The "F Word" in Child Care

There are a few words in daycare that providers consider unofficial cuss words. These words are used by parents to get away with the very worst of behaviors. Like using the words “Allergies” or “Teething” as an excuse to drop a child at daycare that they know is not well and should be at home. Another buzz word for us is “Occasional” because usually it is used by a parent who wants us to watch their child for extra hours without getting paid for them.

I personally hate the “F” word most of all, and by “F” word I mean the word fever. No one word causes providers more grief, and it is probably the one word parents lie about the most. It is the one symptom parents will drug a child for and lie to the provider about, and it is the one they will blame on any non-communicable cause they can think of to not miss work.

In the spirit of improving provider and parent relationships worldwide, I’d like to dispel some myths about the “F” word. Here are just a few things every parent and provider needs to know for everyone to stay well, and conflict to stay at a minimum.

1. There is no relationship between teething and fever. None. Multiple complicated studies have been done that prove exactly that. There isn’t a single study that shows any evidence that children get any more than a 1* increase in body temp when teething, which can be accounted for by a million other factors including warm clothing and blankets. The studies that were done weren’t based on mommy guessing when her child was teething based on fussiness or any of the symptoms that old wives claim teething is responsible for. They were done by charting children’s temps daily from 6 months of age to 28 months of age, twice weekly mouth checks and regular x-rays to chart exactly when teeth were breaking through the gums, and the charting of the child’s disposition and any other symptoms of illness. The result? Teething is a natural growth process, and although it can cause discomfort and crankiness, it does not cause a fever, diarrhea, or vomiting. In addition, there are multiple ways to help a child with teething that do not involve fever reducing medication which is hard on the liver and kidneys. So, for parents who shove the Tylenol in right before daycare and drop off thinking that it won’t hurt anybody not to know (because it’s just teething and today is the big sales meeting), be advised that when your child develops a fever 4-5 hours after arriving at daycare, we’ll know what you did, and we will begin the three strikes policy needed to terminate you.

2. Allergies also have no link to fever. No matter what your child is allergic to they aren’t going to get a fever from it.

3. Your child does not have to have a fever to be sick, and they don’t have to have one to be contagious to everyone around them. There are many contagious illnesses, including food-borne illnesses that never cause a fever but are serious and spread like wildfire. So, if we call to tell you your child has diarrhea or vomiting, don’t ask us if they have a fever to see if you can avoid picking them up. We see children who are ill on a weekly/monthly basis, and we are very familiar with your child’s disposition and what is normal behavior for them. We learn very quickly how to judge if they are sick, and there are certain symptoms we must exclude for no matter what we think the cause is.

4. Your child does not become safe to be around other children the moment their fever breaks. It is a minimum of 24 hours after your child’s temperature returns to normal on its’ own. On its’ own means that all the fever reducing medicine is out of their system, and their temperature has stayed at 99* or lower for a full 24 hours, with no spikes, no further medication, no cold baths or cloths on the back of the neck etc. If you give your child Tylenol (Acetaminophen), the 24 hours does not start until 6 hours after the last dose was given. If you give your child Advil (Motrin) the 24 hours starts 8 hours after the last dose was given and if you give your child Alieve (Naproxen Sodium) the 24 hours starts 12 hours after the last dose was given. This ensures the medication is completely out of their system and not masking any symptoms. Some viruses are contagious for several days after the fever leaves, so it is important to follow your provider’s guidelines when your child is diagnosed with an illness requiring a longer exclusion, such as Influenza A. If you are asked to pick your child up from daycare because they have a fever, do not attempt to return with them the following morning. Your provider may let you drop off to avoid conflict, but you will be the source of her seething resentment all day long, and she will begin debating if you are worth keeping as a client. The 24 hour rule is exactly that, a rule. It is not a suggestion, guideline or request.

5. If your child develops a temperature at home and you medicate them to hide the symptoms, you put everyone’s health at risk. There is no way to know how high a fever is if medication is given to keep the fever down, and fever reducing medications do nothing to keep your child from being contagious. In addition, as far as your childcare provider is concerned, knowingly hiding an illness is child abuse, because we cannot give your child the care and supervision they need if we do not know they are sick. In addition, you are assaulting our children and the other children in our care when you knowingly make them sick for your own selfish gain. Nothing will make us hate a parent more than when they “Dope and Drop” which is the expression we use to describe a behavior that happens to us all the time. Because of this atrocious behavior our children miss a ton of school, we end up getting sick and our spouses end up not only missing work when they get sick, but also missing work to help us when we are down for the count.

I don’t concern myself with whether this article seems harsh or unkind. The only kind of communication that works when it comes to parents who are willing to force their child to spend a day having to deal with a bunch of other children while they feel miserable is brutal honesty. If you engage in this behavior you become an unacceptable liability in our lives, and as soon as we can replace you a termination notice will follow.

To the parents, I give this advice. Save your PTO days for your child’s illnesses. Don’t use them for me days or spa days or clean the house while the kid is at daycare days. Take turns with your spouse so that neither of you need to cover all the sick days. Stay out until your child is well, playing normally and free from all symptoms. Don’t make your provider feel badly about protecting not only your child, but her family and all the other children in her care. If your doctor tells you your child has “just a virus”, don’t ask “How soon can little Johnny go back to daycare?”, ask “How long will little Johnny be contagious to other children?”

To providers I say this. You have an obligation to your own children and all the children you care for to protect them from illness. Sometimes this means losing some income to terminate a parent who will lie and risk everyone’s well-being just to avoid having to miss work and take care of their own child. If you allow a parent to bring their child back less than 24 hours after a fever, you are just as irresponsible and guilty of assault as they are. Most of all, if you don’t tell parents the truth about illness and daycare then you are doomed to have constant illness in your household and your business. This is one of the uncomfortable conversations you will be having with half the clients you take on. It should be addressed before they are ever allowed to enroll and the rules should be made very clear, so that they understand that this is a line that should never be crossed.

In addition, remember that there are children who have less than healthy immune systems because of poor diet, lack of activity or other factors. These children can contract illness every time the play in the mall play area, go to the gym with mom or sit in a shopping cart. It is important to communicate with parents who have children who are frequently ill and educate them on high risk behaviors and ways to end the illness cycle. It is also appropriate to keep an illness log and refer a parent to their pediatrician if their child is having constant or chronic illness symptoms.

Finally, do not allow a parent to diagnose or convince you their child is fine according to the doctor. If they want to return to care, you do not have to make exceptions to your exclusion policy without an exact diagnosis from the doctor. Do not accept a generic doctor’s note when a child is ill. If the parent refuses to provide a doctor’s form with the diagnosis, incubation period and period of contagion, then simply enforce the maximum exclusion period, which is 48 hours with no symptoms whatsoever, and no medication. They don’t have to agree to provide the form, but you don’t have to agree to let their child through your front door without it. You decide who is safe to be around the other children. Doctor’s orders do not hold any legal weight and you cannot be forced to accept a sick child into care no matter how many doctor’s notes the parent shoves in your face. If you suspect a child has been medicated and dropped off, separate the child until you are sure they are illness free.

Last December I terminated a child who had been coming to daycare sick repeatedly, and every time I had to argue that explosive diarrhea is not normal. Mom just kept laughing it off and telling me “That’s just how her poop is.” As a result, I constantly had other children coming down with a stomach virus within 48 hours of her being dropped off sick. Since their termination there hasn’t been a single child in my daycare come down with a stomach virus in 5 months. Although it hurt to lose the income, I have no regrets about getting the germs out of my house. It is my job to guard the well-being of every child in my care, and it is a job I take seriously.