When kids spend time close together, germs can spread between them. This is especially true for infants and toddlers, who often share toys that have been in their hands or mouths.
Knowing when to keep your little one home sick from child care and school helps protect other children from illness. It can also give your child a chance to get extra rest they may need to recover.
When choosing a child care setting for your family, consider this important factor: What is the policy for sick children?
To reduce the risk of illness, child care providers and all the children being cared for need to receive all recommended immunizations. This includes the flu vaccine and COVID-19 vaccine for everyone age 6 months and up. This critically important step puts the health and safety of everyone in the child care setting first.
Common illnesses in child care
The viruses responsible for colds or the flu cause the most common sicknesses in child care settings. Even though your child has had immunizations, they can get still get sick with colds, sore throats, coughs, vomiting and diarrhea.
Children of any age will experience a lot of infection in their first year of group child care. For kids whose first year of child care is during infancy, bouts of illness may be even more frequent. In fact, they may have as many as 8 to 12 more colds than a child cared for at home without exposure to siblings or other children.
The good news: during the second year of attending child care, the number of respiratory illnesses begins to fall. This is because exposure to so many germs causes rapid development of the immune system.
The typical child will also get diarrhea once or twice a year.
Why keep your child home?
The main reasons to keep your child home are that an illness can:
prevent the child from participating comfortably in activities
make them need more care than staff members can provide without compromising the health and safety of other children
pose a risk of spread of harmful disease to others (see list of these conditions below)
AAP child care exclusion recommendations
Any child with respiratory illness symptoms (cough, runny nose, or sore throat) and a fever should not attend their child care program. They can return once their fever associated with these symptoms has been gone for at least 24 hours without the use of fever-reducing medicine.
Your child should also stay home sick from child care if they have these symptoms:
- Signs of severe illness such as being unresponsive, irritable, crying more than usual, is having difficulty breathing, or has a quickly spreading rash.
Fever (temperature above 101°F [38.3°C] by any method) and a change in behavior or other signs and symptoms (such as a sore throat, rash, vomiting or diarrhea).
Note: For infants less than 2 months old, an unexplained fever should be evaluated by a health professional. For these young infants, get urgent medical advice for temperature above 100.4°F (38.0°C), whether or not they have other symptoms.
Diarrhea, defined as having more frequent and loose stool (poop) than usual that’s not caused by a change in diet. Children should stay home if their stool is not contained in the diaper, or if they are toilet-trained but having “accidents” from the diarrhea. Other reasons for child care exclusion: having more than 2 stools above their normal per 24-hours, or stools that contain more than a drop of blood or mucus.
Vomiting 2 or more times in the previous 24 hours. The exception is if the vomiting is found to be caused by a non-infectious condition, and the child is not in danger of dehydration.
Abdominal pain that continues for more than 2 hours, or abdominal pain that comes and goes, along with fever or other concerning symptoms.
Mouth sores with drooling that the child cannot control, unless their doctor or local health department authority states that the child is noninfectious.
Rash with fever or behavioral changes, until a primary care provider determines that the illness is not a communicable disease. If your child has a new, rapidly spreading rash that resembles bruising or small red or purple “blood spots,” call 911.
Skin sores that are weeping fluid located on an exposed part of the body that cannot be covered with a waterproof bandage.
Other conditions that are reasons to stay home
If your child is diagnosed with these conditions, they should not attend child care:
- Streptococcal pharyngitis (such as strep throat or other streptococcal infection), until at least the first 12 hours after antibiotic treatment has started.
Head lice, scabies and ringworm until after the first treatment. Child care exclusion is not necessary before the end of the program day. When treatment starts between the end of the program day and beginning of the next day, no exclusion is needed.
Chickenpox (varicella) until all lesions have dried or crusted (usually 6 days after onset of rash) and no new lesions have showed for at least 24 hours.
- Hepatitis A virus infection, until 1 week after onset of illness or jaundice or as directed by the health department
When it’s OK to stay at child care
Children with the conditions below do not necessarily need to stay home from child care, as long as they feel wellenough to participate in regular activities. However, it also depends on whether staff members determine they can care for the child without compromising their ability to care for the health and safety of other children.
Coughs or colds without fever or other signs of illness
Runny noses (regardless of color or consistency of nasal discharge)
- Yellow, green, white, or watery eye discharge without fever, even if the whites of the eyes are red (pinkeye)
- Ear infection, unless the child has a change in behavior or cannot participate as usual
Fever in children older than 4 months above 101ºF (38.3ºC) taken from any site (axillary, oral or rectal) without any signs or symptoms of illness or behavior changes. Note: the child may be excluded if they have not completed the recommended vaccine series until it is clear that they do not have a vaccine-preventable illness.
Rash without fever and without behavioral changes. The exception would be a child with a new, rapidly spreading rash that resembles bruising or small red or purple ‘blood spots.’ In that case Emergency Medical Services (911) should be called.
All staphylococcal infections. This includes Methicillin-resistant Staphylococcus aureus (MRSA) carriers or children with colonization of MRSA but without an illness that would otherwise require exclusion
Molluscum contagiosum (wart)
- Hand-Foot-and-Mouth disease. No exclusion is needed unless the child has mouth sores with constant drooling or has other symptoms like fever. In some cases, the local health department may require children with hand-foot-mouth disease to stay home to control an outbreak.
- Children who have no symptoms but are known to have a germ in their stools that causes disease. The exception is when they have an infection with a Shiga toxin-producing Escherichia coli (STEC), Shigella or Salmonella serotype Typhi. In these types of bowel infections, follow health department guidelines for return to child care.
Make sure you are reachable at all times
Many child care programs, as well as public and private schools, may contact you right away if your child shows signs of even a mild illness, like a cold. In others, children are allowed to continue the regular program as long as they can take part in most activities and do not have a condition that requires exclusion. Either way, be certain that the school or caregiver has a way to reach you at all times.
Be sure to talk with your child’s pediatrician if you have any questions about their symptoms and whether they should attend child care.
- Take Simple Steps to Avoid Dreaded Spread of Flu in Daycare
- Staying Safe in School During COVID-19
- Preventing the Flu: Resources for Parents & Child Care Providers
- RSV: When It’s More Than Just a Cold
- When to Keep Your Child Home From School