More parents are leaving their children in day care than ever before: According to the Bureau of Labor Statistics, about 65% of women with children under the age of six were part of the labor force in 1998, compared with only 44% in 1975. And more women working means more kids in day care. At least 5.8 million children under age five are in out-of-home child-care facilities, according to the Urban Institute's 1990 National Child Care Survey.
It's no surprise, then, that as the number of kids in day care rises, so does the number of illnesses among those children. However, despite the fact that many studies have shown a link between day care and a greater tendency toward illness in early life, doctors say the bigger picture is not yet clear. "There is little question that day care before the age of two predisposes children to illnesses of the upper and lower respiratory tract," says Juan Celedon, MD, an instructor in the Department of Medicine at Harvard Medical School and a research fellow at Brigham and Women's Hospital. "But we don't yet know the long-term impact of illnesses in early childhood, and that's a very important question. It's possible that some of the infections may be [harmful] and some may be protective, but that is largely unknown."
Until the research can demonstrate which of these illnesses are detrimental, there are basic health guidelines that all day-care facilities should be following to protect young children -- whose immune systems are still developing -- from dangerous illnesses.
Any child-care facility should ask to see your child's immunization records, says Ralph Cordell, PhD, an epidemiologist with the Centers for Disease Control and Prevention. Likewise, you should make sure that all people at the day care have been properly immunized. If your child is at a child-care home (located at the provider's residence and usually with 12 or fewer kids), check up not only on the provider but also on anyone else living in the house, asking to view the records yourself.
The child-care center should also provide you with its policy, in writing, on keeping sick kids out of day care, says Cordell. Children with diarrhea or respiratory infections should not be around other kids. The American Academy of Pediatrics recommends keeping children who have fevers out of day care. (The National Health and Safety Performance Standards have a looser recommendation: Children with fever should only be kept out if they also show some other sign of illness.) Find a provider whose policy you can agree with and who takes the kids' health seriously enough to write it down, says Cordell.
It may also be worthwhile to talk to your child's caretaker about their enforcement of these policies. A March 1999 Archives of Pediatrics and Adolescent Medicine study reported that children in child-care homes were more likely to be sick than those in child-care centers. Researchers attributed this in large part to the fact that while both types of day care had similar exclusion policies, providers in child-care homes were more lenient in accepting mildly ill children at the beginning of the day.
Good old-fashioned cleanliness can go a long way in keeping a child healthy. First, make sure the day care has proper hand-washing arrangements. "The more sinks the better," says Cordell. "Ideally, there would be one sink within arm's reach of the diaper table and a second one that's used for kid hand washing in the room." The sink used to wash dirty dishes should also be completely separate. Also, the day care should require parents to wash their children's hands right after dropping them off, which will significantly decrease the number of germs spread.
In addition to keeping your child as healthy as possible, you want to ensure your child's basic safety at day care. Make sure that background checks have been done on all providers and on anyone in a day-care home. You should also ensure that the day care has a secure system in case someone else needs to pick up your child, says Cordell (for example, a system that authorizes only certain family members or close friends to retrieve your child when you are not able to). If you have an infant, make sure that the providers put the babies to sleep on their backs, which can decrease their risk of sudden infant death syndrome (SIDS).