pitting parents against staff - ugh! One set of parents is mad that they are called to pick up their child and the other set thinks that the staff doesn't do enough to protect their child from getting sick.
There ARE guidelines for child care centers that cover all aspects of health and safety, Caring for Our Children: National Health and Safety Performance Standards, published by the AAP. I called it the health and safety bible in my 30+ years of teaching Early Childhood Education. If the staff have an Early Childhood Education degree they would know about the standards and follow them if they can. Some state's regulations dictate health and exclusion polices and they are contrary to the AAP recommendations. An example is the recommendation to exclude children with a specific temperature even when they don't have other symptoms and are playing happily.
Mr. Carroll could do a lot more good working with state and local child care and referral agencies to educate both parents and staff on best practices rather than unilaterally stating that child care directors are at fault for not being medical personnel. This is just one more example of the early education crisis we have in this country- ugh!
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@Elizabeth We get it, you work at a Day Care Center and you have been chewed out more than once by a parent on the receiving end of your medical training.
5
@Charlie Shame on you. Elizabeth is an early care professional with 30+ years of experience who was able to refer to a well-known standard for care, a degreed program, and a national association, yet your comment attempted to trivialize her entire comment.
Sir, I sincerely hope you aren't in a position to rely on the future generations for your care, employment or support. It's people like Elizabeth who are teaching valuable skills to tomorrow's future workforce. To dismiss them does a disservice to not only those professionals, but those whom they serve.
39
And what about unqualified teachers and principals diagnosing ADHD and demanding that children take ritalin with no doctor's diagnosis as happened in my son's private school a generation ago? There were two first grade classes in that school and they had 20% of the first grade children on ritalin, but NOT our son. We removed him from the school.
42
@fg:
how on earth could a child GET Ritalin without involving a doctor?
13
@RLiss
It happened with my nephew. The teacher informed the parent their child may need ritalin, they took him to the doctor. The doctor just pulled out his prescription pad and said if the teacher said this was needed here you go.
My sister-in-law was infuriated took the prescription, never filled it and gave her son more personnel attention. It worked out fine. Teachers are not doctors.
12
@fg Same for us. Daughter was just too smart for the gifted kids school; they wanted us to dose her for "nonspecific nervous disorder". Thrown out of two preschools. Now has double degrees from MIT. Yes, she was stinking difficult, mostly out of boredom. I pity the boys with brains if that's how they treated the less testosterone afflicted smart kids.
7
This became a problem at our daycare. It became apparent that the daycare "teachers" used illness as a way to eject children that were bothersome or to reduce their workload. Your child could be sent home and not allowed to return for 24 hours (which was really two days, considering a call at noon basically kept you out the next day, too) or unless a doctor certified your child was OK.
We had a great pediatricians office who would take last minute appointments pretty easily. It got to the point that I could pick my child up and have him back in daycare with a doctor's note in under 60 minutes.
After three of these round-trips in a roughly 3 week timespan, I confronted the daycare director with my documentation and told her something was wrong. She agreed to "review" the staff's health concerns and the "sick calls" basically dried up, except for a couple of times (over a few years) that my son actually was sick (which was usually obvious -- vomiting, etc).
Other parents had similar experiences, and one who was an attorney was contemplating filing a civil suit to collect damages related to lost income and missed court dates. We all liked the idea, but as hard as daycare was to come by unless you can handle the lawsuits yourself you risked getting kicked out and having to find daycare.
48
@Mobocracy We had an instance where a day care center worker had an open herpes sore on her lip and was still working with and infecting children until it was spotted by a parent.
5
@Mobocracy
I'm glad that worked out in your favor. When we brought up our concerns with the director, she doubled down on the nonsense policies - even going so far as to revise the parent handbook to make it easier to exclude kids. Long story short, we reported them to the state for an unrelated matter (inadequate egress in our kids' classroom) and they kicked us out. Yay for American parents!
4
Of course directors of day care centers are not doctors, nor do they claim to be. Common sense—and insurance companies—require that these directors take reasonable and prudent steps to keep the children they care for from harm and illness.
Given that pink eye is so contagious, surely one or more of the various US pediatric medicine professional associations has developed specific best-practice guidelines for prevention and management of pink eye—and other contagious diseases—in day care facilities.
If not, what are you waiting for?
7
@Mon Ray:
as a mom and a retired RN, no idea how you can "prevent" pink eye or upper respiratory infections, or diarrhea among kids too young to understand how to practice the sort of hygiene we'd expect among adults.
Conjunctivitis (pink eye) is highly contagious....would you want your child exposed to several other children allowed to be at daycare with it?
I recall the day that between 6 am and noon every single child in my son's daycare came down with chicken pox (pre-vaccine era) and had to go home! Yes, it spread that rapidly.
8
@RLiss-You misspeak. Obviously everyone in the daycare were exposed to the same infectious child two weeks prior. Chicken pox has a 10-14 day incubation period and does not spread among individuals and become active disease within a day.
13
Another trait of our de facto criminal health care system, make money first giving out pills whether it helps the child or not.
I was surprised to see that even in Canada that has a gold standard health policy unlike our de facto criminal one, it is still a problem there.
1
@Paul I see this as more of a response to a potential lawsuit. The same legal system that drives up US health care expenses also creates the incentive to send kids home based on "an abundance of caution."
3
@James-thank you for your reply. Yes, just about everything re our health care system is criminal or abused from the big Phrama/HMO reps making trillions, to the hypos ripping off the system, to the people who don't care of themselves, to the outright thieves etc.
Insurance fraud, rip offs are a fraction of the trillions of dollars being ripped off elsewhere.
2
Sounds good, I suppose, on paper. But hand hygiene for children in a day care is impossible, given that the child will simply touch his eye and anything around him. Not because he's bad, but because he's a child with no impulse control. Nice try, though.
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@Joe
So we're all experts now, huh? A "randomized controlled trial published last year in Pediatrics" found this effective.
Kids can learn (and follow direction) to wash/sanitize their hands regularly, even if they're constantly touching everything, and this "resulted in a reduction in respiratory infections and antibiotic prescriptions, as well as fewer days missed." That's what experts have concluded by using science.
Thank you, thank you for this! I absolutely hate the requirement that people see doctors before they're allowed to attend school/get out of work etc. It costs money and time and generally is pointless. Schools and workplaces don't have the right to require people to consume healthcare services.
8
The bottom line is that 95% of pediatric infections are viral and won't get better with medicine. But the problem is that may take 5-10 days to clear up.
What parent can afford to take 5-10 days off work every single time their child gets a cold? Average school age child will have colds 3-4 times a year. That means minimum of 15 days off per year. Parents cant take that kind of time off in most companies.
What we really need are 'sick' daycares that are OK watching mildly ill children. There's no reason to force all kids with mild congestion/cough who are running around and playing fine to stay at home.
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@Diana
Some larger daycare centers could have a "sick" room for these children, and hire a nurses aid to watch them. The aid should have enough knowledge to send the ones really sick to the doctor for emergency treatments. Maybe charge a little extra for this care to cover the cost of the additional faculty.
16
@Joyce Benkarski-But then all the children in the "sick" room are doomed to get all the other viruses floating around there. Might be weeks before they can escape. But they"d have incredible resistance built up before kindergarten!
17
@Diana They're not necessarily day cares but I have seen a few pediatric clinics that run "sick day" programs. Not common though and parents have to pay out of pocket.
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Mr. Carroll seems to imply that these Teaching Professionals who he claims lack medical training (I disagree since in IL licensed child care centers must have all team members trained in CPR and First Aid at least every two years) should now determine “…how sick.” a child is. He also implies that there is a lack of focus on hygiene, “like proper handwashing…”
If Mr. Aaron visited any Goddard School he would discover that children wash their hands upon arriving at the school, after using the bathroom, before using common sensory material, before meals, after coming in from the playground, in addition to a myriad of other best practice and Health and safety Procedures. Additionally, if he had done any research on state guidelines such as in Il, (Title 89, Part 407, Section 310 ) he would discover that his criticism should be directed at state licensing agencies and their guidelines, which licensed child care facilities must follow. From that IL section, “…in which case exclusion from the day care center is required: I) Purulent conjunctivitis, until 24 hours after treatment has been initiated.” In Il for example, licensed child-care facilities must send a child home if they display symptoms of pink eye.
Although Mr Carroll’s thesis may be well intended, his criticism of Child Care Centers and their Directors is completely misguided. As a licensed child care facility, we not only focus on best practices, but also must follow these State licensing requirements.
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The regulations specify "treatment," but "treatment" need not necessarily mean "antibiotics." The treatment for viral conjunctivitis is, if I recall correctly, warm compresses.
In any event, if the problem is largely regulatory, it may be more tractable than a problem stemming from the policies of individual daycare centers. I'd like to see Dr. Carroll follow on the regulatory aspect.
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@Michael Petrucelli Yeah, who needs years of med school when you’ve got CPR and first aid certifications, right?
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@Mike:
but how do you decide which is viral conjunctivitis and which is bacterial?
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It's likely many policies schools and day care centers write are created with multiple values in mind, two being: 1) well-being for all children, and 2) convenience, health, and efficiency of the teachers. Sometimes it's easy for the teachers/care-takers to forget the burden placed on parents when a child is forced home. Parents should work with the director and teachers to create research-based information to design better policies that serve everyone. (Head lice is another item that drives everyone crazy.)
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@SGK
When did it become the norm that when a parent has to deal with their own child, healthy or otherwise, a burden?
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@EsmeK:
basically work rules/ regulations that penalize parents for taking time off for kid's ailments.
I had to ALWAYS lie and claim to be sick myself. No sick leave due to the kid's illnesses.
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@EsmeK It becomes the norm when both parents have to work full time and have used up the leave they can take for parenting without losing pay. My daughters manage because they have jobs where they can work from home if need be, and can make up the lost time. Not every kid's parents have these kinds of options, and losing a week's paycheck, or the job itself because your child is sick IS a hardship.
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If we keep this up, bacterial infections will become supercharged and antibiotics won't work anymore for anything. And we are using them in small children who have no choice but to be loaded up on these powerful medications to please a day care administrator because there is no one else to look after them. And I bet these people search for "organic" meat and chicken in their food, because they don't want all the antibiotics that go into factory farming.
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@December:
antibiotic resistance is ALREADY a huge problem, and much of it comes from the overuse of antibiotics (usually given to every single animal ) by factory farms which care about nothing but profit.
People who use up a portion of the antibiotic and "leave the rest for later" are also contributors to the problem.
If a bacterial infection is partially suppressed by antibiotics, then the antibiotics are stopped, the remaining living bacteria are that much stronger against that particular antibiotic. Also, as we all know, antibiotics do nothing against viruses.
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I have written more letters stating why antibiotics are NOT indicated to try to explain to day care centers (and schools) that their guidelines are wrong than I can count. Has not changed their policies. The next child comes in with the same letter .....
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@TooBusyDoingOtherThings:
Talk to the director. She/ he are probably basing their rules on county-wide or state-wide regulations.
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Another side effect of these policies is that children grow into young adults who think that every sore throat or cold requires a trip to the doctor and antibiotics. Teaching good hand and cough hygiene, and using common sense about protecting others will benefit children and adults.
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@Rural Farmer Not to mention the fact that they develop a resistance to antibiotics if they use them too often, to the point that they might not work effectively if you actually DO need them for something.
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@Rural Farmer:
Not really. Both my kids are grown now and neither thinks that way.
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@Rural Farmer As an MD, I don't think that's true. In fact, the case is many people continue to go to work while sick because their company doesn't have a good sick leave policy or they are compelled to attend to not appear lazy and risk firing. I know of some places that are now encouraging people to STAY home if they get sick because it's common for illnesses to spread among co-workers. While that might be minor for healthy people and run-of-the-mill viruses, we have seasonal flu epidemics and people who have other illnesses where a minor cold has a major effect.
6