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

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

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

What the Docs May Do

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

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

Most daycare centers use state guidelines to determine who can and cannot attend daycare. Conjunctivitis (or pink eye) is a bacterial infection (rarely viral) and is very contagious between toddlers and young children. Once treatment is begun, a child can return, usually in 24 hours. Most upper respiratory infections are caused by viruses and have varying times of contagiousness.

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

More 19th Month Help

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

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