Aseelah El-Amin is a self-proclaimed germaphobe. When the Atlanta mom was looking for daycare for her 18-month-old daughter, she visited many child-care centers, always asking the directors lots of questions. She asked how they kept toys clean, what the policy was about sick kids, and how they worked to fight germs.

"I knew that when children start daycare, they got sick a lot," she says, "so I was really picky."

She found a place near her home where germ fighting was a top priority. The staff had children take off their shoes in a small room before coming inside. Toys were cleaned every day with natural cleaning products. Parents were given a list of symptoms -- such as diarrhea and pinkeye -- that meant sick kids had to stay home.

Like El-Amin, you may be concerned about germs, hygiene, and sanitation when choosing a daycare center. Then your worries may surface again when cold and flu season starts. That's when you may notice kids with runny noses and coughs playing side by side with your child.

These concerns are very valid, says pediatrician Sheldon Berkowitz, MD, medical director of the General Pediatrics Clinic at Children's Hospitals and Clinics of Minnesota in Minneapolis. "Daycare is a festering ground for bacteria and viruses," he says. "It's so many small kids in a small space together."

Questions to Ask About Germs

Sick kids and daycare may go hand in hand, but Berkowitz says there's plenty you can do to make sure your child-care center is doing its best to keep the cold virus and flu virus -- as well as assorted bacteria -- under control. Start by asking some of these questions.

How often do employees wash hands?

Daycare workers can't wash their hands enough, Berkowitz tells WebMD. He says the best centers should require employees to wash their hands as often as a doctor does -- in between touching every child.

If your child-care center doesn't have a sink in every room, look for  bottles of hand sanitizer. If employees have to leave the room to clean their hands, they may be less likely to do it.

How clean are the toys?

Many centers have a policy that toys are cleaned and sanitized at least once a day. Guidelines from the American Academy of Pediatrics, however, suggest that every time a toy is placed in a child's mouth, it should be set aside until it can be cleaned and disinfected.

What's the policy on sick kids?

No parents want their child playing next to a child with a fever, pinkeye, or the flu. At the same time, if you have a busy day at work, can you afford to stay home because your child has a cough?

Policies on when sick children should stay home differ among daycare centers. According to joint recommendations by the American Academy of Pediatrics, the American Public Health Association, and the National Resource Center for Health and Safety in Child Care and Early Education, a child should temporarily be kept out of daycare for:

• A fever above 101° F (checked orally) accompanied by behavior change or other symptoms (sore throat, rash, vomiting, diarrhea, etc.)
• Diarrhea that can't be contained in a diaper or that makes a toilet-trained child incontinent
• Vomiting more than two times in a 24-hour period

Some centers may be more or less lenient than others. While some may not even allow a child who is sneezing to attend, others allow many types of sick kids but separate them in a different room.

"If a child's not feeling great, do they isolate them or give them attention?" Berkowitz asks. "They need to be doing both."