It's long been a truism that children's daycare can be a petri dish, full of bugs just waiting to pounce. Now, a body representing Canadian pediatricians is for the first time addressing just how parents, staff and doctors can do more to prevent the spread of infection in licensed care.
"We have to figure out when it's safe for children to be in a child-care facility, when should they be at home and when should they be seeing a physician," says Mia Lang, lead author of a new Canadian Paediatric Society position statement about the prevention of injury and infections in daycare.
One factor contributing to infectious children attending daycare, highlighted in a separate Ontario survey of child-care workers, is that parents can be under pressure not to miss work to stay home with a child. In the survey, 64 per cent of child-care workers say they have felt pressure from parents to care for a sick kid.
The new CPS statement suggests updates to a number of regulations that are in place in licensed daycares.
Among the recommendations:
All child-care centres should have a written policy (in accordance with provincial or territorial health policies) on the management of a sick child, which is reviewed by all staff.
The policy should contain information on recognizing an emergent illness or injury, and on when to call for an ambulance, the proper use of antibiotics and the characteristics of common pediatric infections.
Child-care centres should document the reason why a child is excluded from care.
Children with strep throat or pink eye should have 24 hours of antibiotic therapy before returning to child care.
Children with diarrhea should be excluded if their stool cannot be contained in a diaper, cannot be controlled by a toilet-trained child, or there are signs of fever or blood or mucus in the stool.
Dr. Lang, a pediatrician at the Royal Alexandra Hospital in Edmonton, says the risk of respiratory illnesses is one of her biggest concerns. As daycare use increases in Canada, research suggests that for every nine hours a child is in daycare a week, there is a 12 per cent increase in respiratory illness days.
"It's not unexpected for children who are in a child-care facility to get a cold or upper respiratory tract infection at least once a month," she says, adding that symptoms can last two or three weeks.
If a child has energy, is eating and drinking well and does not have a fever, it's fine for him to be in daycare. But if he's coughing, that infection can spread, Dr. Lang says.
Staff and parents sometimes misinterpret the guidelines and rules in place at daycares.
For instance, a common child-care policy allows a child to come back to daycare after 24 hours on antibiotics, but these policies are recommended for such illnesses as pink eye and strep throat, not for colds or respiratory infections.
The Ontario survey of child-care workers found that 69 per cent said they had accepted a child with an upper respiratory tract infection back into care because they were taking antibiotics - without clarifying the nature of the child's illness.
"That's unfortunate because an antibiotic may not have been the right medication choice," Dr. Lang says.
First, the cause of colds and some respiratory infections are viruses, not bacteria.
In these cases, not only will an antibiotic not make a child well, it will do nothing to stop the spread of infection. Second, the overuse of antibiotics may contribute to antibiotic resistance and side effects such as diarrhea.
The CPS statement also encourages government and businesses to develop more sick-care centres, or even "sick rooms" in current centres, staffed by health-care workers, both to keep sick kids away from others and to reduce worker absenteeism.
Sandra Cuming founded a private Toronto service that provides sick care inside the home. Without any backup such as hers, parents may resort to filling kids up with Tylenol and Gravol to mask symptoms and pack them off to daycare, she says.
"And then they don't answer their phone," she says. "They're that panicked. They're between a rock and a hard place."
Last Friday, Hamilton mom Tobi Bruce stayed home with her four-year-old son, who had diarrhea. Although he seemed on the mend, she decided to obey the centre's rule disallowing children with a bout of diarrhea in the last 24 hours.
"Your first instinct is to say, 'They'll never know he was sick,' " she says.
But yesterday, she sent her one-year-old to his new daycare with a cold because he had no fever or diarrhea. If his cold gets worse, she or her partner will stay home with him.
"Even though your instinct is to try to get them in for the day, you wouldn't want another parent to do that," she says.