Tag: croup

Can Your Sick Child Still Go to Daycare or School?

There are a lot of different rules that dictate when kids can go to daycare or school when they are sick.

Kids don't always have to stay at home from daycare or school when they are sick.
Kids don’t always have to stay home from daycare or school when they are sick.

The actual rules of your daycare or school are the ones that you are likely most familiar with, but there are also recommendations from the American Academy of Pediatrics and the CDC, in addition to  state-specific regulations.

Can Your Sick Child Still Go to Daycare or School?

Most people know to stay home when they are sick.

“Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness. Avoid close contact with people who are sick.”

CDC on Information for Schools & Childcare Providers

But what exactly does it mean to be “sick” and how long are you supposed to stay home and avoid other people?

“Most minor illnesses do not constitute a reason for excluding a child from child care, unless the illness prevents the child from participating in normal activities, as determined by the child care staff, or the illness requires a need for care that is greater than staff can provide.”

Recommendations for Inclusion or Exclusion (Red Book)

In general, your child does not need to be kept home and out of daycare or school if they are able to participate in routine activities, do not need extra care, and have:

  • a cold (unless they have a fever) or other upper respiratory infection, even if they have a green or yellow runny nose
  • RSV (unless they have a fever)
  • croup (unless they have a fever)
  • diarrhea that can be contained in a diaper or the child can make it to the bathroom without having an accident, as long as they aren’t having more than 2 stools above their usual or stools that contain blood or mucus
  • a rash without fever – most skin rashes won’t keep your kids out of school, like if they have poison ivy, hives, or even molluscum contagiosum and warts
  • Fifth disease – interestingly, you aren’t contagious once you have the characteristic Fifth disease rash
  • head lice – why not keep kids out of school if they have lice? It doesn’t stop them from spreading. They can get them treated at the end of the day.
  • pinworms – like lice, keeping kids out of school with pinworms isn’t going to stop them from spreading, although kids should be treated
  • pink eye – if caused by an infection, in general, should be able to stay or return if is improving, but keep in mind that most experts now think that kids with pink eye do not need to be excluded from daycare or school at all
  • oral lesions and are able to contain their drool (unless they have a fever), which would include hand foot mouth disease
  • skin lesions that can be covered, and if they can’t, then they can return after they have been on antibiotics for 24 hours (impetigo) or have started treatment (ringworm)
  • strep throat and have been fever free and on antibiotics for 24 hours
  • scabies – if you have started treatment
  • a sore throat (unless they have a fever)

Why don’t you have to keep your kids home when they have RSV or many of these other common childhood diseases?

In addition to the fact that some kids would never get to go to daycare or school, since these diseases are so common, many kids continue to be contagious even after their symptoms have gone away. So excluding them doesn’t really keep the illnesses from spreading through the daycare or school.

So why not just send them when they have a fever or really don’t feel well?

In addition to the possibility that they might be a little more contagious at those times, it is because the typical daycare or school isn’t able to provide the one-on-one care that your child would likely need when feeling that sick, as your child probably isn’t going to want to participate in typical group activities.

Policies that are overly strict at excluding children from daycare and school may also lead to antibiotic overuse, as parents rush their kids to the doctor for and push for a quick cure because they need to go back to work.

Exclusion Criteria for Vaccine Preventable Diseases

While the exclusion criteria for many diseases simply extends to when your child is fever free, starts treatment, or feels well enough to return to daycare or school, for many now vaccine-preventable diseases, you will be excluded (quarantined) for much longer:

  • hepatitis A virus infection – exclusion for one week after illness starts
  • measles – exclusion until four days after start of rash
  • mumps – exclusion until five days after start of parotid gland swelling
  • pertussis – exclusion until completes five days of antibiotics or has had cough for at least 21 days
  • rubella – exclusion until seven days after start of rash
  • chicken pox – exclusion until all lesions have crusted
  • diphtheria – if survives having respiratory diphtheria, would likely be excluded until finishes treatment and has two negative cultures at least 24 hours apart
  • rotavirus – as with other diseases that causes diarrhea, children should be excluded until “stool frequency becomes no more than 2 stools above that child’s normal frequency” as diarrhea is contained in the child’s diaper or they aren’t having accidents
  • tetanus – if survives having tetanus, wouldn’t be excluded, as tetanus is not contagious

Unfortunately, kids are often contagious with many of these diseases, especially measles and chicken pox, even before they have obvious symptoms, which is why large outbreaks used to be so common.

Children will often be excluded from daycare or school if they are unvaccinated or not completely vaccinated and they are exposed to a vaccine-preventable disease.

More on Sending Your Sick Child to Daycare or School

 

It’s Not Always the Flu When You Get Sick During Cold and Flu Season

We hear a lot about flu season.

It typically starts in late fall, peaks in mid-to-late winter, and can continue through early spring.

Cold and Flu Season Viruses

It’s important to understand that a lot more is going on, and going around, during flu season than just the flu.

That’s why it is likely more appropriate to think of flu season as just a part of the overall cold and flu season that we see during the late fall to early spring.

During cold and flu season, in addition to the multiple strains of the flu, we see diseases caused by:

  • respiratory adenovirus – can cause bronchitis, colds, croup, viral pneumonia, pink eye, and diarrhea
  • Human metapneumovirus (HMPV) – can cause bronchiolitis, colds, and viral pneumonia
  • Human parainfluenza viruses (HPIVs) – can cause bronchiolitis, bronchitis, colds, croup, or viral pneumonia
  • rhinovirus – the classic common cold
  • Respiratory syncytial virus (RSV) – can cause wheezing and bronchiolitis in younger children, but colds in older kids and adults
  • seasonal coronavirus – can cause colds, bronchitis, and viral pneumonia
  • norovirus – diarrhea and vomiting
  • rotavirus – diarrhea and vomiting, was much more common in the pre-vaccine era

That there are so many different respiratory viruses that can cause bronchiolitis, colds, croup, and flu-like illnesses helps explain why some kids get sick so many times during cold and flu season.

It also helps explain why some folks think they might have gotten the flu despite having been vaccinated, especially in a year when the flu vaccine is very effective.

Is It a Cold or the Flu?

So how do you know if you have the flu or one of these flu viruses during cold and flu season?

Signs and symptoms of the flu vs a cold.
Signs and symptoms of the flu vs a cold.

While the symptoms can be similar, flu symptoms are usually more severe and come on more suddenly.

Can’t you just get a flu test?

While rapid flu tests are fast and easy to do, they are likely not as accurate as you think.

“This variation in ability to detect viruses can result in some people who are infected with the flu having a negative rapid test result. (This situation is called a false negative test result.) Despite a negative rapid test result, your health care provider may diagnose you with flu based on your symptoms and their clinical judgment.”

CDC on Diagnosing Flu

If your pediatrician is going to diagnose your child with the flu because of their symptoms, even if they have a negative flu test, then why do the test?

Rapid flu tests are usually invalid if they are positive for A and B, but many folks are told that they have both.
Rapid flu tests are usually invalid if they are positive for A and B, but many folks are told that they have both flu virus strains.

Can you test for all of the other viruses that are going around during cold and flu season?

Tests can be done to detect most cold and flu viruses.
Tests can be done to detect most cold and flu viruses.

Sure.

The real question is should you.

Like the rapid flu test, many pediatricians can do an RSV test in their office. But like many other viruses, there is no treatment for RSV and the American Academy of Pediatrics actually recommends against routine RSV testing. Whether your child’s test is positive or negative, it is not going to change how he or she is treated.

And the other viruses? Not surprisingly, there are respiratory panels that can test for most or all of these viruses. They also usually include flu and RSV.

The problem with these tests is cost. They are not inexpensive, and again, in most cases, the results aren’t going to change how your pediatrician treats your child.

And they all involve sticking a nasal swab far up your child’s nose…

What About Strep?

While strep throat can occur year round, it does seem to be more common in the winter and spring.

And while you can certainly have two different infections at the same time, such as strep throat and the flu, it is important to remember that the rate of strep throat carriers is fairly high. These are kids who regularly test positive for strep, even though they don’t have an active group A strep infection.

During cold and flu season, if kids routinely get a “strep/flu” combo test, it is possible, or even likely, that many of the positive strep tests are simply catching these carriers.

Remember that a cough, runny nose, hoarse voice, and pink eye are not typical symptoms of strep throat and are more commonly caused by cold viruses. Adenovirus is especially notorious for causing a sore throat, fever, pink eye, runny nose, with swollen lymph nodes = pharyngoconjunctival fever.

Kids who are likely to have strep throat usually have a sore throat, with red and swollen tonsils, and may have swollen lymph nodes, fever, stomach pain, and vomiting, but won’t have typical cold symptoms.

Why does it matter?

Viral causes of a sore throat don’t need antibiotics, while a true strep infection does.

And remember that none of the other cold and flu viruses need antibiotics either, unless your child gets worse and develops a secondary bacterial infection.

What to Know About Cold and Flu Season Viruses

Flu isn’t the only virus that is going around during cold and flu season. Many others can cause flu-like illnesses, croup, bronchiolitis, or just a cold.

More on Cold and Flu Season Viruses

Ten Things That Aren’t As Scary As Most Parents Think

Being a parent can be scary enough.

Don’t let these every day parenting issues freak you out even more.

Be prepared for when you child eats a bug, has a night terror, or wakes up barking like a seal.

  1. Breath holding spells – in a typical breath holding spell, a young child cries, either from a tantrum or a fall, etc., and then holds his breath (involuntarily) and briefly passes out. Although it sounds scary and the episode might look like a seizure, these kids usually quickly wake up and are fine after. Kids who have breath holding spells are often prone to repeated spells though, so you do want to warm other caregivers so they don’t freak out if your child has one. Eventually, kids outgrow having them.
  2. Febrile Seizures – parents often describe their child’s first febrile seizure as ‘the worst moment of their life.’ Febrile seizures typically occur when a fever rises rapidly, but although they are scary, they are usually brief, stop without treatment, don’t cause any problems, and most kids outgrow having them by the time they are about five years old.
  3. Nosebleeds – a nosebleed that doesn’t stop is certainly scary, but with proper treatment, most nosebleeds will stop in ten to twenty minutes (if not sooner), even if your child wakes up in the middle of the night with a bloody nose for what you think is no reason.
  4. Night terrors – often confused for nightmares, a child having a night terror will wake up in the early part of the night yelling and screaming, which is why parents think their child is having a nightmare. The scary thing though, is that their child will be confused, likely won’t recognize you, and might act terrified – and it all might last for as long as 45 minutes or more. Fortunately, night terrors are normal. Your child likely won’t even remember what happened the next morning. And they eventually stop.
  5. Eating a Bug – “Kids eat bugs all the time. Few if any symptoms are likely to occur.” – that’s a quote from the National Capital Poison Center, who must get more than a few calls from worried parents about their kids eating bugs. Or finding the evidence later – when you see a dead bug in their diaper…
  6. High Fever – pediatricians have done a lot of education about fever phobia over the years, but parents often still get scared that a high fever is going to cause brain damage or hurt their child in some other way. Try to remember that fever is just another symptom and doesn’t tell you how sick your child is.
  7. Playing Doctor – even though it’s natural for young kids to be curious about their bodies, the average parent is likely going to be scared and upset if they “catch” their kids playing doctor. Understand that it is usually a normal part of child development and don’t turn it into a problem by making it into more than it is.
  8. Hives – a child with classic hives might have a red raised rash develop suddenly all over his body. And since hives are very itchy, that child is probably going to be miserable, which can make hives very scary, even though without other symptoms (like vomiting or trouble breathing), they typically aren’t a sign of a serious allergic reaction. The other thing about hives that can be scary is that even when they go away with a dose of Benadryl, they often come back – sometimes for days, but often for weeks. And your pediatrician might not be able to tell you what triggered them.
  9. Croup – your child goes to bed fine, but then wakes up in the middle of the night with a strange cough that sounds like a barking seal, has a hoarse cry, and it seems like he is wheezing. Scary, right? Sure, but if you realize he probably has croup and that some time in the bathroom with a hot shower (getting the room steamy can often calm his breathing), you’ll be ready for this common viral infection.
  10. Choking – while choking can be a life-threatening emergency, most episodes of choking aren’t. In addition to learning CPR and how to prevent choking, remember that if you child “is still able to speak or has a strong cough” then you may not have to do anything, except maybe 911 if he or she is having some breathing difficulties. It is when your child is choking and can not breath at all (and can’t talk and isn’t coughing) that you need to quickly react and do the Heimlich Maneuver while someone calls 911.

Even with a little foreknowledge and preparation, many of these very common pediatric issues are scary. Don’t hesitate or be afraid to call your pediatrician for more help.

For More Information on Things That Scare Parents