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September 20, 2019

Does your sick child need to stay home? Probably not, according to this pediatrician.

Daily Briefing

    While minor ailments such as pink eye and sore throats seldom need prescription treatment, many day cares unwisely urge all sick kids to stay home and seek medical attention—and this  "amounts to a tax on being a parent," Aaron Carroll, a professor of pediatrics at Indiana University School of Medicine, writes for the New York Times' "The Upshot."

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    Almost every parent with a child in day care or preschool has received a phone call from school explaining that their child has a minor illness and has to be seen by a doctor before they can return, Carroll notes. "Sometimes, they even say your child can't come back until they're on antibiotics."

    But while growing evidence shows children should be given less treatment for minor illnesses such as pink eye, "day care centers usually ignore this evidence—and  parents often pay the price," according to Carroll.

    He cites a study published in 2010 that examined the medical policies of day care centers in Pennsylvania found that 97% of day cares had policies that stated when sick children should stay home. However, "In almost all cases, those making decisions about who was too ill to attend were directors or teachers—neither of whom had medical training," Carroll writes.

    Additionally, more than 90% of the day care centers required antibiotics for pink eye with discharge and more than 50% required antibiotics for diarrhea, according to the study. "Neither requirement makes sense," according to Carroll. While pink eye can be highly contagious, it's often caused by viruses, which are "unaffected by antibiotics," Carroll writes.

    The price of unnecessary care

    Although the "urge to be protective when it comes to children" is "understandable," continuing unnecessary treatment for these minor illnesses comes with a cost, Carroll writes.

    "Parents have to skip work to take their children to the doctor," Carroll writes, adding, "Visits to the doctor aren't free, nor are drugs."

    Further, parents "already pay a lot for day care," Carroll writes. According to a recent "Upshot" article by Claire Cain Miller, child care can cost one-third of a family's income, "and this is a forced expense that often lacks value," according to Carroll.

    And visits to the doctor aren't always "harm-free," Carroll writes. In some cases the children can be exposed to sick children in the waiting room. "Day care centers seem concerned that children could spread disease to other children in their facilities, but not nearly as concerned that they could spread illnesses to other children in a clinic," he writes.  

    When should children stay home?

    The American Academy of Pediatrics recommends that day care centers consider two main criteria when deciding whether sick children should go home, Carroll notes. Carroll paraphrases the criteria, writing that AAP recommends children stay home if they "are so sick that they cannot participate in activities" or "[i]f they need more attention than the staff can provide." In both of these cases, the children should stay home, Carroll writes.

    "Otherwise, it should depend not on whether they are sick, but on how sick," Carroll writes. While a very ill child should say home, children experience illnesses differently, he explains. For instance, a "fever requires staying away only if it causes changes in activity participation or if it's accompanied by other symptoms like a sore throat or rash," Carroll writes.

    Instead of focusing on "after-the-fact measures to prevent the spread of disease," research shows a day care's "best bet is still focusing on hygiene, like proper hand washing, covering your mouth when you cough or sneeze, and not sharing food and drink with others," according to Carroll.

    While many schools and day cares may be too worried about a contagious illness spreading throughout the school to follow the guidelines, "current practices don't seem to be serving anyone well," Carroll writes. Instead, schools and day cares should remember that "we're never going to be able to prevent all transmission of illness," Carroll concludes (Carroll, "The Upshot," New York Times, 9/16).

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