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Too Sick to Attend Day Care? How to TellIt's seven o'clock in the morning and family rush hour begins. The teakettle is whistling, the toaster's popping, and the traffic report is the usual bad news. Enter a whine that will turn your already overbooked day upside down. By reflex you lay hands on your baby's head. "On, no, a fever!" To day care or not to day care, that is the question. Suddenly you realize that it is not so easy to change jobs at the touch of a forehead.How sick is sick enough to miss day care? This decision affects three parties: Does your baby feel too sick to attend day care? Is she contagious to the other children? How convenient is it for you to take a day off from work? Here are some practical guidelines on what germs are the most catchy.Diarrhea IllnessesHere is one set of germs that all doctors agree are very contagious. Frequent, watery, mucousy, and sometimes bloody diarrhea is a sure indication to stay home, both for your baby's sake and to prevent an outbreak in the center. Add vomiting -- parents call this a double ender -- and your baby is certainly too weak and too upset to leave home. As soon as the vomiting is over, the stools are no long explosive and watery, and your baby feels better, she may return to day care. Be prepared for the bowel movements to remain loose and frequent for weeks, as the intestines are notoriously slow to recover. During this convalescent state of diarrhea, your baby is not contagious.Colds and FeversWhile diarrhea illnesses merit quarantine, respiratory and febrile illnesses are a different bag of germs. Most cold germs do not threaten an outbreak in the day-care center as much as diarrhea germs do. In fact, studies in school-age children have shown that excluding children from school does not diminish the spread of colds; admitting kids with colds to school does not increase their spread (the contagious period so variable, and babies are most contagious a day or two before they act sick). When you send your two-year-old to day care with a cold, this is one time to teach her not to share. Show her how to cover her nose and mouth with a tissue when she sneezes or coughs and to turn her head away from others. "Two-year-olds may be able to learn this sanitation gesture but are likely to forget. If your baby has a fever (persistent temperature of at least 101 degrees F/38.3 degrees C) it is prudent to keep her out of day care until you ask your doctor whether she is contagious.Sore ThroatsSore throats, especially those associated with fever and throats' sores (for example, hand, foot, and mouth disease, are very contagious and are a red light for day-care attendance until the fever and the throat sores are gone -- usually around five days.When to Stay Home with a ColdIf your baby's nasal secretions are clear and watery, and your baby is happy and playful, pain free, and has only a low-grad fever (100 degrees F/37.8 degrees C) there is no need to keep your baby home from day care. If the nasal secretions become more think, yellow, and green, especially if accompanied by a fever, an earache, frequent night waking, or a peaked look -- in mother jargon, a sick-looking face -- this is a stay-home-and-call-the-doctor cold. Your baby may have and ear or sinus infection. In reality, a cold can be contagious for two or more weeks, yet is unrealistic to expect to miss work for that long. When to send only a mildly sick baby to day care depends a lot on the ability of the day care to separate potentially contagious children.Before you jump to change your whole day, here's a nasal secretions tip: The goop from the nose is always thicker upon awakening in the morning, since it has had a chance to stagnate during the night. To help assess the situation, squirt a few saline nose drops into each of your baby's stuff nostrils and encourage a gentle nose blow, or remove the secretions with a nasal aspirator. If the remaining secretions are clear and your baby breathes better, you can breathe easier, and it's off to day care.Eye DrainageThe nose is not the only thing that runs when baby gets a cold. Eye drainage is often associated with an underlying cold, especially a sinus infection. These eyes are not contagious, and usually neither is the rest of the baby. This type of goopy eye drainage does, however, merit a doctor visit.Some runny eyes are due to conjunctivitis (often called pinkeye), a contagious infection that will send day-care providers rushing to make a come-get-your-baby call. If the eyes are bloodshot in addition to draining, this is contagious pinkeye, which is quickly treated and made noncontagious by an antibiotic eye ointment or drops. The baby may attend day care as long as treatment has begun. If the eyes are not bloodshot, this is seldom contagious conjunctivitis, and your child may still attend day care.Colds versus AllergiesDay-care centers often reject a coughing, sneezing child because of a cold when it's really an allergy that is not contagious to playmates and is no more than a nuisance to the child. How to tell a cold from an allergy? Back to the telltale nasal secretions. Allergic noses run and drip, are clear and watery, and are accompanied by other allergic signs: watery eyes, sneezing, wheezing, a past history of allergies, and the fact that it's hay fever season The nasal drainage from a cold is too think to run, It dangles. Also, with a cold there are other signs of infection, such as fever. In general, allergic children are noisy (sneezy and wheezy), but don't act sick. They may attend day care and are not contagious. Children with colds act sluggish, mopey, or cranky and may be contagious.CoughsMost colds end but the coughs of some linger, keeping babies out of day care and parents out of work. But all coughs are not automatically stay-home illnesses. A dry, hacking cough that neither awakens the baby nor is associated with fever, pain, difficult breathing, or other colds signs is not a reason for quarantine. These nuisance-type coughs linger on for weeks, are rarely contagious, and seldom bother the child or her mates, who themselves may also be coughing. Then there's the baby who coughs a lot at night but seems well during the day except for annoying throat-clearing sounds and may have several similar episodes during allergy season. This child suffers from postnasal drip, she is noncontagious, and this seldom is a reason to stay home from day care.Of course, any cough accompanied by fever, chills, and coughing up of green or yellow mucus warrants medical attention and absence from day care. Your baby can return to day care then the fever subsides and she feels better (usually in a few days), though the cough itself may linger for a week or two.RashesThe problem with rashes is that the day-care provider sees them and sends your baby home. But not all rashes are contagious or uncomfortable enough for a baby to miss day care.Impetigo.A bacterial infection in the skin, impetigo begins as tiny red spots resembling picked-at pimples that enlarge to coin-sized blisters which rupture and produce an oozy, stick, honey-colored crust. These circular spots may be as small as a pimple or as large as a quarter. They tend to occur in patches where babies scratch, such as beneath the nose and on the diaper area, but may occur anywhere on the skin. Scratching spreads these eruptions. You can cover the infected areas with the prescribed antibiotic ointment and a square bandage and send your baby back to day care. More severe cases may require oral antibiotics and a longer stay-at-home break.Ringworm.A circular rash with red, raised borders, ringworm is caused by a fungus and is even less contagious than impetigo. Cover the area with an over-the-counter antifungal cream (ore a prescription cream if necessary) and pack your baby off to day care.Chicken pox.Unlike he rashes just mentioned, chicken pox is one of the most contagious of all childhood infections and a sure prescription to stay home. It begins as a flu-like illness (low-grade fever and tiredness), and the spots usually appear a day later. Initially, they resemble tiny bites over the back, chest, abdomen, and face. Frequently parents take their child to the doctor wondering if "these spots" could be early chicken pox. The doctor pronounces them as prickly heat or flea bites and dispatch the spotted baby to day care.If you're uncertain about your baby's spots, circle a few with a felt-tipped pen; in a day they'll change from pimples to blisters if they're chicken pox, and new crops will appear. After several days, the early spots will crust. Baby can return to day care once all the spots are scabbed over, about a week after they first appear.Head LiceWhere there are lots of children in a crowded place, expect little parasites to tag along. A typical scene: You get a call at your office or your baby is sent home from day care with a note informing you that she has head lice. Your first reaction is embarrassment ("But my house is so clean!") followed by incredulity ("She has to miss day care and I have to miss work because of a lousy louse?)What's wrong with this picture? First, head lice are no reflection of your housekeeping. They live in warm, crowded environments like classrooms and day care, where they can easily pass from head to head as babies snuggle together. Lice don't carry disease and are more of a nuisance than a medical problem. They reside deep in the hair, most commonly around the nape of the neck and around the ears. In return for a warm, fuzzy place to live, they often don't bother the host, except for an irritating itch and unnecessary quarantine by the day-care provider.Lice themselves are difficult to see (they're tiny, light brown, and may sometimes be seen with a magnifying glass), but you may find the whitish nits (egg sacs) attached to the base of individual hairs. You can distinguish nits from dandruff because nits are round and adhere to the hair shaft, unlike the flat flakes of dandruff that slide off easily.If you see nits, you don't have to immediately share your discovery with your doctor. An over-the-counter lice shampoo (following directions on package) and a specially designed nit-removal comb will suffice for an evening at-home treatment. Your baby may return to day care the next morning, but be prepared for the day-care provider to scan every hair looking for nits -- hence the term "nit picker" -- and to call for pickup if even one egg is found.Who Plays Nurse When Baby Is Sick?For dual-income families, who stays home when baby can't go to day care, mom or dad? Who can most afford to stay home? Who is most needed at work? Do you and your spouse split the shift or bring in the reserves? (Sick babies should have their mothers if at all possible -- mother preference intensifies when baby is sick.)While there is no better nurse than a caring parent in a child's own home, this ideal may not be possible, especially for financially strapped and single parents. Consider these alternatives.Try shift work. Mom is nurse in the morning, dad in the afternoon. Your child gets special TLC from both parents and both sharpen their sick-child-care skills.Take your baby to work. If you baby is not sick enough to stay home but is not permitted in day care, prepare a "sickroom" at work, if circumstances permit. If you have your own office, set up camp in the corner, including her favorite books, toys, and blankets. This scene is also a prime chance for your child to learn about your work. If the older patient is willing and able, give her some time-occupying task to "help" you at work. Your child will feel important and get her mind off being sick.Have grandmother on call. If blessed with a nearby extended family, ask grandma to pinch-hit. Grandmothers have time, unlimited patience, and the price is right.Use a sick-child-care center. Explore what facilities for sick children are available in your community. Some day-care centers and hospital pediatric wards have get-well rooms, staffed with sensitive caregivers trained to care for sick children. However, they are expensive.Plan ahead. Before your baby gets sick -- and she will -- devise a family game plan rather than scrambling for on-the-spot decisions with the first fever. Decide with your spouse who will stay home. Have backup caregivers on call. Find out your day-care center's sick-child admission policies. Are there home-care agencies available, and what is their cost? Find out what's available, affordable, and above all what's best for your child.Sick-leave benefits.Taking a baby out of day care may mean paycheck deductions for working parents, but a day at home with your sick child can have its compensations. Being at home with your sick baby is a chance to rebond. Especially if you have recently locked horns with your child or she is going through an independence streak, a day at home may do wonders for your relationship. Babies go from independent to dependent when sick, as if clicking into a memory of what "mother" and "father" really mean. Making chicken soup and popsicles, giving back rubs and reading stories -- a day at home with your baby is a chance for your nursing, and parenting, skills to shine.There will be more articles on infants, breast or bottle feeding and other related topics to follow. So please keep an eye out for more of my articles. Article Tags: Stay Home, Nasal Secretions, Home From, Day-care Provider