Will my child be sent home for cough, runny nose? What to know about day care guidelines during COVID-19

As schools make the difficult decision to go virtual or attempt in-person learning, child care providers are left to create their own blueprint for a safe reopening with little guidance from federal agencies and local health departments.

Most child care facilities adhere to guidelines from the Centers for Disease Control and Prevention that say children shouldn’t be admitted to a facility if they have a fever of 100.4 degrees or “other signs of illness.”

But now that flu, cold and allergy season are almost here, pediatricians and child care experts said “other signs of illness” are almost inevitable at these facilities.

“We have families where parents are working outside the home or have a real need to focus on kids in school virtually," said Colleen Kraft, a pediatrician at Children’s Hospital Los Angeles.

So what are parents supposed to do?

Can my child go to day care with a runny nose? A cough?

A runny nose and cough are common symptoms of many childhood illnesses and seasonal allergies.

Kraft said context is key. If a child comes from a household where family members have been infected by the virus, that runny nose could be a symptom of COVID-19. This is why most child care providers will survey the child or parent when they arrive at the facility.

“We like to do health assessments when children are getting to the door,” said Amber Horton, the regional manager for Learning Care Group’s Great Lakes region. “Do all the health questionnaires with the parents right there on the spot.”

Horton says the teacher and staff will monitor a child throughout the day if symptoms develop throughout the day. If they’re concerned, they’ll separate the child.

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While child care providers say they won’t request a parent pick up their child in the middle of the day, they will notify the parent of the child’s symptoms and advise they see a pediatrician or primary care doctor.

As parents, teachers and doctors navigate child care during a pandemic, Laura Jana, a pediatrician and previous Primrose Schools Franchise owner, says good communication is essential.

"That’s what puts us in the position to allow child care to continue safely and realistically, and be prepared for whatever this virus throws at us," she said.

Sarah Redgrave, vice president of Center Operations for KinderCare Education, said the organization has always had a policy of notifying families if there’s an illness in their child’s classroom, however, Learning Care Group says a runny nose, cough or fever alone is not something they would typically communicate to all families.

“Children with a runny nose should be able to stay particularly if they’re over two years of age and if their masks are worn,” Kraft said. Some providers don’t require children under age 5 to wear masks.

If children aren't old enough to wipe their nose, they will be instructed to wash their hands right after, a spokesperson with Learning Care Group said. If they're not old enough to wipe their own nose, staff will step in wearing gloves and wash their hands afterward. 

When can my child return to day care after a fever?

Most child care providers are doing temperature checks and will not allow a child to enter the facility with a temperature above 100.4 degrees, as recommended by the CDC and most local health departments.

Other facilities have a lower threshold and send children home with a temperature above 99.7 degrees.

Most providers don’t require a child to take a COVID-19 test as testing is still not widely available in some parts of the country. However, they do require that children be fever-free without medication for 24 to 48 hours, or more depending on local health department guidelines.

These fever policies were in place in most day care centers before COVID-19; however, they've heightened procedures to include anyone entering the building including staff, children, families and vendors. Staff conducting these temperature checks must wash their hands, put on gloves and have a cloth face covering. 

According to Learning Care Group, health checks are also conducted throughout the day to ensure the child's well-being.

Horton and Redgrave also refer to local health department guidelines if a child tests positive for COVID-19. Most health departments follow CDC guidelines that say a person should be quarantined for at least 14 days and symptom-free.

Some providers temporarily close the center for up to 72 hours to clean and disinfect the building. Almost all programs say they notify parents when there’s a positive test in the school but they exclude identifying information to maintain the child’s privacy.

“The emphasis continues to be transparency and sharing and partnering with parents,” Jana said.

Masks, hand-washing and social distancing: What else is there to know?

Almost all child care providers say all adults in the facilities will wear masks throughout the day.

Depending on age, some children will be asked to wear masks, especially in common areas. In some cases, parents can write a letter saying their child will not wear a mask if they have prior issues with respiratory health, or if they're not able to put on masks by themselves. 

Frequent hand-washing has always been enforced in child care programs even before the coronavirus pandemic. However, social distancing has forced facilities to become more creative, especially with younger children.

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Some classrooms are grouped into pods, teachers are assigned to a specific room and are not allowed to mix with other classrooms. Many child care programs have also established staggered pick-up and drop-off times, socially distanced nap times and scheduling playtimes with enough time to disinfect outdoor play structures.

While these policies are in place for the moment, pediatricians and child care programs say it’s important parents stay flexible and understand that these guidelines might change as scientists learn more about the virus.

“It’s a difficult decision for a lot of parents,” said Dane Snyder, a primary care physician at Nationwide Children’s Hospital. “My best advice is to learn what’s going on locally, be ready to be flexible and just ask a lot of questions.”

Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT. 

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.