My son (18 months) was sent home from daycare yesterday and the providers told me they were 99% sure he had hand foot mouth disease. I took him to the dr and the dr said that he definitely didn't have hfmd and it was just a nonspecific rash on his chin, most likely from teething. So I took him back today to daycare with the dr note saying he was ok to return only to get a call an hour later from the director saying that she didn't believe that my dr was correct and she wanted me to come get him and get a second opinion. So I left work again, took him to a second dr who again said that it is NOT hfmd and is just a non contagious rash. Got a note, called the daycare to let them know and they said they won't let my son back until they actually talk to the dr. The dr said she will not talk to them because they communicate with letters and if that's not good enough than tough! Then told me that I need to file a complaint against the daycare. Problem is, this is the only daycare in town

Is this legal?!? They still want to be paid for this week but have already made me miss 2 days of work and are now saying they want him to stay out for a week "just in case". What are my options here?? I'm in California by the way.

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Not sure about your specific situation but I am a family child care owner whom a few years back sent home a child 3 consecutive days for excessive diarrhea....all three days the parents would bring a note from the dr back saying the child was not contagious....well, by the weekend the parents called to inform me they were very sorry but the child had rotovirus and was in the hospital. My point being, sometimes doctors are wrong and experience of daycare providers should be respected and honored...we are responsible for a group of children and make decisions accordingly. I now have in my contract/policy that I make the final decision when a child may return.

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As a provider, I have a lot of experience in recognizing contagious conditions such as hfmd, but I'm no doctor. No fever? No vomiting? No diarrhea? If he has no signs of a contagious condition and the center is refusing care anyway, despite two Dr's notes to return to care, then I'm wondering if there is some other underlying issue that the director has with you and maybe she wants to push you out? Have you had previous disagreements with her? Don't get me wrong, that doesn't make it Ok to exclude your child without a valid reason, but that's the first thought I had. And I'm not sure of the legality of it because I know many businesses have the right to refuse service, I just can't understand why you're being refused. I have been no help whatsoever, I know! I'm sorry...

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I am one who trusts a doctor's opinion. I know that is kind of unpopular these days.....I am very trusting of authority . So, after 2 different doctors say it is not HFMD, I would accept the child back if the only symptom is a rash on the chin. That can be from drooling. If there was a fever or a rash in other parts of the body, too, I would be more concerned. Is your child drooling alot with his teething? Is there a history of your child coming to daycare sick? It just seems a little odd that the daycare is being so adamant about this.

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Nope, no fever, no diarrhea, great appetite, happy. No other symptoms except a rash on his face. Me and all the staff have always been very friendly with each other. I usually talk to them a few minutes when I drop him off and stay a bit and chat when I pick him up. We have always gotten along great, so I don't think they are trying to push me out. When I told the dr what was going on they told me that this daycare is really weird and they often hear complaints from other parents going through similar situations as me with them.

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You are right in saying it is unpopular to trust a dr these days. I think the issue with trusting is many families do not see a primary dr all the time. With the rapid expansion of walk-in clinics, very rarely are children seen by the same dr twice. So it would be hard to really know a child and just get the perception of someone on any given day. I have seen children diagnosed with flu when they have mono or kids with hfmd diagnosed with strep. It happens and nothing surprises me anymore. It is possible this particular daycare in question has an issue with the poster but, as a provider, I would have to make the call on an individual basis.

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The doctor actually said that it is most likely from teething since he also has a diaper rash, but my daycare still doesn't want to believe it. I think it is partly because they just took in a 6 week baby on a heart machine and so they are being overly cautious.

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I had a former client who had her kid in a new daycare and was told to come get the kid on day 2. The kid had marks on his back. The clinic doctor said he had blisters on his throat and diagnosed with hfm. The mom was 2 mo pregnant and scared senseless. They bring the kid to me and one look at his back I could tell the "rash"on the back was a series of bites.

With moms permission I sent the pics to Cathearder and she and her husband confirmed the five bites. The bites were from a two year old (spacing of teeth). The provider had a two year old son.

The kid never broke out in blisters. The doc was so far off it was ridiculous.

I do not trust doc notes.

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right...and your former career was a NURSE, right?

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Doctors aren't always right. They often make decisions based on past experiences rather than what's right in front of them. I know several people who went to the doctor for stomach PAIN and each were told that they were constipated. One had an emergency appendectomy the next day, the others had their gallbladders out. NONE were constipated.

I've been misdiagnosed SOOOO many times.

They do their best, they're not malicious, but they're not always right. This is why we exclude children based on SYMPTOMS, not diagnosis. I don't know what you could report the provider for, in my state (not California), I am required to exclude children with rashes. If the rash wasn't diagnosed, HOW could the doctor say it wasn't contagious?

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And that's why they practice medicine

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I would hope the OP could have a conversation with the daycare, and try to understand what each of them is thinking and why.

Wondering if it's a center or family daycare.

I remember having to work with a family whose child was exposed to some childhood disease, when I had a six week old beginning that same week.
I think some dc parents were talking about having a chicken pox party, and I was opposed to this, given the new little one starting. So not fair to baby. Parents do sometimes have to exercise a different level of responsibility (that dc providers sometimes have to explain to them) when their children attend child care.

But that's why I would hope that a conversation could take place. That might lead to understanding by this parent.

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A rash on the face AND diaper area would make me exclude too. Even if it's not hfm, I would want it cleared behind admitting back into daycare. As for the doctor saying that he's heard complaints about your daycares strict sick policy, I say 'bravo!' Since you know they will be cautious if another child is sick & exclude when they feel it's necessary.

I would recommend asking for a meeting w the director and ask what exactly do they need to admit your child back. If the doctor won't talk to them
For privacy reasons, then what are your other options.


I wanted to add that the face rash ANd diaper rash made me thing it's a food sensitivity thing.
Good luck!

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Thank you all for your input. It's good to hear the point of view from a child care providers prospective. I was beyond mad today but I have calmed down and I do understand their reasoning for not wanting to expose other children to a potentially contagious disease. It's just so hard to try to be a working mom and having to take so much time off I guess that's how it has to be though and thankfully my boss called me today and told me not to stress and to take as much time off as I need until he can be admitted again. I think I will call the daycare tomorrow and apologize for being short with them today and ask when they would feel comfortable with him coming back.

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Hope your talk goes well. It is hard to take time off of work. I think most providers understand that, but have a responsibility to protect their entire group from illness or infection, as well as themselves.
Calm is a good place to start the conversation

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We had HFM a few months ago and it looked different in all four children who got it. Only one was the classic hands, feet, and mouth! She was the case that got me thinking and figured out the rest. Of the other three--one was primarily legs and trunk (I'm his mom and I thought it was just bad dry skin that he itched and made scabby!). Another was all groin/diaper area (he came with it after a weekend and I thought bad diaper rash). A third was older (six) and had just the barest few spots here and there, but was out of sorts and not feeling well.

So....it *could* be HFM with a weird presentation. Though chances are excellent that either everyone was already exposed OR you will never know.

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I had a case of HFM recently. Rash on mouth and buttocks, then spreaded to back and eyes swollen.

Also, one of my clients is a doctor and can get any number of peers to sign off on any medical forms.

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Just because a a client has a note from a Dr. does not mean I allow a child back into my childcare if I feel they are contagious, or generally unfit for childcare. My job is to ensure all the children in my care are safe. Any mystery rash needs to heal or be covered before I allow them back in care. This is my business, my rule and has nothing to do with licensing. In fact, I'm sure licensing would back me up not allowing sick children in my care.

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This is my policy, as well. And I am quite specific about what a doctor's note should say but I still stand by my policy that I have the final word, for many of the above reasons already mentioned.

I would suggest, as someone else did, to talk to the director again. They sound like they really are acting in the best interest of everyone involved.

Good luck!

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A doctor's note was how Fifth's Disease came to my day care - while I was pregnant.

On a side note OP - it *is* hard to be a working parent and take time off for sick kids. I would gently suggest that you and your spouse come up with a plan for how to handle it - I have dc families that have retired grandparents or other relatives who will care for children with mild illnesses, some of my parents have work from home arrangements, others alternate so mom stays one day and dad stays another so not one parents is always using their time. Kids get sick, they miss day care, they miss school, etc. You have to build those safety nets for your family

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My guess is they have likely been getting a lot of kids coming in with contagious diseases lately and are determined to put an end to it but being super strict with the families.

Sometimes it is the other families not respecting the rules who ruin it for the good families.

I personally would have accepted the note and allowed him back into care...especially with something as benign as HFMD or 5th Disease...unless there was a pregnant staff member.

Is it possible someone at the center is expecting?

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I guess my area must be odd. As far as I know most of my dcf's over the years had a specific pediatrician or specific practice with a group of physicians they saw for issues just as I do and went for check ups regularly. The only time I have used clinics is when my kids would get symptoms on the weekend (Friday as soon as they got home from school, of course) and I wanted to make sure they didn't have strep (they got strep ALL THE TIME ). Guess my experience is just not the same as most and I was very fortunate. I never had a dck diagnosed with something mild and had the doctor miss something big so I never thought to question a doctor diagnosis. Possibly questioned parent diagnosis but not a doctor diagnosis.

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Update us on how your talk goes!

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I am glad you are feeling better about it all. I totally understand how hard it is to be able to take off work for sick children. Sometimes this forum sounds like it should be no big deal, but it can be a huge stress on a mom. I understand and agree providers cannot take kids presenting with symptoms of contagious illnesses, but it is still super stressful for parents whose workplace is not understanding.

I worked full time with my first two kids for 9 years and it was so stressful when anyone got sick. I only got 5 sick days a YEAR...company policy. And it was NOT flexible. With 2 small boys in daycare (where they usually picked up any illnesses for which they had to be excluded), you know how difficult that made it. My husband was the main income so his job was more "important" so he couldn't miss or leave early. We couldn't quite make it without my income at that time so I needed that job.

So, I understand what you are going through and why you would be upset initially with the daycare. I am glad your boss is understanding in your case. Nothing I can do to really help you but know that I understand your side.

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I'm curious as to what the center's rules actually say about returning to care or being excluded from care....

If the rules/policies state you must have a Dr's note before returning, then I would NOT be ok with them excluding since you DID comply with their rules. Just because they may not like or agree with what the Dr said, doesn't mean they can still exclude AND charge you.

If the rules/policies say that it is up to the center to ultimately decide even if you do have a Dr's note, then I guess they can exclude AND charge.

I understand their fears about spread and such but this type of situation is why the rules/policies need to be clearly written and understood by both parties.

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We recently had an out break of hand foot and mouth at our center. Our policy is that a child can not return with out a doctor's note stating that the child is no longer contagious. However, if a child returns with a doctors note and we notice the rash spreading or a new fever or any other symptom, they would be sent home again for the new symptom. There were a few children who were just uncomfortable and just didn't feel right. In those cases I would call the parent and let them know it was in their child's best interest for them to be picked up regardless of the doctors note and I must say most of my families agreed with me. I am in CA also and have 120 children in my center. Sometimes you have to make parents upset if it is in the best interest of all the children.

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I am a Registered Nurse. I am licensed.

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me too!! Happy nurses day!!!!!

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