When to keep your child home from day care — and for how long

Dec. 1, 2020

It’s a predicament many parents with kids in child care have found themselves in at one point or another: Your child seems sick … but are they sick enough to warrant keeping them home from day care? Before COVID, the answer was a little more cut and dried. In fact, the American Academy of Pediatrics (AAP) gave the OK for kids to attend day care with a mild cough, cold or runny nose, so long as other symptoms weren’t present and it wasn’t during flu season. In this new world, though, those same rules don’t apply. 

“Right now, the recommendation is to keep your child home from day care and call your pediatrician if they have symptoms of fever, cough, cold or congestion,” says Dr. Sara Siddiqui, a pediatrician and clinical assistant professor in the Department of Pediatrics at NYU Langone’s Hassenfeld Children’s Hospital in New York. “Now more than ever, it is absolutely imperative to not send your child into school or day care if your child is not feeling well or acting sick.”

While different child care centers will have varying sick policies, here’s what the experts recommend keeping in mind when debating when to keep your child home from day care.

When is a child too sick for day care?

While sick policies at day cares have gotten more stringent since the onset of COVID, generally speaking, if your child has a slight runny nose — and no other symptoms — it’s worth checking with their child care center, as it’s likely OK to send them. Beyond that, though, there’s not much wiggle room right now.  

“If your child has a cough, shortness of breath, difficulty breathing or loss of taste or smell, they shouldn’t go to day care until you’ve discussed their symptoms with their healthcare provider,” says Dr. Katie Lockwood, a pediatrician at Children’s Hospital of Philadelphia. “Additionally, if your child has two or more other symptoms, like fever, sore throat, headache, vomiting/diarrhea, runny nose/congestion, fatigue or nausea, they should not go to day care, and you should talk to their doctor.”

Can my child go to day care with a fever?

Even before COVID hit, it was always advised to keep kids home from day care and school if they had a true fever, which is a temperature of 100.4 F or higher. Now, though, parents may want to be a little more cautious than usual. “If a child is feeling well and their fever is lower than 100.4 F, technically, they are able to attend school or day care,” says Dr. Jen Trachtenberg, a board-certified pediatrician in New York City. “However, in addition to each facility having their own rules, it’s best to stay home if you’re sick until COVID is under control.”  

While there’s no universal rule that forbids kids from attending day care if they have a low-grade fever, Siddiqui recommends keeping children home for anything 100 F or above, if possible. She also advises looking for other symptoms that may be present and discussing the situation with your doctor. Additionally, if a child is under 3 months old, a doctor should be called immediately if a fever is 100.4 F, as it may be a sign of a dangerous infection. 

If your child has been seen by their pediatrician, and a COVID test has come out negative, or if another diagnosis has been found to be causing symptoms, kids can return when they’re feeling better and have been fever-free for 24 hours, according to Trachtenberg. 

Can you take child to day care with a cold or cough?

While the AAP previously said it was OK to send kids to child care if they had a mild cold, cough or runny nose (and no other symptoms), now it’s generally recommended kids see their doctor before attending day care, even if they only have common cold symptoms.

“Kids really shouldn’t go to day care with any type of illness without an evaluation by their pediatrician,” notes Trachtenberg. “Obviously, this can be frustrating, as the average child gets about 6-8 colds a year that last a week or more, but COVID in kids may just be a runny nose or mild cough. Keeping kids with these symptoms out of day care will help prevent the spread of the virus, whether it’s COVID or not.” Siddiqui adds that this is especially true in areas where infection rates seem to be rising. 

But when they can return if it’s just a cough or cold? Each day care will have their own protocol, but some may not want kids returning until after a negative COVID test or until they’re symptom-free (particularly if there’s a fever) for 24 hours.  

Can child go to day care after throwing up?

According to Lockwood, if your child is vomiting without other symptoms, it’s unlikely that it’s COVID — however, they should still stay home. “Kids can return to school 24 hours after vomiting, as long as no other symptoms are present and they seem OK,” notes Lockwood. “But, if other symptoms are present, there’s a chance that it could be COVID, so they should be taken in for an evaluation.” 

Fortunately, most pediatricians now have some rapid testing available, according to Siddiqui, which can “help differentiate COVID from other gastrointestinal viral illnesses.”

Can a child go to day care with diarrhea?

The AAP recommends keeping kids with diarrhea home from day care if they’re experiencing any of the following:

  • Diarrhea isn’t contained to the diaper.

  • Two or more stools than normal per 24 hour period.

  • Accidents are occurring. 

  • Blood or mucus is present.

However, if diarrhea is accompanied by other symptoms, such as fever or vomiting, they should stay home, regardless. 

Can a child go to day care with a rash?

When it comes to hives and rashes, especially those accompanied by fever or behavioral changes, the AAP recommends keeping kids home from day care, as many are a result of a virus. Typically, other symptoms, such as fever, cough or diarrhea, will accompany viral rashes, so it’s important to have them evaluated.

A few viruses that will likely cause a rash, sores or lesions:

  • Chickenpox. Kids shouldn’t return to day care until all lesions have crusted over and no new ones have formed for 24 hours. 

  • Hand-foot-and-mouth disease. Kids shouldn’t return to day care until they’re symptom-free for 24 hours. 

  • Rubella. Kids shouldn’t return to day care until 7 days after rash appears. 

  • Measles. Kids shouldn’t return to day care until 4 days after rash appears. 

  • Scarlet fever (a rash that’s caused by the same bacteria that causes strep). Kids shouldn’t return to day care until 24 hours after starting antibiotics. 

Is it COVID?

Ultimately, the only way to know for sure if your child has COVID is to get a test. That said, the following could be symptoms of the virus, according to Siddiqui and Lockwood:

  • Cough.

  • Shortness of breath.

  • Difficulty breathing.

  • Loss of taste or smell. 

  • Fever.

  • Chills.

  • Body aches and pains.

  • Fatigue.

  • Unusual crankiness.

“Loss of taste and smell seem to be symptoms unique to COVID,” says Siddiqui, adding that, even with that being the case, any symptoms should give parents pause right now. “Parents should keep children home if they’re sick and communicate with their primary care doctor about the next course of action,” she explains. 

How long after COVID diagnosis can kids return to school?

If your child does test positive for COVID, they should isolate for 10 days, and all of the primary contacts — defined as within 6 feet for more than 10 minutes, regardless of masks — should quarantine for 14 days, according to the Centers for Disease Control (CDC). “After 10 days, kids can return to school, as long as they’re feeling better and have been fever-free for three days,” says Siddiqui.

General recommendations for returning to day care after illness*

Illness/symptoms

Keep kids home until they:

Fever

Have been fever-free for 24 hours.

Cold or cough

Have been symptom-free, particularly if there’s a fever, for 24 hours.

Vomiting

Have not vomited for 24 hours and are otherwise symptom-free.

Diarrhea

Are not experiencing any of the more extreme symptoms listed above.

Rash or hives

Have been fever-free for 24 hours and are released by their pediatrician, as it depends on rash type.

COVID-19

Have isolated for 10 days, feel better and have been fever-free for three days.

* These guidelines are for general informational purposes only. Always consult a health care provider concerning any medical condition or treatment plan.

In short: When in doubt, it’s best to keep kids home and talk to their doctor about how to proceed. Additionally, familiarize yourself with your child care center’s policy on returning to the facility after illness.

Tips and stories from parents and caregivers who’ve been there.

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