Perhaps because of my dual roles as both a pediatrician and the owner of a child care center, I find myself asked about the unwanted sharing of germs and how best to limit the spread of infection more than just about any other aspect of child care. I fully understand this parental concern, since having a sick child has such a predictably large impact on both children and parents alike. That said, I determined long ago that none of us gets total say in what our children learn to share in the process of becoming socialized. While learning to share one’s toys with one’s friends is a universally desirable outcome for preschoolers, the sharing of germs inherently takes place as well.

While I may  seem like the bearer of bad news, the fact of the matter is that not all germ-sharing is bad, and there are very reasonable things that can be done to limit the spread of germs and infection in child care.

First, let’s address the issue of having your pediatrician tell you that your child is sick due to his attendance in child care. The reality is that whereever children (and adults, for that matter) come in close, repeated, and/or frequent contact with those who are sick, especially during cold and flu season – whether it’s in child care, on an airplane, or at the grocery store – there’s bound to be sharing of germs. This undesirable sharing of germs becomes even more likely for those who are not skilled at keeping their mucus and/or saliva to themselves. By definition, this includes all young children, since they all have the inconvenient yet quite predictable tendency to put everything in their mouths, fingers in their noses, forget to cover their coughs and sneezes, or wash their hands.

Now to the good news, or at least the silver lining, when it comes to child care and illness. You can take research-supported comfort in knowing that not only have studies shown that the frequency of illness decreases after a child’s first full year of attendance in child care, but children who attend child care end up getting sick less often as kindergartners. And while further study is needed, there even seems to be an association between child care attendance and a decreased risk of asthma.

Finally, I would be remiss as a pediatrician if I didn’t conclude  by emphasizing that there are plenty of realistic and proven-to-be-effective measures or practices that both parents and child care providers can model, teach and reinforce in order to minimize everyone’s likelihood of getting sick. They include:

• Wash your hands. When it comes to staying healthy, washing one’s hands with soap and water is a hugely important life skill that can easily be taught and consistently reinforced both at home and in the early education setting.
• Cover your cough…..or sneeze, and preferably in a tissue or with your arm rather than using your hand. This can significantly limit the spread of germs that inevitably takes place when germs settle on hands.
• Vaccinate. Making sure that both your children’s and your own immunizations are up-to-date is one of the single best ways to protect against disease-causing germs and illness.
• Disinfect contaminated surfaces. We know that illness-causing germs can live for hours on surfaces. That means that a door handle, a used tissue set on a table or countertop, or a toy that has made its way to the mouth of a child can all serve to spread germs unless effective and targeted methods such as the use of disinfecting wipes and/or appropriately diluted bleach cleaner are routinely put into practice.
• Limit exposure. While you simply can’t eliminate all risk of exposure to illness-causing germs and still venture out in public – especially during cold and flu season – parents can definitely do their part by keeping children home when sick in order to minimize exposure of others. Also check to make sure that your child care has in place (and follows) policies in place for managing infectious diseases, including appropriate exclusion criteria for when to send a child home, in order to minimize the spread of infection.

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