You're not imagining things — if it seems like your baby or toddler is often sick since starting day care, that's because he probably is. During their first year of day care, babies are likely to be under the weather an average of eight to 12 times. That number may drop during their second year because of increased immunity.
Still, runny noses, fevers and sore throats come and go frequently enough to leave you wondering when your little one is too ill to go to day care — and when he isn't.
It's always best to consult your health care provider if you do have questions, but these tips can help you discern what's serious enough to warrant a sick day (and a doctor's visit) — and what's minor enough to send your baby on his way.
How sick is too sick for day care?
Depending on what bug your little one has caught, he may want to stay home and cuddle, especially if he doesn't feel well enough to participate in day care activities. And there are times when your sick baby or toddler poses a risk to other children and could spread a virus or a more serious illness, like COVID-19, which in children often only resembles the common cold. Here are the symptoms to consider:
Fever
Running a fever is an obvious indication that your baby or toddler is not well enough for day care. If your baby has a temperature of more than 100.4 degrees Fahrenheit (sometimes with other symptoms like a sore throat, congestion, a cough, aches, chills or vomiting), he needs to stay home and recover. The same holds true for toddlers.
Your day care and your pediatrician will also likely want you to get your child tested for COVID-19 if he has a fever. If your baby is 2 months old or younger, a fever of 100.4 degrees or higher requires an ER visit. When he's 2 to 3 months old, call the pediatrician. You may need to visit the doctor's office or urgent care.[1]
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Wait until your child's temp has gone down without the help of fever-reducing medications like acetaminophen (and until you get a negative result on a COVID test) before he returns to day care. If the test is positive, your child will have to stay home and isolate for at least five days.
Flu-like cough, runny nose or sore throat
If your child has a cough, runny nose, sore throat or fever when there's a flu outbreak in your area, it's best to keep him home until the illness passes. You will also likely be asked to keep your child home with these symptoms until you get him tested for COVID-19 and it comes back negative, as cough, sore throat and fever can be among the symptoms of the virus.
Getting a flu shot is your best protection against the flu. Once your child is 6 months old, make sure you get him a flu shot too. And make sure all your child's caretakers have had the flu vaccine too.
Irritability
Sometimes being sick can cause your baby or toddler major discomfort, which leads to irritability. What would you do if you felt terrible and couldn't put it into words? This calls for a sick day with tons of snuggle time and an extra long nap.
Tummy ache
It's not easy to tell when infants have a serious stomach ache because they can't tell you, though older babies and toddlers may be able to communicate what's wrong. Typically, if a baby cries persistently, tenses up and grabs his abdominal area, he may be in pain.
Blood in the stool and green vomit are also indicators that you need to seek immediate medical attention.
Vomiting
If your baby or toddler has thrown up more than twice in the past 24 hours, it's best to skip day care.[2] Dehydration is the most common complication associated with diarrhea and vomiting, which is another reason your infant or tot should be at home under close supervision. If he can't keep fluids down, consider offering sips of Pedialyte or other rehydration beverages.
Gastrointestinal symptoms such as diarrhea and vomiting can also be signs of COVID-19 in babies and toddlers, so you might consider getting your child tested if the tummy troubles persist.
Diarrhea
Suffering from diarrhea can be caused by any number of illnesses or other triggers, but if your baby or toddler hasn't had any foods added to his diet that could lead to digestive issues, diarrhea may be a sign that he's sick.
If it's serious enough that it leaks out of his diaper (or a potty-trained child has trouble making it to the bathroom without an accident) and could cause a blow-out at day care, your little one needs to stay home.
Sore or rash
Mouth sores that cause excessive drooling may mean that your baby or toddler has an infection that could spread to other children. They can be caused by a number of conditions, from hand, foot and mouth disease to a simple canker sore.
But unless a doctor has determined that your little one isn't contagious, it's best to keep him home. Skin sores (especially those secreting fluid) and rashes that are associated with fevers are all signs of an infection or illness that other kids could catch.
Certain illnesses
Some doctor-diagnosed conditions require your child to spend some time at home recovering, including strep throat or other streptococcal infections, head lice, scabies and ringworm. The same holds true for COVID-19, which may present as nothing more than the common cold in babies and toddlers and will require you to keep your child quarantined at home for at least five days.
If your baby or toddler contracts a super-contagious, vaccine-preventable disease like chicken pox, rubella, pertussis, mumps, measles or Hepatitis A, it's crucial that he is isolated from other children. Talk to your doctor (and in some cases, the health department) about how long your little one needs to stay home. It's extremely important to get your child vaccinated, as these serious illnesses are entirely preventable.
Stay up-to-date on the vaccination schedule recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), and make sure all your child's caretakers are also up-to-date. And check that your day care facility does not accept unvaccinated children.
Unresponsiveness and difficulty breathing
If your baby or toddler is unresponsive and seems to have trouble breathing, that's a sign of a serious illness that requires a trip to the emergency room.
When can your child stay in day care?
Just because your little one has a stuffy nose or mild cough doesn't necessarily mean he needs to stay home from day care. Just make sure the center can reach you if your baby or toddler's condition worsens. The below illnesses don't require day care exclusion:
- Common colds (though you will probably be asked to get your child tested for COVID-19 to rule that out, since the symptoms are similar to those of the common cold in little ones)
- Ear infections
- Runny nose
- Eye issues: Experts no longer recommend exclusion for pink eye, because it's a common, typically viral infection that most kids will get at some point. That said, the AAP recommends checking on your school or center's policy regarding pink eye before making the decision (and advises it may be prudent to keep your child home if he also has a fever).
- Rash without fever
- Thrush (fungal infection of the mouth)
- Fifth disease (common skin rash)
- Staph infections
- Molluscum contagiosum (skin infection)
- Cytomegalovirus infection (common viral infection)
- Hepatitis B
- HIV infection
- Certain bowel infections
How can parents avoid getting into a day care bind?
The U.S is one of the only developed countries in the world that doesn't mandate paid leave for new parents, even though both parents now work full-time in close to half of all two-parent families. That can put parents in a serious bind when little ones fall ill. When it comes to dealing with the unfortunate and unfair lack of paid leave in our country, here are a few tips:
Know your rights
The only form of leave that parents automatically get is the Family and Medical Leave Act, or FMLA.[3] The bill provides workers up to 12 weeks of unpaid leave to care for a sick family member, recover from illness or care for a new baby within a 12-month time period.
But private-sector companies that have fewer than 50 employees are exempt, and employees must have worked at the same company for at least a year. And most problematic, the leave is unpaid, which for many families is a deal-breaker that can cause real financial repercussions.
Talk to your employer
Have a conversation with your HR department or manager before you ever need to take a sick day and get a good understanding of your company's policies so you're not blindsided when your child ends up with a bad viral infection. Maybe you can work from home when your little one is under the weather.
Have backup child care
When your baby or toddler is really sick, being with him may be all you can think about, but in some cases work won't allow for it. Make sure that before your baby ever falls ill, you have backup child care in place. Maybe it's your spouse, a grandparent or a babysitter you can call in a pinch.
In some places, there are also special day care facilities that accept sick children, though the downside of that option is that your little one will need to be cared for by a stranger, which might be tough for him and for you when he's not feeling well.
How do I keep my baby from getting sick at day care?
Being around all those runny noses and coughs means that from time to time your little one will get sick. The upside is that his immune system is getting stronger and more resilient by the day. But there are steps that you can take to minimize the chances he'll catch that pesky bug in the first place.
- Don't share eating utensils. At snacktime and lunchtime, ensure that your little one isn't sharing eating utensils, bowls and sippy cups. If he brings his pacifier to day care, make sure that he's the only one using it.
- Sneeze safely. Encourage your little one to sneeze into a tissue or his elbow rather than into his hands which is more likely to easily spread germs.
- Disinfect frequently. Ask about your day care's disinfecting policies. They should regularly be wiping down surfaces like changing tables, toilet seats, cafeteria tables and other frequently touched surfaces with a disinfectant like a bleach cleaning solution.
- Teach hand washing. Make sure hand washing hygiene is a ritual at your little one's day care, and as he gets older you can also teach him to wash hands before meals, after a bathroom break, after going outside and after sneezing or coughing. Kids and adults need to wash hands for 20 seconds to effectively remove germs.
- Check your day care's sick policy. Your day care should have a policy in place to prevent other parents from dropping sick and especially contagious children off. For example, a child cannot come back to day care until fever, vomiting or diarrhea have subsided for a certain period of time.
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