For working parents, getting that phone call from your child’s childcare center that Johnny has “pink eye” and must be picked up immediately often creates a lot of unwarranted stress. Of course, there is worry about your child’s health and well-being, but then the concern becomes when can your child return to school and who will watch him until he is able to return.

The American Academy of Pediatrics (AAP) and the American Public Health Association (APHA) created national guidelines 2 decades ago about when children can return, but when it comes to the states; adoption of these guidelines has not been the least bit consistent. In fact, in one state where formal childcare exclusion guidelines don’t exist, a study found 6 out of 7 children were inappropriately excluded from their childcare centers.

So yes, there are some clear-cut reasons for exclusion from daycare-- such as the gastrointestinal ailments (AKA diarrheal illnesses) E. coli, Shigella, and Salmonella-- but when numbers show that nearly 80% of the childhood daycare illnesses involve runny nose, cough and sore throat, most children are unnecessarily being excluded from daycare.

So 2 general guidelines to keep in mind-- and bear in mind these are national guidelines regardless of whether or not your state and/or child care center follows them. Keep a child out of childcare if that child:

- is unable to participate in activities

- requires more care than staff can provide while adhering to appropriate and safe staffing ratios

But for those looking for more specifics when it relates to specific symptoms/conditions, here are some specific recommendations with my thoughts shared in italics.

- Fever: exclude the child if associated with behavior change or other signs of illnesses. Ok, I might take it a step further and state for CCCs (maybe not when in high school), no child with a temperature (>100.4) needs to be at a CCC. Typically, a child is contagious when the fever exists so it would make more sense to keep the child out of a CCC when he/she is most contagious.

- Diarrhea: exclude the child if the child is having spillage outside the diapers/pants, there are 2 or more stools above baseline, the amount is affecting safe staffing ratios, or if any blood or mucus in the stool. Bottom-line, I’m comfortable with these guidelines.

- Vomiting: exclude if 2 or more episodes in 24 hours. As with diarrhea, this makes sense to me.

- Rash: exclude if accompanying symptoms include fever, behavioral changes, or draining sores. After 24 hours of antibiotics (if a bacterial cause) the child may return to his/her CCC. Rashes are an interesting one as most are not directly contagious. For clarity, a visit to your child’s physician may be in order.

- “Pink eye”: no exclusion criteria. I repeat no exclusion criteria and I agree. There is no evidence to support that treatment reduces spread and most often, the child is not ill. But as this garners so much attention with the providers at the CCCs, I typically say 24 hours of the antibiotic eye drops (as it may help clear the symptoms a bit sooner) and the child may return to school.

So I hope that helps clarify things a bit for those of you with younger children who attend childcare.

- Dr. Jeremy