This is ridiculous.

http://www.huffingtonpost.com/claire...ushpmg00000037

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I am a provider who is strict in my illness policy, and I completely agree with this physician. I've been around long enough to know when a rash needs attention, and will not send away for every rash. I don't send home a child with a fever of 100, whom a acting normal, but the one who is 100, droopy eyes, lethargic I would. I don't close for normal childhood illnesses such as HFM, croup, but will exclude when the child is miserable. It's all common sense. I trust my instincts, and so far they've served me quit well. I've not had to send a single ill child home this year so far as alm my parents have kept them home when required. My rules are clear and fair, so there isn't too much fuss anymore. They're all long time clients as well who know that I don't exclude lightly so they are able to respect my decision when I have to make it.

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Please excuse my above typos. On my phone

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What about the providers that have illness regulations that require exclusion? The Dr should be discussing policy, not that providers are following what we were told to do.

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I just completed a webinar put together by the AAP that basically says there are very little reasons to exclude.

Here's the specific webinar:
http://www.healthychildcare.org/PDF/...?eventid=43532

Here's a list of their other webinars:
http://www.healthychildcare.org/webinars.html


For many of us, it's up to what our regulations say. My surveyor actually told me she highly recommends that we create our own policies that are stricter than the state regulations.
http://www.kdheks.gov/bcclr/applicat..._Exclusion.pdf

Of all of my policies, my symptom policy is the strictest. Yet, I don't actually have to send anyone home very often. Maybe ever few months or so? So it's not like I'm just itching to keep everyone home and for all of my parents to lose their jobs. I care for children ages 0-3 and in order to provide the safest and healthiest environment I feel it's important to have a strict symptom policy. Everyone else can do what they want. That's the awesome part of owning our own businesses

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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.

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I feel kind of attacked, you know? Like we're just using any excuse to make parents miss work. And asking for a major overhaul of the childcare system? I agree that it's a common sense thing...but I am also not a doctor. I do not claim to know for 100% sure that something is not contagious or that it's "just" a little virus.

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This. I have NO medical training! I am NOT going to make a decision about what illness a child has. I do not diagnose! Hence the reason they're sent to the doctor.

Also, the examples that the writer included about the daycare requiring eye drops or the daycare requiring medicine for the fever to go down... I will never, ever, ever require a child's doctor to do or prescribe anything. That's something that's between the doctor and their patient and I have no business telling a parent that their child requires medication before coming back. In fact, I don't require them to even take them to the doctor.

My policy simply states that if their child has any of the listed symptoms then they have to be excluded.

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Thanks so much for sharing that link to the webinars! I am reading through the illness one right now and getting so annoyed. There is another post going on right now about pink eye, and YES I exclude for pink eye, but that webinar claims that pink eye should be treated just like the common cold and not excluded for!

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Isn't it infuriating?! I have to do what's best for my whole group of children AND my family AND myself. I don't want to get sick and I don't want my son getting sick.

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The exclusions listed in the article are common practice. The article supports these exclusions. Exactly what, I wonder, does the article believes to be overhauled?

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WSS.

I have let parents tell me ONCE that the doctor said it was x, y and you know what?! WE ALL GOT IT! Sure as heck wasn't blow outs from juice, mama! And then I closed for 3-4 days due to puking so much my throat bled! I don't know the difference and I am not hedging my bets anymore - you claim your 100.4 temp, coughing, hacking, wheezing kid is just suffering from seasonal allergies - whatever. Get a doctors note, then!

And, anyway, we're damned either way. Send them packing and we're too strict. Next week, we don't and suddenly we're horrible people running germ incubators. Whatever. Can't make everyone happy.

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Loved your FB post! I'm hoping she responds

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

Nan ...

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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.....

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Not flaming you
Just saying that you and your family were lucky to have the exposure to germs work for you.
My first three were around before I did day care and are healthy as horses.
My last two that were present while I did day care, were sick when they started school, even to the point of being held back for absences, and are still always sick.
Exposure to germs can still go both ways, and think your more correct about the good genes factor, vs. that doctors article.

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A lot of providers have been burned too many times by a parent who said that the child "only puked once", or "it's just allergies", and then everyone ends up sick. Or the provider themselves ends up sick enough that they have to close, and no one can go to work.

I think both sides just need to be honest and work together. I don't exclude for minor illness, but I expect parents to be honest, and know when they should keep their child home.

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<<<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.

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Here's my "middle of the road" suggestion:

Open daycares that cater specifically to ill children. All providers must have a nursing degree, at minimum. No parent will need to miss work.

Of course, the cost for a daycare like that would EASILY be double the going rate for well-child daycares.


Not enough families would enroll due to the high rates needed for that level of care and the place would shut down quickly.


Parents need to understand that if they want a daycare to accept ill children they better be ready with their wallets open. I'm not introducing illness on a consistent basis into my home without some serious money behind it. Again, parents already want the cheapest child care possible... there's NO WAY they're going to pay for sick care.

(Even the "right" amount of money wouldn't convince me to allow it... my family's health is just way too important. Just making a point)

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We had one of those. Strictly for mildly ill children. NO regular attendance

The child could only stay for a max of 4 hours per day and it was strictly drop in for those times in which parent HAD to wrap up things at work or had to go in for a bit to get some work done.

It was run by two pediatric nurses. It closed down within a year.

They couldn't keep enough staff on site to maintain ratios...

Why?

Because everyone kept getting sick

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I thought the whole purpose of quality child care and the efforts behind QRIS was for improvements, especially in consideration to children's safety.
Isn't it a safety issue for us to contain illnesses?
Of course it's going to be the parents of sick children that complain!
I know my parents are happy and trust in me to exclude the sick child, to help keep their child and other's healthy.
And it's not like we're running to call parents to pick up their children from the first sight of a runny nose.....please!

Funny thing.....one of my clients had the same pediatric doctor as my children. I always exclude for unknown rashes, especially when accompanied with a temp. And when I had to exclude this clients child for a rash, the pediatrician agreed 100% for rash exclusion, and gave the client a list of the possible reasons why. Never again did this client question exclusions for rashes.

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The problem sick bays have is that they have little attendance on Monday and Friday. On Monday the kid has been home so provider is unaware the kid is sick so the parents dope and drop and get by till after nap. On Friday the worst thing that can happen is the same thing that happened monday. The provider isn't going to exclude the next working day do it's worth the risk.

They have to make their money Tuesday through Thursday.

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When I was a teacher and my husband and I were planning when to have our first, one of the first things we discussed was what our backup plan would be when our child couldn't go to daycare because neither of us could take many days off. It was never even a THOUGHT that we would send our child to daycare sick. I wouldn't want that for my provider or for my child. When or backup person was no longer able to watch our child on short notice, we changed OUR lifestyle and I became a provider so that our jobs would not have suffer from us taking days off. If you have a job and have children it is YOUR responsibility to juggle them. I don't understand the argument that parents lose their jobs because the providers wouldn't provide care when the child was sick. The provider did not choose for that parent to have the child, the employer did not choose; the parent did. Their problem and their problem only.

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Everyone should share their opinions with the Dr! Here is the Facebook link

https://www.facebook.com/ClaireMcCarthyMD

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This for sure!!!!!

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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.

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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.

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

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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? I'm following state guidelines!

Blame the state not me

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

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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

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

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.

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"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...

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PERFECT!!

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

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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!

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I posted too. Couldn't help myself.

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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

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Loved this! Seriously good

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

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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) 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!!!

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Not sure why she singled out my comment as the one to respond to.

I want her to respond to the other issues with her article.

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link please.......

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Oh, it's the Facebook link from the first page of this thread. I THINK one of the Vaca ladies posted it

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I thought that was odd also. She's just going to keep responding by rewording what she said in the article and is too full of herself to admit otherwise. She said that she knows when parents are lying by the exam, I call bull. Even a 20 minute exam isn't going to show if the parent gave the child fever meds and besides that she doesn't know these people, at least not like we do, and you can't tell if people are lying until you've gotten to know their regular habits of speaking and acting. I wish she'd respond to nanny d but she can't because nanny was spot on and there is no response other than "I never thought of it that way" which this woman would never say.

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I can't see where she has responded to the Facebook comments. Is there other comments?

If she can tell when the parents are lying then she is in the wrong profession. A human lie detector makes way more money than a Dr.

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lol coffee just came out my nose.......................

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I clicked the link in the above post and on the right side are all the comments

No log in necessary

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Found it....

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It's kinda crazy I know, but I do NOT trust drs. There is too much liability in it for them so they cover their butt every chance they get. This dr's POV almost proves it even more. They don't see anything wrong with having a contagious illness in my daycare and will voluntarily send the parent with a note releasing them back with sympathy that their big bad DCP won't let little Timmy come back with a green snotty nose and goopy eyes.
I have been told SO many different lies by different doctors over the years its hard for me to trust any of them. I trust our own pediatrician more than probably any other doctor I've known but even he admits he's made mistakes! Recently I requested a doctor's note for a DCB before returning because he had these sores on his mouth and they looked awful. Mom kept him home and everything but the dr released him with a note that was so stupid... "Johnny can return when his sores are no longer active"... Uh DUH! LOL That didn't really tell me anything! I already told her that to begin with. They had done a culture but didn't know what it was at that point. Of course that was a new client's first week and his first day back the sores were scabbed up and almost gone but his face still looked tore up from the sore scars. Ugh! They were like "ummm... what's up with the..." and points to their mouth while looking at little Johnny. I assured them that it wasn't contagious and that he was released back to care and had been out an entire week before. I also assured them of my illness exclusion policy and that I had just sent another DCG home sick with a fever and lethargy. I don't do it often, but when I do it's for a good reason. Why should this dr make such a large and ignorant blanket statement which then gives these entitled parents already pushing the limits with illnesses another excuse to bring their kids and then refuse to take them! This Dr is setting herself up for some serious backlash! I saw the FB page but wasn't signed in. I read the comments and she tries to backstep and say "minor illnesses"... well HELLO? Who is excluding for minor illnesses?? Most professionals have an illness policy in place and do allow for minor illnesses! But to say a feverish child should be at childcare is ridiculous!

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Impetigo, scabies, bronchiolitis, stomach bugs, chicken pox(back in the day), not to mention all the green nosed colds and common viruses; these are just a few of the things that have gone through my daycare in the past 30 years. Some kids have had to be hospitalized for the exposures, even my own 18 month old(broke my heart watching her walk down the corridors hitched to an IV and the mother of the sick child she caught it from WAS a doctor!!). I once told a part time dcm that chicken pox was going around and asked if that was a concern. She chose to keep her child out of daycare until the incubation period was well over. Why? Because she was also caring part time for a child with leukemia that absolutely could not be exposed.

There is more to an illness than us simply sending home a child with a green nose. There is so much more to consider. This doctor is taking it all out of context and not thinking of long term ramifications, how it could filter down and cause other problems within other families.

I am not one to exclude over a couple loose poops, or a green nose but if that same child won't get up off the couch, eat, join in at all, then home with a loving parent who has time to care for them, is obviously where they need and want to be.

Wouldn't schools do the same thing? Who can nurse a child when there are other children to care for? And what is fair about exposing all the other children, plus families, plus who knows who else they touch along the way to wellness??? And most of all, how is that fair to the sick child? Isn't taking care of a sick child part of raising a child, part of showing you care about a child? How does that child feel when they're shoved off to school or daycare, sick as a dog, nobody to really care for them??? THESE are the kinds of caring acts we do as parents. It's not necessary to buy them McDonalds or a tv for their bedroom or all the toys in the world....but what is necessary is showing them you care enough to love, nurture, take care of them. We do what we can as providers but we are NOT their parents.

Idiot doctor.

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The good doctor had finally responded on Facebook....

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