I see it all the time at our practice. Parents come with kids who really don't need to go to the doctor; they are only mildly ill, or already getting better. When I ask them why they came, the answer is simple: daycare.
They need a note saying the child is better in order for the child to go back. They need a note saying that a rash isn't contagious. They need an ointment for the eye infection that is probably a virus (or allergies) and doesn't need treatment -- because they can't go back without it. They want me to find a way to make the little fever or the last bit of diarrhea go away (which I can't do, sadly) because until it does, they can't go to work.
For me as a doctor, it's kind of nuts -- and not the best use of anyone's time, let alone health care dollars.
In a study just published in the journal Pediatrics, 88 percent of parents who have kids in daycare reported that they took them to the doctor when sickness kept them from daycare. Of those, 30 percent went because they needed a note -- and many of them went to an emergency room or urgent care site (which costs more) instead of their primary care doctor, because they needed that note fast in order to get back to work.
This doesn't really make sense.
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. Given that these things happen fairly often in little kids, this can mean a lot of missed days from work for parents.
For many families, that's a very real hardship. I've seen parents lose jobs. I've seen families make really dicey childcare decisions with sick kids because they felt that they had no other choice -- or take them to work, which rarely works out well.
I get that daycares need to think about the health of the other kids there. I can see other paying parents bumming out about having a kid with a fever playing with their well child. 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 (hence the getting more illnesses at daycare).
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 American Academy of Pediatrics (AAP) says that the two most important questions we should ask in deciding whether a sick child should go to daycare are:
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?
If the answer to either one is yes, the AAP says that the child should stay home. They do add a third question: Could other children get sick from being near the child? But they point out that most illnesses aren't harmful -- and that keeping a child home doesn't necessarily stop others from getting it.
If we really want to support working families, then we are going to have to tackle this problem. We need to find a way to change the culture of daycare and understand that minor illnesses are part of life -- and very much part of early childhood.
We need to find a new middle ground, one that takes care of not just children, but families.