Sick Kids From A Physician's View

[nanglgrl]

I tried really hard not to post but couldn't help myself and ended up posting multiple times. Ugh, I'm so mad. Every day we see the posts and articles about how expensive daycare is but now we also want providers to take sick children? The same providers that are lucky to make minimum wage when you count all of the time outside of daycare spent cleaning, shopping and planning. Not to mention all of the times we have to go to a doctor or get a prescription for us or our families because of "teething" or "allergies" that were brought in by a daycare child.
We once had a child with headlice make it in to daycare. I sent him home and treated my family and house. He came back and I realized an hour later that he still had it so I had to re-treat everything and spend all of that time dealing with it. It ended up costing me more than I even made watching the child that week. The same thing has happened with HFM when my child got painful sores in his mouth and could barely eat and colds that turned into bronchitis. In some instances it cost me to watch the child after you took what I made and deducted what the illness ended up costing my family.
I now have strict illness policies and I don't remember the last time I sent a child home for illness. On top of that the children in my care stay home on an average of 3 days a year because of illness but in those cases their parents kept them home and sometimes for mild symptoms but only because they didn't want to take the risk of spreading illness and having to find new daycare.
Parents need to understand that when they pay for group care they are paying for a portion of our time. 8 children = 1/8 of my time and after cleaning up and sanitizing after that one episode of diarrhea or vomiting you've used up your time.
I know I'm ranting. I've probably said the same things previous posters have mentioned but ugh, I'm so mad!

[NightOwl]

I tried really hard not to post but couldn't help myself and ended up posting multiple times. Ugh, I'm so mad. Every day we see the posts and articles about how expensive daycare is but now we also want providers to take sick children? The same providers that are lucky to make minimum wage when you count all of the time outside of daycare spent cleaning, shopping and planning. Not to mention all of the times we have to go to a doctor or get a prescription for us or our families because of "teething" or "allergies" that were brought in by a daycare child.
We once had a child with headlice make it in to daycare. I sent him home and treated my family and house. He came back and I realized an hour later that he still had it so I had to re-treat everything and spend all of that time dealing with it. It ended up costing me more than I even made watching the child that week. The same thing has happened with HFM when my child got painful sores in his mouth and could barely eat and colds that turned into bronchitis. In some instances it cost me to watch the child after you took what I made and deducted what the illness ended up costing my family.
I now have strict illness policies and I don't remember the last time I sent a child home for illness. On top of that the children in my care stay home on an average of 3 days a year because of illness but in those cases their parents kept them home and sometimes for mild symptoms but only because they didn't want to take the risk of spreading illness and having to find new daycare.
Parents need to understand that when they pay for group care they are paying for a portion of our time. 8 children = 1/8 of my time and after cleaning up and sanitizing after that one episode of diarrhea or vomiting you've used up your time.
I know I'm ranting. I've probably said the same things previous posters have mentioned but ugh, I'm so mad!

Now THAT was a rant nan!! Good job! Notice she hasn't responded since we all jumped on the bandwagon?

[Shell]

Dr. Claire McCarthy,

My name is Tori Fees. I’m a Registered Nurse and veteran child care provider. I have cared for kids in the capacity of private nanny, elementary school nurse, and home child care provider for thirty years.

I came upon your article “Why Sick Kids Should Be Allowed at Daycare” published by Huffpost. As a veteran and expert child care provider, I feel it is important to address your publication as it speaks to many of the common misconceptions Physicians have regarding admittance into child care after the child has been excluded by a school, child care center, or home child care. My hope is that you will reconsider some of your viewpoints when you hear some of the concerns from the ladies on the ground who are caring for multi-level aged group children in these settings.

Each licensed and registered child care providers have illness policies. Every state in the U.S. requires that guidelines are set to differentiate an excludable illness and a “mild” or “minor” illness. Independently owned child care providers have the blessing and burden of developing their own policies that must at least meet the minimum standards set forth by their respective state. I’m certain you have come across variations in the policies of the privately owned child care services.

When a parent brings a child into your office, you may not be aware of what the child care policies are. Fortunately for you, you don’t have to know the specifics as your job is to simply diagnose the child and provide treatment should it be deemed necessary. The parent may ask you to provide a “return to daycare” note but you are not required to do so.

Your article laments on the frustration you feel when parents access expensive treatment such as emergency rooms and urgent care clinics for minor illnesses solely for the purpose of obtaining a return to daycare note. I agree wholeheartedly that these very expensive medical services should not be utilized for this purpose if the child is experiencing a mild illness. Remember that the parent is the one choosing to access this level of care. You would be hard pressed to find a child care provider who would encourage a parent to go to this extreme. It is likely the cost of the services in these expensive care centers far exceeds the salary loss the parent will endure while missing a few days of work. If the parent is given free or near free access to these services and chooses to utilize them for minor illness, there should be a swift and immediate financial recourse to recoup the unnecessary expense. As long as it is free or near free this practice will continue. I encourage you to use your position to campaign for financial accountability when these services are being misused.

When a parent accesses medical care for the purpose of obtaining a “return to child care” note the first question you need to ask is if the child care asked for one. It used to be standard practice to ask your opinion but that is no longer the case. Providers across the country have had SO many bad experiences with these notes that they have changed their requests to ONLY a diagnosis, determination of whether or not the child is communicable, and documentation of any treatment you may prescribe. There is also a high likelihood that the parent wasn’t asked to take the child to the doctor. The child may have been excluded based on symptoms observed by the provider and was simply excluded until the symptoms are no longer present within a certain time frame. There’s a good chance that a recommendation to seek medical care for the symptoms wasn’t requested.

Often, a parent who has received an exclusion comes to you because they want you in the middle of the “no” they have just received. They misunderstand our relationship because they believe your determination would somehow trump ours. It doesn’t.

Child care providers don’t work with or under your license. We can’t rely upon your determination for return to daycare because you don’t know our population. You can’t possibly know what children are in attendance in our care. You don’t know if we have newborns, children with compromised immune systems, special needs children, new children to the child care, or children who have been out on vacation. You don’t know whether or not the children in attendance have even met your patient. You don’t know if the children have been exposed before diagnosis and whether or not the illness could have devastating affects on one when the effect on your patient is minor. You don’t know if repeated exposure will increase the likelihood of infection.

We can’t rely upon your determination for return to daycare because we aren’t a part of the history you take on the child before the exam. We don’t know if the parent has been truthful to you when giving an oral account of the child’s condition. We don’t know if the child’s fever has been masked with antipyretics before coming into your office. We don’t know if the parent has minimized the account of the excludable symptoms by words such as “spit up” instead of “vomit”, “loose poop” instead of blowout diarrhea. We don’t know if the parent is attributing the symptoms to something he ate, undiagnosed allergies, or the infamous “teething” used in nearly every parental diagnosis.

The other parents of the children attending child care with a sick kid aren’t going to be bummed out when they find out your patient is attending with a fever. They are going to find another daycare. Parents are very concerned about the health of the other children BEFORE their child becomes ill. Once their child becomes ill the concern for the health of the other children wanes dramatically. That lack of concern often drives them to your office to ask for you to intercede and remediate the decision of the provider. There are some exceptional parents who have consistent concern regardless of what child is ill but they are becoming extremely difficult to find.

You are correct that children in child care have more viral illnesses than children who don’t attend child care. Have you ever considered that the reason for this is that the parents of the children attending day care are bringing their kid in for your return notes when parents of kids who are not in child care don’t access medical care for the same symptoms? If you stop offering return notes you may find the statistics change dramatically.

If you truly believe the illnesses are minor and the child should not be excluded maybe you should consider offering the child to hang out in your office the next day. Put him squarely in the middle of the waiting room lounge where the “well child” visit kids are. When the well child’s visit is over let their mothers know that the kids sharing their space were excluded from daycare because of “minor” illnesses like one vomit, a little fever, a diarrhea bout that’s on the tail end, and a slight case of pink eye. The mothers will be bummed and they will find a new doctor.

If you really want to make a difference and are willing to become involved in this vicious cycle of exclusion the best thing you could do would be to counsel parents on the average number of illnesses young children get per year. Explain to them that they are going to have to miss work because their kid is most likely going to get sick often. Encourage them to use their precious paid time off wisely. Tell them to not be tempted to squander their paid time off with “me” days. Tell them to **** it up and go to work when they are mildly ill so they have the time available to care for their baby when he is mildly ill. Tell them it is better for them to go to work amongst other adults with their mild illness than to send their mildly ill kid to daycare with other babies.

If you want to make a difference, put in writing that you will assume all liability if another child in the child care contracts the illness. Put in writing that you will cover the cost of the missed days of work the provider will have if she contracts the illness. Put in writing that the child care providers children can be cared for by you free of charge while you are at it.

Fever is the number one indicator of health and it is masked with a nickel worth of medicine. If you want to make a difference, test for the presence of antipyretics in the child’s system. Do not take the parents word for it. Let your client know that you will ask and you will check. Google “dope and drop” and get a real education of how providers are deceived by parents to buy time through nap time or a day of daycare. Realize that not only are we the unwilling victim of deception but you are too. It happens a lot. If you start testing for it you will write far fewer return notes in your future.

The things that would really make a difference you won’t do. It’s easy to write a return note. It’s easy to please your customer. It makes you money. It’s hard to tell a parent you can’t recommend return either way because you don’t have the information you need to make a decision and you don’t want the liability. Encourage them to find a provider with illness policies they agree with rather than use you to intercede when the illness exclusions they agreed to before enrollment are enforced.

Better yet, stay out of the return to daycare notes business. It’s not your job to make sure a parent keeps their job. Just offer a diagnosis, whether you deem the illness as contagious, and the treatment you are giving the child. That’s all we need.

If a child care provider or school asks you to give a determination then by all means, accommodate them. Make sure you are actually being asked before you offer it. Most child care providers can determine the return time on their own. Their policies are in place for a reason. With your diagnosis and declaration of contagiousness, we can make our own decisions on a case by case basis. If you have any questions feel free to call the provider. Maybe a few conversations with the ladies on the front lines will change your prospective a bit. I hope mine has.

Sincerely,

Tori Fees R.N., B.S.N.

This is very articulate, very to the point, and really speaks to our (providers) side of the illness debate. Nice work! happyface

[Little Buttons]

I can't even with this article...

Does the Doctor author not realize some of these decisions are not even ours to make?

Maybe this Doctor should open a sick child care facility so all of the working parents can have the "support" they need.

I am so over the ever so common argument lately that everyone else needs to accomodate for parents who do not want to be parents when things get tough. No one ever promises you that parenthood is easy....children get sick, **** it up buttercup!

[granny04]

Sick kids at daycare

I read the article in the Huff--okay doc--I get part of that.
I also have a home day care where a parent (who worked for The World Health Organization) doped his twins up when they were sick and sent them to day care. By the time the meds wore off it would be naptime. Then by the time the parent finally managed to get there to pick up the child--WOW! It was almost "day over"!! These were kids who spiked fevers of 102 while playing this little game.

My issue is this--almost everyone has Sick days, personal days, and vacation days at their jobs. I have parents who will use a whatever day from work to stay home and wrap Christmas presents so the kids aren't there???? but would balk at picking up a sick child when I called! Take a day off work for "ME" time......but come get the child?!?!?!
I agree with the other comment----they choose to have the children---choose to let someone else raise them ---- and then give grief to the person trying to do the best job for all concerned.

The problem with the DOC is--he's accustomed to having a room full of sick people all day--desensitized is the word I think.

On the plus side--MOST of my parents for the past 10 years have been of the other type---they keep the child home if ill--and hurry to get them if I raise a doubt about them being here. THANK GOODNESS!!!

[saved4always]

Great post NannyD!


Parent picks up sick child from DC goes to doctor irritated about leaving work, parent complains about DC, Doctor writes article. ::

I will not post on her FB...so difficult!

Yep! This is exactly how her article happened!

[nannyde]

I don't get why the docs just don't get out of the business of writing them. The docs are educated. They want their cake and eat it too. They want the quick office visit and the happy customer who gets the note.

If they did just the visit and no note the parent would stop coming to them with the minor illness. That would hurt their bottom line.

It takes TIME to counsel a parent on transmission of illness, how many sick days to plan on for the average kid, and warning to be frugal with the days the parent takes off. Those are icky convos and they are going to have to sit thru the crying and pissed off arguments they WILL get when this generation gets a no.

That is exactly why they get in the middle of it. Get in... get out.... get paid.

[allsmiles]

i am REALLY appallled by this seeing that I am a new provider (2 years) and my trying to be flixible and helpful to parents work schedule and accepting excuses caused a spread of stomach virus and a few pink eye cases in my daycare and family. In both cases once i FINALLY insisted the parent go to the dr for something they felt was allergies or growth spurt, the child turned out to be sick. By the time i got my backbone and enforced what STATE REGULATIONS required, it was too late.

Now I understand a note sometimes seems a waste of time to him, but as someone else said before I require a note only after a long stint of symptoms and nobody has had to bring back one yet WHY? because the child WAS sick

[nannyde]

i am REALLY appallled by this seeing that I am a new provider (2 years) and my trying to be flixible and helpful to parents work schedule and accepting excuses caused a spread of stomach virus and a few pink eye cases in my daycare and family. In both cases once i FINALLY insisted the parent go to the dr for something they felt was allergies or growth spurt, the child turned out to be sick. By the time i got my backbone and enforced what STATE REGULATIONS required, it was too late.

Now I understand a note sometimes seems a waste of time to him, but as someone else said before I require a note only after a long stint of symptoms and nobody has had to bring back one yet WHY? because the child WAS sick

I was thinking back on the last year or two and I can only think of twice when I asked for a diagnosis from a doc. Both were breathing issues and one I was right and one was nothing.

The one I was wrong.was a tiny newborn and he was making a breath sound I had NEVER heard before. It scared the be$hit out of me. The parents brought him right back and the doc was right. There was nothing wrong. I just didn't know what else to do.

Other than that I haven't asked for doc visits. If the parent asks me what I would do then I tell them what I would do as a mom. As a child care provider, I only ask for a visit if it's serious.

Now I have had LEGIONS of times where parents have taken their kid in to undo an exclusion. Countless. I have even had sick kids I didn't exclude who have been taken to the doc on Sunday to get a note so they could come Monday with excludable illnesses.

I tell the parent the same thing... if the kid has x symptoms they are excluded regardless if they are concomitant with allergies, teething, blocked tear duct, or ear infection.

[Sugar Magnolia]

She seems extremely anti-daycare.

She can afford nanny care. And for those that can't......let them eat cake. That logic worked really well for Marie Antoinette, didn't it?

[KiddieCahoots]

"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."

says it all.

I grew up with my mom doing DC before I was even born. She and Dad, as well as us kids, were exposed to all kinds of c.r.a.p. While I concede the fact that maybe good genes are part of the reason, I still say that it's BECAUSE of being exposed to all the c.r.a.p. that NONE of us are ones to get sick more than once every 10 years. I've done DC 20 years, and have called off twice - about 15 years apart. And only for one day each.

Not flaming you
Just saying that you and your family were lucky to have the exposure to germs work for you.
My first three were around before I did day care and are healthy as horses.
My last two that were present while I did day care, were sick when they started school, even to the point of being held back for absences, and are still always sick.
Exposure to germs can still go both ways, and think your more correct about the good genes factor, vs. that doctors article.

[craftymissbeth]

Not sure why she singled out my comment as the one to respond to.

I want her to respond to the other issues with her article.

[Blackcat31]

Not sure why she singled out my comment as the one to respond to.

I want her to respond to the other issues with her article.

link please.......

[craftymissbeth]

link please.......

Oh, it's the Facebook link from the first page of this thread. I THINK one of the Vaca ladies posted it

[nanglgrl]

Not sure why she singled out my comment as the one to respond to.

I want her to respond to the other issues with her article.

I thought that was odd also. She's just going to keep responding by rewording what she said in the article and is too full of herself to admit otherwise. She said that she knows when parents are lying by the exam, I call bull. Even a 20 minute exam isn't going to show if the parent gave the child fever meds and besides that she doesn't know these people, at least not like we do, and you can't tell if people are lying until you've gotten to know their regular habits of speaking and acting. I wish she'd respond to nanny d but she can't because nanny was spot on and there is no response other than "I never thought of it that way" which this woman would never say.