Originally Posted by Play Care:
I replied to both the article and her facebook - just couldn't help myself:o:lol:

Me too! I'm watching the FB page and would love to see her eat her words lol

Originally Posted by craftymissbeth:
See, but what she's not understanding is we aren't normally qualified health professionals therefore we cannot determine when an illness is "minimal". And oftentimes those "minimal" illnesses wipe out our whole daycare, family, and US.

exactly, I am not a doctor, I could play the guessing game all day long of it could be this it could be that and more than likely I could be wrong.

Originally Posted by daycare:
exactly, I am not a doctor, I could play the guessing game all day long of it could be this it could be that and more than likely I could be wrong.

Sorry, daycare, I just reread what I wrote and it sounds like I'm disagreeing with you, but I'm not. :) I totally agree!

lol I knew what you meant and I hope you know I agree...

This Dr is making our day is she not!!! She got my husbands panties in a bunch. He on the other hand does have a PHD in medicine and he said it is always easy to see things from "YOUR" prospective. And for this doctor to complain that people are coming in for these reasons is just something to complain about. Money is money, mildly ill, severely ill, it's all the same money that goes into the doctors pocket.

He laughed at that article and said those are the doctors that keep our DCs full of sick children and allowing illnesses to pass because they only see if from "THEIR" prospective

Originally Posted by Angelsj:
There ARE providers out there excluding for every little thing, and I feel these are the people to whom he is speaking, not those of us who use common sense. As someone said, most of us are asking those same questions.

I guess my point is that there is usually a good and legitimate reason these providers are being so strict. These are the providers who have been burned, whose clients think they don't have to follow policy, etc.
I think for the doctor to write that type of article with out getting to the "why" of the policies is irresponsible.

lesson learned
 

I learned my lesson I don't trust doctors any more. A doctor told one of my daycare mom's on a Sunday his deep barking cough was due to allergies. Everyone had this virus by Friday and was on antibiotics and steroids. The fallowing week I have it and had to take antibiotics and this week a steroid I'm done with sick kids. Doctor's notes won't do it for me anymore. Doctors are not always right.

Don't let them tell you that the kids with a virus are only contagious when they have a fever this is not true! Some kids don't get fevers. You can be contagious without a fever!

Originally Posted by Blackcat31:
Quoted from the article:

"If we really want to support working families, then we are going to have to tackle this problem. We need to find a way to change the culture of daycare and understand that minor illnesses are part of life -- and very much part of early childhood.

We need to find a new middle ground, one that takes care of not just children, but families."

If you really want to find a middle ground, how about we start educating parents on what THEIR responsibilities are and what the PROVIDERS responsibilities are.

Parents need to start stepping up and start paying their providers what they are really worth and stop bitching left and right about the high cost of children THEY choose to have.

If you really want to support working families then maybe working families need a MAJOR lesson in priorities so they understand that their child is only a child for a short while and putting that paycheck before their child's needs is an embarrassment to our entire society.

The culture of daycare doesn't need to change.

PARENTS do!

Parents need to come to understand that if they didn't try to pull a fast one on their provider, or didn't keep their kids up until midnight, feed them crappy foods and park them in front of their DVD players, i-pads and video games, and stay the he77 home once in a while instead of racking up more miles than Dale Earnhardt Jr on a Sunday afternoon, then maybe JUST maybe.... these kids wouldn't be sick as often as they are.

I am so sick and tired of daycare being the problem but NEVER the solution when WE (DC providers) do THE most for a child. Children that aren't even ours.

Yet, we're the bad guy that needs a lesson in early childhood illness...

Seriously?! :rolleyes: :rolleyes:

Just keep telling yourself that Dr McCarthy. Because while you bring home the big dollars and point your finger at us...WE are the ones raising YOUR child. ;)

likethislikethis 100%

Originally Posted by Unregistered:
.

Don't let them tell you that the kids with a virus are only contagious when they have a fever

Interesting. When a parent told me the doctor said this (not contagious because only a low grade fever) I actually thought she made it up, or misinterpreted. It's clearly not true, in my experience.

Originally Posted by SunshineMama:
I also love the "we don't have any more sick/personal/vacation days to use so pookie HAS to go to daycare." I got this after a parent used all their vacation days by May, going on vacations. Pookie ended up getting termed.

You know......when I was a daycare parent, my DCP took two weeks off in a row, every summer. One week for vacation and one week for home maintenance. Our families lived far away, so my DH would take one week off, and I would take the other week. For years, that was our yearly vacation time. We did what we had to do. We knew that it was temporary, and we sacrificed accordingly.

When DH and I would get sick, we would try to go to work or work from home, anyway. We saved all of our sick days for DD. We would even split up the morning and afternoon, if DD required multiple sick days at a time.

I completely understand and sympathize with the frustration of sick days, but for the last five years, the majority of DCP that I provide care for, use their sick days for themselves, while their child and I will be trudging along, with the exact same cold. They take several vacations and long weekends a year, and use their personal days for "me" time. I'm just saying, don't bitch to me that you have to come and get YOUR sick child, when you took a half day, last week, to be home to receive a package...

Originally Posted by CraftyMom:
Wait, I want to add...We are not doctors. We can not accurately say for certain what is or is not something to worry about. We can not look at a rash and say "oh no big deal".

These kids are in OUR HOMES with illness! How about we send all of our "not really sick kids" to the Dr's home to hang out all day, wiping their noses on his furniture and spreading their germs everywhere?! Maybe he'll think differently about it then.

I guarantee if the majority of providers did this, we would be the ones getting blamed for the spread of illness (more than we already are) instead of being praised for keeping the kids out of the doctors office and keeping the parents in work like the article suggests.

likethis.............

Another funny story...... Years ago, with my first pediatric doctor, before she had discovered I ran a child care. My children were sick with cocksackie virus, which they had gotten from a dirty bubbler in a gym. The first question the good doctor asked, "Do they attend child care? Child care's tend to spread a lot of germs." Well....you can imagine the look on her face when I told her that I ran a child care, needless to say she was not our pediatric doctor long after that. Lol!

This was the same doctor's office, that regardless of what I brought my children in for, would end up sick with something new, 1-3 days after our visit.

Some doctor's are just quacks! :lol:.........

I see part of the doctors point seeing a Dr. and taking up their time for a note is stupid. But sending a child to childcare because it is just something viral is stupid also.

If it was the doctors newborn at childcare when the others had pink eye vomiting 1x a day and diarreah that Dr. would terminate care and report the provider.

Originally Posted by itlw8:
If it was the doctors newborn at childcare when the others had pink eye vomiting 1x a day and diarreah that Dr. would terminate care and report the provider.

Or have a 'nanny' instead.

Maybe a slightly different perspective...
As daycare providers for a lot of kids you spend more time with the kids than their actual parents have done. In the US its not uncommon for kids to start daycare at 6 weeks. They spent the majority of their waking hours with you providers until they turn 5 and go to school. Your are their norm, their comfort, their home in many ways, kids come back to care after the weekend wild and exhausted because that norm was disrupted by biological strangers in a lot of cases.



TLEMother (can't log in from work)

Originally Posted by Unregistered:
Maybe a slightly different perspective...
As daycare providers for a lot of kids you spend more time with the kids than their actual parents have done. In the US its not uncommon for kids to start daycare at 6 weeks. They spent the majority of their waking hours with you providers until they turn 5 and go to school. Your are their norm, their comfort, their home in many ways, kids come back to care after the weekend wild and exhausted because that norm was disrupted by biological strangers in a lot of cases.



TLEMother (can't log in from work)

This is true, but sadly I don't have the time or arms to comfort a sick child and take care of all of the other children's needs.

Dr. Claire McCarthy,

My name is Tori Fees. I’m a Registered Nurse and veteran child care provider. I have cared for kids in the capacity of private nanny, elementary school nurse, and home child care provider for thirty years.

I came upon your article “Why Sick Kids Should Be Allowed at Daycare” published by Huffpost. As a veteran and expert child care provider, I feel it is important to address your publication as it speaks to many of the common misconceptions Physicians have regarding admittance into child care after the child has been excluded by a school, child care center, or home child care. My hope is that you will reconsider some of your viewpoints when you hear some of the concerns from the ladies on the ground who are caring for multi-level aged group children in these settings.

Each licensed and registered child care providers have illness policies. Every state in the U.S. requires that guidelines are set to differentiate an excludable illness and a “mild” or “minor” illness. Independently owned child care providers have the blessing and burden of developing their own policies that must at least meet the minimum standards set forth by their respective state. I’m certain you have come across variations in the policies of the privately owned child care services.

When a parent brings a child into your office, you may not be aware of what the child care policies are. Fortunately for you, you don’t have to know the specifics as your job is to simply diagnose the child and provide treatment should it be deemed necessary. The parent may ask you to provide a “return to daycare” note but you are not required to do so.

Your article laments on the frustration you feel when parents access expensive treatment such as emergency rooms and urgent care clinics for minor illnesses solely for the purpose of obtaining a return to daycare note. I agree wholeheartedly that these very expensive medical services should not be utilized for this purpose if the child is experiencing a mild illness. Remember that the parent is the one choosing to access this level of care. You would be hard pressed to find a child care provider who would encourage a parent to go to this extreme. It is likely the cost of the services in these expensive care centers far exceeds the salary loss the parent will endure while missing a few days of work. If the parent is given free or near free access to these services and chooses to utilize them for minor illness, there should be a swift and immediate financial recourse to recoup the unnecessary expense. As long as it is free or near free this practice will continue. I encourage you to use your position to campaign for financial accountability when these services are being misused.

When a parent accesses medical care for the purpose of obtaining a “return to child care” note the first question you need to ask is if the child care asked for one. It used to be standard practice to ask your opinion but that is no longer the case. Providers across the country have had SO many bad experiences with these notes that they have changed their requests to ONLY a diagnosis, determination of whether or not the child is communicable, and documentation of any treatment you may prescribe. There is also a high likelihood that the parent wasn’t asked to take the child to the doctor. The child may have been excluded based on symptoms observed by the provider and was simply excluded until the symptoms are no longer present within a certain time frame. There’s a good chance that a recommendation to seek medical care for the symptoms wasn’t requested.

Often, a parent who has received an exclusion comes to you because they want you in the middle of the “no” they have just received. They misunderstand our relationship because they believe your determination would somehow trump ours. It doesn’t.

Child care providers don’t work with or under your license. We can’t rely upon your determination for return to daycare because you don’t know our population. You can’t possibly know what children are in attendance in our care. You don’t know if we have newborns, children with compromised immune systems, special needs children, new children to the child care, or children who have been out on vacation. You don’t know whether or not the children in attendance have even met your patient. You don’t know if the children have been exposed before diagnosis and whether or not the illness could have devastating affects on one when the effect on your patient is minor. You don’t know if repeated exposure will increase the likelihood of infection.

We can’t rely upon your determination for return to daycare because we aren’t a part of the history you take on the child before the exam. We don’t know if the parent has been truthful to you when giving an oral account of the child’s condition. We don’t know if the child’s fever has been masked with antipyretics before coming into your office. We don’t know if the parent has minimized the account of the excludable symptoms by words such as “spit up” instead of “vomit”, “loose poop” instead of blowout diarrhea. We don’t know if the parent is attributing the symptoms to something he ate, undiagnosed allergies, or the infamous “teething” used in nearly every parental diagnosis.

The other parents of the children attending child care with a sick kid aren’t going to be bummed out when they find out your patient is attending with a fever. They are going to find another daycare. Parents are very concerned about the health of the other children BEFORE their child becomes ill. Once their child becomes ill the concern for the health of the other children wanes dramatically. That lack of concern often drives them to your office to ask for you to intercede and remediate the decision of the provider. There are some exceptional parents who have consistent concern regardless of what child is ill but they are becoming extremely difficult to find.

You are correct that children in child care have more viral illnesses than children who don’t attend child care. Have you ever considered that the reason for this is that the parents of the children attending day care are bringing their kid in for your return notes when parents of kids who are not in child care don’t access medical care for the same symptoms? If you stop offering return notes you may find the statistics change dramatically.

If you truly believe the illnesses are minor and the child should not be excluded maybe you should consider offering the child to hang out in your office the next day. Put him squarely in the middle of the waiting room lounge where the “well child” visit kids are. When the well child’s visit is over let their mothers know that the kids sharing their space were excluded from daycare because of “minor” illnesses like one vomit, a little fever, a diarrhea bout that’s on the tail end, and a slight case of pink eye. The mothers will be bummed and they will find a new doctor.

If you really want to make a difference and are willing to become involved in this vicious cycle of exclusion the best thing you could do would be to counsel parents on the average number of illnesses young children get per year. Explain to them that they are going to have to miss work because their kid is most likely going to get sick often. Encourage them to use their precious paid time off wisely. Tell them to not be tempted to squander their paid time off with “me” days. Tell them to suck it up and go to work when they are mildly ill so they have the time available to care for their baby when he is mildly ill. Tell them it is better for them to go to work amongst other adults with their mild illness than to send their mildly ill kid to daycare with other babies.

If you want to make a difference, put in writing that you will assume all liability if another child in the child care contracts the illness. Put in writing that you will cover the cost of the missed days of work the provider will have if she contracts the illness. Put in writing that the child care providers children can be cared for by you free of charge while you are at it.

Fever is the number one indicator of health and it is masked with a nickel worth of medicine. If you want to make a difference, test for the presence of antipyretics in the child’s system. Do not take the parents word for it. Let your client know that you will ask and you will check. Google “dope and drop” and get a real education of how providers are deceived by parents to buy time through nap time or a day of daycare. Realize that not only are we the unwilling victim of deception but you are too. It happens a lot. If you start testing for it you will write far fewer return notes in your future.

The things that would really make a difference you won’t do. It’s easy to write a return note. It’s easy to please your customer. It makes you money. It’s hard to tell a parent you can’t recommend return either way because you don’t have the information you need to make a decision and you don’t want the liability. Encourage them to find a provider with illness policies they agree with rather than use you to intercede when the illness exclusions they agreed to before enrollment are enforced.

Better yet, stay out of the return to daycare notes business. It’s not your job to make sure a parent keeps their job. Just offer a diagnosis, whether you deem the illness as contagious, and the treatment you are giving the child. That’s all we need.

If a child care provider or school asks you to give a determination then by all means, accommodate them. Make sure you are actually being asked before you offer it. Most child care providers can determine the return time on their own. Their policies are in place for a reason. With your diagnosis and declaration of contagiousness, we can make our own decisions on a case by case basis. If you have any questions feel free to call the provider. Maybe a few conversations with the ladies on the front lines will change your prospective a bit. I hope mine has.

Sincerely,

Tori Fees R.N., B.S.N.

I've said before.....I'll say it again......
Nannyde, LOVE YOUR LOGIC!!!!! happyface.......

I didn't get to read all the post but here is the funny thing:

I exclude for the things my state says to exclude for!!!

Green runny nose
Diarehha
Fever over 100 degrees
Vomiting
Not able to participate with children
Any communicable dieses

How is this my fault?:confused: I'm following state guidelines!

Blame the state not me:D

Originally Posted by debbiedoeszip:
<<<Besides, if your daycare would take care of your child if she gets sick, then at least you won't have to worry about missing work.>>>

The line above (from the article) really takes the cake. I'm running a daycare, not an infirmary. I'm not a nurse, and I'm not the parent. I also don't want to be trying to figure out how to rush a kid to the hospital, a kid who is having a febrile seizure (because his "low fever" suddenly spiked), with four other kids in tow. Not my flippin' job, thank you very much.

likethis This for sure!!!!!

Originally Posted by nannyde:
If you truly believe the illnesses are minor and the child should not be excluded maybe you should consider offering the child to hang out in your office the next day. Put him squarely in the middle of the waiting room lounge where the “well child” visit kids are. When the well child’s visit is over let their mothers know that the kids sharing their space were excluded from daycare because of “minor” illnesses like one vomit, a little fever, a diarrhea bout that’s on the tail end, and a slight case of pink eye. The mothers will be bummed and they will find a new doctor.

:lol::lol::lol::lol::lol::lol::lol::lol::lol::lol::lol::lol::lol::lol:

Originally Posted by saved4always:
likethis This for sure!!!!!

count me in on that one.... I always tell parents..

you want your child with you when they are sick because the only thing that I can do is something serious was to happen was to call 911.

Originally Posted by MV:
So pretty much what the Dr. says is "Daycares are requiring Dr notes when they are barely sick and that's dumb" (im paraphrasing here) and then goes on to say that "only kids that have high fevers, feel so bad that they can't function and need more care than the provider can offer should stay home" .... um, that's what we're doing. :confused:

Loved your FB post! I'm hoping she responds :)

Originally Posted by NeedaVaca:
Loved your FB post! I'm hoping she responds :)

Yeah, I hope so too ... but I doubt it.

Nan ...

http://i679.photobucket.com/albums/v...ppy_yippee.gif

I posted too. Couldn't help myself.

Why Sick Kids Should “NOT” Be Allowed at DaycareDaycare.com Presents
https://www.daycare.com/nannyde/why-...at-daycare.htm

I added a few things to the original letter. Now to figure out how to post to her blog. I can't see where to comment

I only read through the first 8-10 responses, but I have to say I kind of agree with this doctor.

This:

"Already I get lots of parents complaining about how daycare makes their kids sick -- and it's absolutely true that kids in daycare are more likely to get viral illnesses than those who aren't.

But... that's not all bad. There's plenty of research these days to suggest that getting a few illnesses as a young child ends up being good for you in the long run. It helps to strengthen the immune system. And since very often we are contagious before we even realize we are sick, kids (and staff) are getting exposed anyway."

says it all.

I grew up with my mom doing DC before I was even born. She and Dad, as well as us kids, were exposed to all kinds of c.r.a.p. While I concede the fact that maybe good genes are part of the reason, I still say that it's BECAUSE of being exposed to all the c.r.a.p. that NONE of us are ones to get sick more than once every 10 years. I've done DC 20 years, and have called off twice - about 15 years apart. And only for one day each.

And I completely agree with this as well:

"Nobody is saying that kids should go to daycare if they are really sick. They shouldn't go if they have a high fever, if they are having frequent vomiting or diarrhea, if their cough is so bad it limits activity, if they are miserable in any way. But lots of daycares exclude kids for things like the slightest fever, any diarrhea, one episode of vomiting, the mildest pinkeye or any rash besides a diaper rash."

They need to be kept home if they're currently puking or have things like a high fever that make them lethargic. It's more work for US if these things happen, so of course they should stay home where THEY are most comfortable and comforTED by Mom.

"1. Does the child's illness keep him or her from comfortably taking part in activities?
2. Does the sick child need more care than the staff can give without affecting the health and safety of other children?"

^^^ Exactly!

I realize we're all different in our methods. Yours is great if you have strict sickness policies! But merely speaking for myself, I feel like kids are exposed to it before symptoms occur, so it's pretty much a moot point. AND I feel that kids NEED to have exposure to at least some germs.

I feel like as a society, we over-wash our hands too. So there!!! I know I'm the odd man out. Whatever.....

Originally Posted by Angelsj:
I deal with a lot of childhood illnesses and don't exclude for many things for which other providers will exclude. In return, if I call a parent and say "take this child to the doctor" they do exactly that.

I also have gotten respectful parents who know when to stay home and care for their child, or will call and say, "This is going on...what you like me to do?"
I don't think that physician is "ridiculous" but I do think parents, doctors and providers need to work together to find a balance.

There ARE providers out there excluding for every little thing, and I feel these are the people to whom he is speaking, not those of us who use common sense. As someone said, most of us are asking those same questions.

YES!!! You said it well. I ditto all of what you said!

Originally Posted by nannyde:
Why Sick Kids Should “NOT” Be Allowed at DaycareDaycare.com Presents
https://www.daycare.com/nannyde/why-...at-daycare.htm

I added a few things to the original letter. Now to figure out how to post to her blog. I can't see where to comment

Loved this! Seriously good likethis

You may just have to post a link in comments because I don't see a way to post either? Maybe Daycare.com can put your letter up on their facebook page:)

Originally Posted by nannyde:
Dr. Claire McCarthy,

My name is Tori Fees. I’m a Registered Nurse and veteran child care provider. I have cared for kids in the capacity of private nanny, elementary school nurse, and home child care provider for thirty years.

I came upon your article “Why Sick Kids Should Be Allowed at Daycare” published by Huffpost. As a veteran and expert child care provider, I feel it is important to address your publication as it speaks to many of the common misconceptions Physicians have regarding admittance into child care after the child has been excluded by a school, child care center, or home child care. My hope is that you will reconsider some of your viewpoints when you hear some of the concerns from the ladies on the ground who are caring for multi-level aged group children in these settings.

Each licensed and registered child care providers have illness policies. Every state in the U.S. requires that guidelines are set to differentiate an excludable illness and a “mild” or “minor” illness. Independently owned child care providers have the blessing and burden of developing their own policies that must at least meet the minimum standards set forth by their respective state. I’m certain you have come across variations in the policies of the privately owned child care services.

When a parent brings a child into your office, you may not be aware of what the child care policies are. Fortunately for you, you don’t have to know the specifics as your job is to simply diagnose the child and provide treatment should it be deemed necessary. The parent may ask you to provide a “return to daycare” note but you are not required to do so.

Your article laments on the frustration you feel when parents access expensive treatment such as emergency rooms and urgent care clinics for minor illnesses solely for the purpose of obtaining a return to daycare note. I agree wholeheartedly that these very expensive medical services should not be utilized for this purpose if the child is experiencing a mild illness. Remember that the parent is the one choosing to access this level of care. You would be hard pressed to find a child care provider who would encourage a parent to go to this extreme. It is likely the cost of the services in these expensive care centers far exceeds the salary loss the parent will endure while missing a few days of work. If the parent is given free or near free access to these services and chooses to utilize them for minor illness, there should be a swift and immediate financial recourse to recoup the unnecessary expense. As long as it is free or near free this practice will continue. I encourage you to use your position to campaign for financial accountability when these services are being misused.

When a parent accesses medical care for the purpose of obtaining a “return to child care” note the first question you need to ask is if the child care asked for one. It used to be standard practice to ask your opinion but that is no longer the case. Providers across the country have had SO many bad experiences with these notes that they have changed their requests to ONLY a diagnosis, determination of whether or not the child is communicable, and documentation of any treatment you may prescribe. There is also a high likelihood that the parent wasn’t asked to take the child to the doctor. The child may have been excluded based on symptoms observed by the provider and was simply excluded until the symptoms are no longer present within a certain time frame. There’s a good chance that a recommendation to seek medical care for the symptoms wasn’t requested.

Often, a parent who has received an exclusion comes to you because they want you in the middle of the “no” they have just received. They misunderstand our relationship because they believe your determination would somehow trump ours. It doesn’t.

Child care providers don’t work with or under your license. We can’t rely upon your determination for return to daycare because you don’t know our population. You can’t possibly know what children are in attendance in our care. You don’t know if we have newborns, children with compromised immune systems, special needs children, new children to the child care, or children who have been out on vacation. You don’t know whether or not the children in attendance have even met your patient. You don’t know if the children have been exposed before diagnosis and whether or not the illness could have devastating affects on one when the effect on your patient is minor. You don’t know if repeated exposure will increase the likelihood of infection.

We can’t rely upon your determination for return to daycare because we aren’t a part of the history you take on the child before the exam. We don’t know if the parent has been truthful to you when giving an oral account of the child’s condition. We don’t know if the child’s fever has been masked with antipyretics before coming into your office. We don’t know if the parent has minimized the account of the excludable symptoms by words such as “spit up” instead of “vomit”, “loose poop” instead of blowout diarrhea. We don’t know if the parent is attributing the symptoms to something he ate, undiagnosed allergies, or the infamous “teething” used in nearly every parental diagnosis.

The other parents of the children attending child care with a sick kid aren’t going to be bummed out when they find out your patient is attending with a fever. They are going to find another daycare. Parents are very concerned about the health of the other children BEFORE their child becomes ill. Once their child becomes ill the concern for the health of the other children wanes dramatically. That lack of concern often drives them to your office to ask for you to intercede and remediate the decision of the provider. There are some exceptional parents who have consistent concern regardless of what child is ill but they are becoming extremely difficult to find.

You are correct that children in child care have more viral illnesses than children who don’t attend child care. Have you ever considered that the reason for this is that the parents of the children attending day care are bringing their kid in for your return notes when parents of kids who are not in child care don’t access medical care for the same symptoms? If you stop offering return notes you may find the statistics change dramatically.

If you truly believe the illnesses are minor and the child should not be excluded maybe you should consider offering the child to hang out in your office the next day. Put him squarely in the middle of the waiting room lounge where the “well child” visit kids are. When the well child’s visit is over let their mothers know that the kids sharing their space were excluded from daycare because of “minor” illnesses like one vomit, a little fever, a diarrhea bout that’s on the tail end, and a slight case of pink eye. The mothers will be bummed and they will find a new doctor.

If you really want to make a difference and are willing to become involved in this vicious cycle of exclusion the best thing you could do would be to counsel parents on the average number of illnesses young children get per year. Explain to them that they are going to have to miss work because their kid is most likely going to get sick often. Encourage them to use their precious paid time off wisely. Tell them to not be tempted to squander their paid time off with “me” days. Tell them to suck it up and go to work when they are mildly ill so they have the time available to care for their baby when he is mildly ill. Tell them it is better for them to go to work amongst other adults with their mild illness than to send their mildly ill kid to daycare with other babies.

If you want to make a difference, put in writing that you will assume all liability if another child in the child care contracts the illness. Put in writing that you will cover the cost of the missed days of work the provider will have if she contracts the illness. Put in writing that the child care providers children can be cared for by you free of charge while you are at it.

Fever is the number one indicator of health and it is masked with a nickel worth of medicine. If you want to make a difference, test for the presence of antipyretics in the child’s system. Do not take the parents word for it. Let your client know that you will ask and you will check. Google “dope and drop” and get a real education of how providers are deceived by parents to buy time through nap time or a day of daycare. Realize that not only are we the unwilling victim of deception but you are too. It happens a lot. If you start testing for it you will write far fewer return notes in your future.

The things that would really make a difference you won’t do. It’s easy to write a return note. It’s easy to please your customer. It makes you money. It’s hard to tell a parent you can’t recommend return either way because you don’t have the information you need to make a decision and you don’t want the liability. Encourage them to find a provider with illness policies they agree with rather than use you to intercede when the illness exclusions they agreed to before enrollment are enforced.

Better yet, stay out of the return to daycare notes business. It’s not your job to make sure a parent keeps their job. Just offer a diagnosis, whether you deem the illness as contagious, and the treatment you are giving the child. That’s all we need.

If a child care provider or school asks you to give a determination then by all means, accommodate them. Make sure you are actually being asked before you offer it. Most child care providers can determine the return time on their own. Their policies are in place for a reason. With your diagnosis and declaration of contagiousness, we can make our own decisions on a case by case basis. If you have any questions feel free to call the provider. Maybe a few conversations with the ladies on the front lines will change your prospective a bit. I hope mine has.

Sincerely,

Tori Fees R.N., B.S.N.

lovethislovethislovethis!!!
Words cannot describe how much I love this....especially the bolded.

Is it just possible that this doctor is a bit of a crackpot?
Read this article on biting: http://www.boston.com/lifestyle/heal...her_child.html
where she says "If biting is happening in school or daycare, the stopping it part is reasonably straightforward. You have every right to expect that professionals (especially those you are paying) will keep your child safe. ... It's just not okay for that to happen in that setting. Anybody can be caught off guard once, but there should be no repeat biting."

And then this "It's way harder if Biter is a playgroup pal, or the child of a friend or a family member."

Yes, dear, it's soo much harder when each child has one-to-one supervision versus a group care situation :rolleyes::rolleyes::rolleyes:

Originally Posted by nannyde:
Dr. Claire McCarthy,

My name is Tori Fees. I’m a Registered Nurse and veteran child care provider. I have cared for kids in the capacity of private nanny, elementary school nurse, and home child care provider for thirty years.

I came upon your article “Why Sick Kids Should Be Allowed at Daycare” published by Huffpost. As a veteran and expert child care provider, I feel it is important to address your publication as it speaks to many of the common misconceptions Physicians have regarding admittance into child care after the child has been excluded by a school, child care center, or home child care. My hope is that you will reconsider some of your viewpoints when you hear some of the concerns from the ladies on the ground who are caring for multi-level aged group children in these settings.

Each licensed and registered child care providers have illness policies. Every state in the U.S. requires that guidelines are set to differentiate an excludable illness and a “mild” or “minor” illness. Independently owned child care providers have the blessing and burden of developing their own policies that must at least meet the minimum standards set forth by their respective state. I’m certain you have come across variations in the policies of the privately owned child care services.

When a parent brings a child into your office, you may not be aware of what the child care policies are. Fortunately for you, you don’t have to know the specifics as your job is to simply diagnose the child and provide treatment should it be deemed necessary. The parent may ask you to provide a “return to daycare” note but you are not required to do so.

Your article laments on the frustration you feel when parents access expensive treatment such as emergency rooms and urgent care clinics for minor illnesses solely for the purpose of obtaining a return to daycare note. I agree wholeheartedly that these very expensive medical services should not be utilized for this purpose if the child is experiencing a mild illness. Remember that the parent is the one choosing to access this level of care. You would be hard pressed to find a child care provider who would encourage a parent to go to this extreme. It is likely the cost of the services in these expensive care centers far exceeds the salary loss the parent will endure while missing a few days of work. If the parent is given free or near free access to these services and chooses to utilize them for minor illness, there should be a swift and immediate financial recourse to recoup the unnecessary expense. As long as it is free or near free this practice will continue. I encourage you to use your position to campaign for financial accountability when these services are being misused.

When a parent accesses medical care for the purpose of obtaining a “return to child care” note the first question you need to ask is if the child care asked for one. It used to be standard practice to ask your opinion but that is no longer the case. Providers across the country have had SO many bad experiences with these notes that they have changed their requests to ONLY a diagnosis, determination of whether or not the child is communicable, and documentation of any treatment you may prescribe. There is also a high likelihood that the parent wasn’t asked to take the child to the doctor. The child may have been excluded based on symptoms observed by the provider and was simply excluded until the symptoms are no longer present within a certain time frame. There’s a good chance that a recommendation to seek medical care for the symptoms wasn’t requested.

Often, a parent who has received an exclusion comes to you because they want you in the middle of the “no” they have just received. They misunderstand our relationship because they believe your determination would somehow trump ours. It doesn’t.

Child care providers don’t work with or under your license. We can’t rely upon your determination for return to daycare because you don’t know our population. You can’t possibly know what children are in attendance in our care. You don’t know if we have newborns, children with compromised immune systems, special needs children, new children to the child care, or children who have been out on vacation. You don’t know whether or not the children in attendance have even met your patient. You don’t know if the children have been exposed before diagnosis and whether or not the illness could have devastating affects on one when the effect on your patient is minor. You don’t know if repeated exposure will increase the likelihood of infection.

We can’t rely upon your determination for return to daycare because we aren’t a part of the history you take on the child before the exam. We don’t know if the parent has been truthful to you when giving an oral account of the child’s condition. We don’t know if the child’s fever has been masked with antipyretics before coming into your office. We don’t know if the parent has minimized the account of the excludable symptoms by words such as “spit up” instead of “vomit”, “loose poop” instead of blowout diarrhea. We don’t know if the parent is attributing the symptoms to something he ate, undiagnosed allergies, or the infamous “teething” used in nearly every parental diagnosis.

The other parents of the children attending child care with a sick kid aren’t going to be bummed out when they find out your patient is attending with a fever. They are going to find another daycare. Parents are very concerned about the health of the other children BEFORE their child becomes ill. Once their child becomes ill the concern for the health of the other children wanes dramatically. That lack of concern often drives them to your office to ask for you to intercede and remediate the decision of the provider. There are some exceptional parents who have consistent concern regardless of what child is ill but they are becoming extremely difficult to find.

You are correct that children in child care have more viral illnesses than children who don’t attend child care. Have you ever considered that the reason for this is that the parents of the children attending day care are bringing their kid in for your return notes when parents of kids who are not in child care don’t access medical care for the same symptoms? If you stop offering return notes you may find the statistics change dramatically.

If you truly believe the illnesses are minor and the child should not be excluded maybe you should consider offering the child to hang out in your office the next day. Put him squarely in the middle of the waiting room lounge where the “well child” visit kids are. When the well child’s visit is over let their mothers know that the kids sharing their space were excluded from daycare because of “minor” illnesses like one vomit, a little fever, a diarrhea bout that’s on the tail end, and a slight case of pink eye. The mothers will be bummed and they will find a new doctor.

If you really want to make a difference and are willing to become involved in this vicious cycle of exclusion the best thing you could do would be to counsel parents on the average number of illnesses young children get per year. Explain to them that they are going to have to miss work because their kid is most likely going to get sick often. Encourage them to use their precious paid time off wisely. Tell them to not be tempted to squander their paid time off with “me” days. Tell them to suck it up and go to work when they are mildly ill so they have the time available to care for their baby when he is mildly ill. Tell them it is better for them to go to work amongst other adults with their mild illness than to send their mildly ill kid to daycare with other babies.

If you want to make a difference, put in writing that you will assume all liability if another child in the child care contracts the illness. Put in writing that you will cover the cost of the missed days of work the provider will have if she contracts the illness. Put in writing that the child care providers children can be cared for by you free of charge while you are at it.

Fever is the number one indicator of health and it is masked with a nickel worth of medicine. If you want to make a difference, test for the presence of antipyretics in the child’s system. Do not take the parents word for it. Let your client know that you will ask and you will check. Google “dope and drop” and get a real education of how providers are deceived by parents to buy time through nap time or a day of daycare. Realize that not only are we the unwilling victim of deception but you are too. It happens a lot. If you start testing for it you will write far fewer return notes in your future.

The things that would really make a difference you won’t do. It’s easy to write a return note. It’s easy to please your customer. It makes you money. It’s hard to tell a parent you can’t recommend return either way because you don’t have the information you need to make a decision and you don’t want the liability. Encourage them to find a provider with illness policies they agree with rather than use you to intercede when the illness exclusions they agreed to before enrollment are enforced.

Better yet, stay out of the return to daycare notes business. It’s not your job to make sure a parent keeps their job. Just offer a diagnosis, whether you deem the illness as contagious, and the treatment you are giving the child. That’s all we need.

If a child care provider or school asks you to give a determination then by all means, accommodate them. Make sure you are actually being asked before you offer it. Most child care providers can determine the return time on their own. Their policies are in place for a reason. With your diagnosis and declaration of contagiousness, we can make our own decisions on a case by case basis. If you have any questions feel free to call the provider. Maybe a few conversations with the ladies on the front lines will change your prospective a bit. I hope mine has.

Sincerely,

Tori Fees R.N., B.S.N.

PERFECT!!happyface

Originally Posted by SignMeUp:
Is it just possible that this doctor is a bit of a crackpot?
Read this article on biting: http://www.boston.com/lifestyle/heal...her_child.html
where she says "If biting is happening in school or daycare, the stopping it part is reasonably straightforward. You have every right to expect that professionals (especially those you are paying) will keep your child safe. ... It's just not okay for that to happen in that setting. Anybody can be caught off guard once, but there should be no repeat biting."

And then this "It's way harder if Biter is a playgroup pal, or the child of a friend or a family member."

Yes, dear, it's soo much harder when each child has one-to-one supervision versus a group care situation :rolleyes::rolleyes::rolleyes:

"if your child has a bite that breaks the skin, you should definitely call your doctor"

:eek: yes, call your doctor right away if they have a bite that breaks the skin, but be outraged if daycare excludes them for an actual illness symptom. :eek:

"If biting is happening in school or daycare, the stopping it part is reasonably straightforward. You have every right to expect that professionals (especially those you are paying) will keep your child safe. So if your child comes home with a bite, complain up the wazoo. Expect explanations and responses, and don't stop complaining until you get them--and until the biting stops. It's just not okay for that to happen in that setting. Anybody can be caught off guard once, but there should be no repeat biting."

Here's the rest of that paragraph... :eek:

She seems extremely anti-daycare.

Originally Posted by :
"If biting is happening in school or daycare, the stopping it part is reasonably straightforward. You have every right to expect that professionals (especially those you are paying) will keep your child safe. So if your child comes home with a bite, complain up the wazoo. Expect explanations and responses, and don't stop complaining until you get them--and until the biting stops. It's just not okay for that to happen in that setting. Anybody can be caught off guard once, but there should be no repeat biting."

So funny that she says that it's reasonable to expect us to keep their child safe (true, that's very reasonable), but she wants us to put children (the same children we are expected to keep safe) at risk by playing a guessing game with illnesses.

Great post NannyD!


Parent picks up sick child from DC goes to doctor irritated about leaving work, parent complains about DC, Doctor writes article. :lol::rolleyes:

I will not post on her FB...so difficult!

I tried really hard not to post but couldn't help myself and ended up posting multiple times. Ugh, I'm so mad. Every day we see the posts and articles about how expensive daycare is but now we also want providers to take sick children? The same providers that are lucky to make minimum wage when you count all of the time outside of daycare spent cleaning, shopping and planning. Not to mention all of the times we have to go to a doctor or get a prescription for us or our families because of "teething" or "allergies" that were brought in by a daycare child.
We once had a child with headlice make it in to daycare. I sent him home and treated my family and house. He came back and I realized an hour later that he still had it so I had to re-treat everything and spend all of that time dealing with it. It ended up costing me more than I even made watching the child that week. The same thing has happened with HFM when my child got painful sores in his mouth and could barely eat and colds that turned into bronchitis. In some instances it cost me to watch the child after you took what I made and deducted what the illness ended up costing my family.
I now have strict illness policies and I don't remember the last time I sent a child home for illness. On top of that the children in my care stay home on an average of 3 days a year because of illness but in those cases their parents kept them home and sometimes for mild symptoms but only because they didn't want to take the risk of spreading illness and having to find new daycare.
Parents need to understand that when they pay for group care they are paying for a portion of our time. 8 children = 1/8 of my time and after cleaning up and sanitizing after that one episode of diarrhea or vomiting you've used up your time.
I know I'm ranting. I've probably said the same things previous posters have mentioned but ugh, I'm so mad!

Originally Posted by nanglgrl:
I tried really hard not to post but couldn't help myself and ended up posting multiple times. Ugh, I'm so mad. Every day we see the posts and articles about how expensive daycare is but now we also want providers to take sick children? The same providers that are lucky to make minimum wage when you count all of the time outside of daycare spent cleaning, shopping and planning. Not to mention all of the times we have to go to a doctor or get a prescription for us or our families because of "teething" or "allergies" that were brought in by a daycare child.
We once had a child with headlice make it in to daycare. I sent him home and treated my family and house. He came back and I realized an hour later that he still had it so I had to re-treat everything and spend all of that time dealing with it. It ended up costing me more than I even made watching the child that week. The same thing has happened with HFM when my child got painful sores in his mouth and could barely eat and colds that turned into bronchitis. In some instances it cost me to watch the child after you took what I made and deducted what the illness ended up costing my family.
I now have strict illness policies and I don't remember the last time I sent a child home for illness. On top of that the children in my care stay home on an average of 3 days a year because of illness but in those cases their parents kept them home and sometimes for mild symptoms but only because they didn't want to take the risk of spreading illness and having to find new daycare.
Parents need to understand that when they pay for group care they are paying for a portion of our time. 8 children = 1/8 of my time and after cleaning up and sanitizing after that one episode of diarrhea or vomiting you've used up your time.
I know I'm ranting. I've probably said the same things previous posters have mentioned but ugh, I'm so mad!

Now THAT was a rant nan!! Good job! Notice she hasn't responded since we all jumped on the bandwagon?

Originally Posted by nannyde:
Dr. Claire McCarthy,

My name is Tori Fees. I’m a Registered Nurse and veteran child care provider. I have cared for kids in the capacity of private nanny, elementary school nurse, and home child care provider for thirty years.

I came upon your article “Why Sick Kids Should Be Allowed at Daycare” published by Huffpost. As a veteran and expert child care provider, I feel it is important to address your publication as it speaks to many of the common misconceptions Physicians have regarding admittance into child care after the child has been excluded by a school, child care center, or home child care. My hope is that you will reconsider some of your viewpoints when you hear some of the concerns from the ladies on the ground who are caring for multi-level aged group children in these settings.

Each licensed and registered child care providers have illness policies. Every state in the U.S. requires that guidelines are set to differentiate an excludable illness and a “mild” or “minor” illness. Independently owned child care providers have the blessing and burden of developing their own policies that must at least meet the minimum standards set forth by their respective state. I’m certain you have come across variations in the policies of the privately owned child care services.

When a parent brings a child into your office, you may not be aware of what the child care policies are. Fortunately for you, you don’t have to know the specifics as your job is to simply diagnose the child and provide treatment should it be deemed necessary. The parent may ask you to provide a “return to daycare” note but you are not required to do so.

Your article laments on the frustration you feel when parents access expensive treatment such as emergency rooms and urgent care clinics for minor illnesses solely for the purpose of obtaining a return to daycare note. I agree wholeheartedly that these very expensive medical services should not be utilized for this purpose if the child is experiencing a mild illness. Remember that the parent is the one choosing to access this level of care. You would be hard pressed to find a child care provider who would encourage a parent to go to this extreme. It is likely the cost of the services in these expensive care centers far exceeds the salary loss the parent will endure while missing a few days of work. If the parent is given free or near free access to these services and chooses to utilize them for minor illness, there should be a swift and immediate financial recourse to recoup the unnecessary expense. As long as it is free or near free this practice will continue. I encourage you to use your position to campaign for financial accountability when these services are being misused.

When a parent accesses medical care for the purpose of obtaining a “return to child care” note the first question you need to ask is if the child care asked for one. It used to be standard practice to ask your opinion but that is no longer the case. Providers across the country have had SO many bad experiences with these notes that they have changed their requests to ONLY a diagnosis, determination of whether or not the child is communicable, and documentation of any treatment you may prescribe. There is also a high likelihood that the parent wasn’t asked to take the child to the doctor. The child may have been excluded based on symptoms observed by the provider and was simply excluded until the symptoms are no longer present within a certain time frame. There’s a good chance that a recommendation to seek medical care for the symptoms wasn’t requested.

Often, a parent who has received an exclusion comes to you because they want you in the middle of the “no” they have just received. They misunderstand our relationship because they believe your determination would somehow trump ours. It doesn’t.

Child care providers don’t work with or under your license. We can’t rely upon your determination for return to daycare because you don’t know our population. You can’t possibly know what children are in attendance in our care. You don’t know if we have newborns, children with compromised immune systems, special needs children, new children to the child care, or children who have been out on vacation. You don’t know whether or not the children in attendance have even met your patient. You don’t know if the children have been exposed before diagnosis and whether or not the illness could have devastating affects on one when the effect on your patient is minor. You don’t know if repeated exposure will increase the likelihood of infection.

We can’t rely upon your determination for return to daycare because we aren’t a part of the history you take on the child before the exam. We don’t know if the parent has been truthful to you when giving an oral account of the child’s condition. We don’t know if the child’s fever has been masked with antipyretics before coming into your office. We don’t know if the parent has minimized the account of the excludable symptoms by words such as “spit up” instead of “vomit”, “loose poop” instead of blowout diarrhea. We don’t know if the parent is attributing the symptoms to something he ate, undiagnosed allergies, or the infamous “teething” used in nearly every parental diagnosis.

The other parents of the children attending child care with a sick kid aren’t going to be bummed out when they find out your patient is attending with a fever. They are going to find another daycare. Parents are very concerned about the health of the other children BEFORE their child becomes ill. Once their child becomes ill the concern for the health of the other children wanes dramatically. That lack of concern often drives them to your office to ask for you to intercede and remediate the decision of the provider. There are some exceptional parents who have consistent concern regardless of what child is ill but they are becoming extremely difficult to find.

You are correct that children in child care have more viral illnesses than children who don’t attend child care. Have you ever considered that the reason for this is that the parents of the children attending day care are bringing their kid in for your return notes when parents of kids who are not in child care don’t access medical care for the same symptoms? If you stop offering return notes you may find the statistics change dramatically.

If you truly believe the illnesses are minor and the child should not be excluded maybe you should consider offering the child to hang out in your office the next day. Put him squarely in the middle of the waiting room lounge where the “well child” visit kids are. When the well child’s visit is over let their mothers know that the kids sharing their space were excluded from daycare because of “minor” illnesses like one vomit, a little fever, a diarrhea bout that’s on the tail end, and a slight case of pink eye. The mothers will be bummed and they will find a new doctor.

If you really want to make a difference and are willing to become involved in this vicious cycle of exclusion the best thing you could do would be to counsel parents on the average number of illnesses young children get per year. Explain to them that they are going to have to miss work because their kid is most likely going to get sick often. Encourage them to use their precious paid time off wisely. Tell them to not be tempted to squander their paid time off with “me” days. Tell them to suck it up and go to work when they are mildly ill so they have the time available to care for their baby when he is mildly ill. Tell them it is better for them to go to work amongst other adults with their mild illness than to send their mildly ill kid to daycare with other babies.

If you want to make a difference, put in writing that you will assume all liability if another child in the child care contracts the illness. Put in writing that you will cover the cost of the missed days of work the provider will have if she contracts the illness. Put in writing that the child care providers children can be cared for by you free of charge while you are at it.

Fever is the number one indicator of health and it is masked with a nickel worth of medicine. If you want to make a difference, test for the presence of antipyretics in the child’s system. Do not take the parents word for it. Let your client know that you will ask and you will check. Google “dope and drop” and get a real education of how providers are deceived by parents to buy time through nap time or a day of daycare. Realize that not only are we the unwilling victim of deception but you are too. It happens a lot. If you start testing for it you will write far fewer return notes in your future.

The things that would really make a difference you won’t do. It’s easy to write a return note. It’s easy to please your customer. It makes you money. It’s hard to tell a parent you can’t recommend return either way because you don’t have the information you need to make a decision and you don’t want the liability. Encourage them to find a provider with illness policies they agree with rather than use you to intercede when the illness exclusions they agreed to before enrollment are enforced.

Better yet, stay out of the return to daycare notes business. It’s not your job to make sure a parent keeps their job. Just offer a diagnosis, whether you deem the illness as contagious, and the treatment you are giving the child. That’s all we need.

If a child care provider or school asks you to give a determination then by all means, accommodate them. Make sure you are actually being asked before you offer it. Most child care providers can determine the return time on their own. Their policies are in place for a reason. With your diagnosis and declaration of contagiousness, we can make our own decisions on a case by case basis. If you have any questions feel free to call the provider. Maybe a few conversations with the ladies on the front lines will change your prospective a bit. I hope mine has.

Sincerely,

Tori Fees R.N., B.S.N.

likethislikethislikethis This is very articulate, very to the point, and really speaks to our (providers) side of the illness debate. Nice work! happyface

I can't even with this article...

Does the Doctor author not realize some of these decisions are not even ours to make?

Maybe this Doctor should open a sick child care facility so all of the working parents can have the "support" they need.

I am so over the ever so common argument lately that everyone else needs to accomodate for parents who do not want to be parents when things get tough. No one ever promises you that parenthood is easy....children get sick, suck it up buttercup!

Sick kids at daycare
 

I read the article in the Huff--okay doc--I get part of that.
I also have a home day care where a parent (who worked for The World Health Organization) :rolleyes: doped his twins up when they were sick and sent them to day care. By the time the meds wore off it would be naptime. Then by the time the parent finally managed to get there to pick up the child--WOW! It was almost "day over"!! These were kids who spiked fevers of 102 while playing this little game.

My issue is this--almost everyone has Sick days, personal days, and vacation days at their jobs. I have parents who will use a whatever day from work to stay home and wrap Christmas presents so the kids aren't there???? but would balk at picking up a sick child when I called! Take a day off work for "ME" time......but come get the child?!?!?!
I agree with the other comment----they choose to have the children---choose to let someone else raise them ---- and then give grief to the person trying to do the best job for all concerned.

The problem with the DOC is--he's accustomed to having a room full of sick people all day--desensitized is the word I think.

On the plus side--MOST of my parents for the past 10 years have been of the other type---they keep the child home if ill--and hurry to get them if I raise a doubt about them being here. THANK GOODNESS!!!