Thursday, December 8, 2016

When is your child contagious? 2016


Some of my most common questions revolve around when kids are contagious and at what point are they ready to go back to nanny-share, day care or school.
The answer is almost never clear cut. In a black and white world, this is my 50 shades of gray.  In order to logically best make these decisions there are many issues that we need to consider.
Of course we want to be a responsible parents and not expose others to our sick child. We also want to protect our own recovering child from going back into the 'germ pool' too quickly. If they are just getting over something, their immune system may a bit diminished and they are vulnerable to coming down with something new.

For older kids,sometimes they have an important test that they are reluctant to miss. Some are reluctant to miss school. (others not so much.....)
Another consideration is that some parents have an easy time taking time off and others simply can't afford to. It is naive to think that these aren't real factors.

What makes it all so tricky  is that most viral syndromes can be spread a day or two before the kids show clear signs that they are ill. Many kids may be a little fussier than usual. Perhaps they don't eat quite as much. Most savvy parents know enough to be suspicious when their 5 year old who fights naps with a vengeance announces that they are going up to have a daytime snooze. Your antenna might be up that something is brewing, but are those reasons to miss work and keep your child at home??? Of course not!

The fact is, if you child comes home from school in the afternoon and is sick that evening, most likely everyone they were with earlier that day has already been exposed and I am going to take that into consideration when we try to come up with the most sensible plan on when they can return.
It is nearly impossible to isolate siblings. Of course be scrupulous with your hand washing, avoid sharing utensils and sloppy wet kisses, but it is likely that they will catch each others cooties. Breast feeding moms, sorry to say that by the time you realize you are ill, it is too late to prevent an exposure. Hopefully the magic of breast milk will protect your baby, but it is rare that we would suggest that you avoid nursing. Most of the time we will recommend that you keep on with the feedings. (Make sure that you are getting plenty of fluid. If you are given medication, check with your nurse or doctor’s office to see if it is compatible with breastfeeding.)

If you are in a small share care situation, it is essential to have a talk with the nanny and the other families involved to make sure you are all on the same page.
I would suggest that you agree that the kids will have  a "sibling" relationship. This simply means that you all accept that the kids are most likely going to get each others mild illnesses.


As far as common colds go, the average child under 2 years of age has EIGHT colds a year. Frankly, if you plan on keeping your child at home until your little toddler is free from a runny nose, you will be waiting a very long time before you leave the house.
Remember that some clear runny noses are not contagious. Teething as well as some allergies can be the cause. (There is debate about whether or not teething is associated with congestion. Nurse Judy votes yes.)

While I would strive to keep my youngest and most vulnerable patients free from viral syndromes and colds as long as possible, exposure to these common viruses is in fact developing the immune system. At some point they are going to have to deal with the myriad of  illnesses that make the rounds. Think of it as a rite of passage. It is actually better to get some of the childhood illnesses out of the way. Unfortunate adults that lack immunity and catch these illnesses are pretty miserable.

Typically if I have a child with a fever over 101, a  new case of diarrhea, or a brand new cold that has them spewing green mucous it is worth keeping them home for at least a day or so to see what  is coming next. 

If your child has an infection that is being treated with antibiotics, we generally consider them no longer contagious after they have been on the medication for at least 24 hours.

Bacterial conjunctivitis is also usually given the all clear after 24 hours of eye drops (of course you need to finish the course.) 

Hand Foot Mouth issues come up a lot. I respect that schools want to keep this yucky virus from getting spread around. Patients can shed that virus in their stool for several weeks. I would suspect that there is a reasonable chance that the infected kids likely got it from school in the first place and/or were contagious before they were identified and segregated.Since I don’t think schools are able to genuinely keep them out until they are completely clear, I suggest common sense guidelines. If they have a fever keep them home. If they are fussy and miserable, they will be much happier home with mom or dad. If they seem to be feeling okay and are fever free, for the above reasons, I don’t think it is reasonable to exclude them from daycare/school until all the blisters are gone. Kids are going to get this.

If you are questioning whether or not to go on an upcoming play date, explain your situation to the other parents. They may be perfectly fine hanging out with you and your snotty nosed child, or perhaps they have an important event or vacation coming up and want to be more cautious. Let them decide. Full disclosure ahead of time is the best practice.

There is never any complete assurance that can be given that your little one is "not contagious".
Use your best common sense. When in doubt avoid contact with anyone who is vulnerable. This would include newborns, or someone with a compromised immune system.

Nurse Kenlee tells parents that she wishes there were a magic light that signaled the "all clear." Alas, there isn't.

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