Every year in the middle of cold and flu season, parents head to the pediatrician's office worried their child might have "daycare syndrome." That's the nickname given to a revolving door of daycare-related illnesses that keep kids at home and force lots of parents to call in sick to work. The colds and stomach viruses are real, but retired pediatrician Susan Aronson said "daycare syndrome" isn't really a thing.
Sick kids happen, she says, in daycare and at home.
"There's a tendency to blame that group exposure, but in fact children who stay only at home with their families and siblings get most of those infections also," said Aronson, an adviser to the American Academy of Pediatricians on early childhood issues.
Even if a young child isn't enrolled in group care, when she gets old enough to explore beyond a parent's reach she touches things at church, at the grocery store, and in playgroup, Aronson said.
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Infants and toddlers who are cared for exclusively at home get about six to eight respiratory infections, Aronson said, and they suffer one or two bouts of diarrhea each year.
"If they go to group care setting, they add another one or two on that," she said.
Aronson co-wrote the book "Managing Infectious Diseases in Child Care and Schools" for the American Academy of Pediatrics.
She says some early education programs are too conservative about keeping kids at home.
"There is no reason to exclude a child who is sniffling and sneezing, because, in fact, their biggest opportunity to share their organism, their germs was before they had any symptoms," she said.
Aronson encourages parents to embrace the idea that children need to develop immunity to common infections. She counsels them to shake off guilty feelings and the tendency to think that kids catch coughs and sniffles only at daycare. Beyond that, she really stresses proper hand washing.
Her advice: scrub between your fingers, the back and front of your hands, and once you've lathered well, to turn your fingers down, then don't touch the faucet handles.
To control germs, the Centers for Disease Control and Prevention says the soaping-up step should last at least 20 seconds. But getting a toddler to stay on task is tough.
Some teachers and parents sing a counting song or "Row, Row Your Boat" to keep kids on engaged.
At the Maternity Care Coalition's Early Head Start in South Philadelphia, a buzzer goes off when kids have been lathering up for 20 seconds.
Hand washing is the first thing kids do each day. Mom Monika Kaskardi says she checked out the preschool's cleaning procedures before she enrolled her 2-year-old daughter Hadassah.
"They are very clean in here," Kaskardi said. "It makes me feel very, very safe to let her in here."
In teacher Doris Young's class the toddlers aren't quite coordinated enough to cover their mouth with an elbow, so often they use their hands. And each time that happens, there's another trip to the sink to scrub up. Young wears gloves to wipe runny noses.
And the changing tables and breakfast tables are sanitized before and after every use. The students are still learning spoon skills so lots of cereal bits end up on the table. Often the children abandon their utensils and use sticky fingers to eat food directly off the table.
"If you don't get to them quick enough they will eat them," Young said.
Toddler-age kids learn by putting things in their mouth, so in a preschool you could spend day chasing germs.
"If you are constantly sanitizing when do you do activities with the children?" said Jessica Smith, the center's early childhood development coordinator.
Teachers have to strike a balance and try to integrate good hygiene practices into the educational and fun things kids do throughout the day.
The center follows hygiene protocols and procedures from three different state and national groups.
"We are a Keystone STAR 2 facility, in the process of becoming a Keystone STAR 3," Smith said.
STARS is a Pennsylvania acronym for Standards, Training, Assistance, Resources and Support. It's just one accreditation that the state Department of Human Services says parents should look for when they are shopping for childcare.
At Early Head Start, the furniture, sheets, and play clothes are cleaned once a week. Some toys get sanitized at the end of every day.
"So if a toy goes into a child's mouth, when the child is done playing with it, the teacher will put it in the dirty toy bucket," Smith said.
To help keep illness in check, experts say it's best if the same children—and same teacher—stay together most of the time. That's called "cohorting." Kids who eat and play together regularly encounter the same germs and build-up resistance to each other's particular set of cooties.
So kids should stay together, but the newest safety recommendation is to keep their stuff separate to avoid spreading viruses, lice and other things that get carried to daycare from home.
"The children's hats, coats, gloves, and other belongs can't touch," Smith said.
The center purchased reusable grocery bags—and labeled each with a child name. As soon as kids come in the door, parents stuff all their kid's extra belongings completely inside the bag.
Lots of playschools take kids outside most days. And, pediatrician Susan Aronson said it's also good to open a window or have another way to air-out the classroom to keep fresh air circulating.
There's no such thing as a public registry where you can look-up a playschool's illness track record. Still, Aronson advises parents to spend time in the child's prospective classroom and watch to see how teachers handle hygiene.
Finally, she has a bit of good news for weary parents: By the time children reach age 3 they get sick with about half as many colds in a typical year.