Nursery illness policy

[Spry]

AIBU to think our nursery’s illness policy is irresponsible?

Our boy-girl twins started nursery last September, aged 8 months. They’d both been extremely healthy babies until that point. Since then however, they have been ill at least half the time - ear infections, throat infections, conjunctivitis, D&V. They’ve had numerous courses of antibiotics (including both ending up on intravenous antibiotics in hospital in December) and I seem to be in contact with the GP virtually every week. So frequent and severe were my son’s infections that he was referred to an immunity specialist who - thankfully - has ruled out any underlying problem.

Our GP said that children should never attend nursery until at least 24 hours after a high temperature has returned to normal, even if the child seems well otherwise. She said that this was to speed the child’s recovery and to minimise the risk of infecting other children at nursery. (She also said that a child with D&V should not attend nursery until at least 48 hours after the last episode.) Over the last few months, we have rigidly followed this advice. (It has been a complete nightmare in terms of my return to work - but that’s another story.)

My partner, who is usually responsible for dropping off our children at nursery in the morning (when they’re well enough to go) recently noticed that other parents were giving the staff bottles of Calpol and instructions as to when it could be administered to their decidedly runny-nosed children. I have since enquired about the nursery’s policy on illness. It turns out that they are happy for children with a fever to attend, so long as it responds to Calpol and so long as the child is not so unwell that s/he needs 1:1 care. (The policy on D&V is the same as our GP’s one.)

I can see that, if you’re a working parent, being able to hand over your somewhat unwell child to nursery can be handy in the short-term. However, I feel that the GP’s policy on temperatures is the one that is in the long-term interests of everyone as I strongly suspect it minimises the total number of infections. (This is a classic "prisoner's dilemma" situation - if my hazy memory of one of my Uni courses is correct.)

What should I do:
(a) complain to the nursery about their illness policy and seek to have it brought in line with our GP's advice? (The nursery is part of a large, international chain by the way - so I’m not sure how easy this would be in practice.)
(b) accept the policy as is but continue to keep our toddlers at home for at least 24 hours if ever they have a fever?
(c) accept the policy as is and send our toddlers to nursery dosed up with Calpol, if we think they could cope with it?
(d) remove the kids from this nursery?

I would go for (d) although my dc2 started nursery at 6 months and was ill/off every other week with hospital trips like yours until she turned 2. Now she's at a nursery with no babies ,all 2+, her illnesses have dramatically decreased. Small babies transmit illnesses very quickly and easily. If you do move them you may find you move them into a new pool of germs.

If you think you can get the nursery to re-evaluate their illness policy then have a go but I think you may be forced to find a new, more suitable nursery.

I've never heard of the advice to keep a child away from nursery for at least 24 hours after a high temperature.

On the other hand, the nursery where I work will not administer calpol or similar unless it has been prescribed by the GP for a specific illness.

If we know that children have been given Calpol before they come to nursery, we always warn parents that will will phone them if we feel the effects of the calpol have worn off and their child is no longer well enough to be at nursery.

The nursery should have a local authority document giving details of the expected response to contagious illnesses/infections etc. You could ask to see this.

Unfortunately I think the reality is if nursery changed their policy, parents would lie. I know nursery won't take DD if I say she had a temperature when she woke up, and I also know they will only give Calpol 20 minutes to take effect which isn't quite long enough. So you can imagine the temptation (assuming she is just a bit under the weather rather than properly ill) to dose her up, send her in and hope she makes it until lunchtime.

You're totally at the mercy of the other parents, a childminder might be lower risk if your dc seem to pick up everything? Having said that, starting nursery just as winter starts is probably a bit of a double whammy, hopefully summer will not bring so many bugs!

Probably worth looking at NHS guidelines as my GP thinks nurseries send kids home too fast and a high fever isn't something to worry about, if there are no other worrying symptoms.......so there is a variation in opinion. My nursery takes children who are sick and administers paracetamol and keeps a close eye.
My kid isn't sick so often but I haven't been called to take her home either.
I guess it is down to personal choice and what you want and need from a nursery. All her illnesses have been mild and I would prefer she picks up everything now than when she gets to school.

This is the government's advice about how long children should be kept away from nursery:

www.gov.uk/government/uploads/system/uploads/attachment_data/file/353953/Guidance_on_infection_control_in_schools_11_Sept.pdf

"On the other hand, the nursery where I work will not administer calpol or similar unless it has been prescribed by the GP for a specific illness."

This policy isn't supported by Ofsted, who say that nurseries can give appropriate medication to children with their parents' permission. Getting GPs to prescribe Calpol is inappropriate in the vast, vast majority of situations:

www3.hants.gov.uk/giving_medication_to_children_in_registered_childcare1.pdf

DS2's nursery will only administer prescription medicines and don't hesitate to send poorly children home; I've been phoned twice at school to come and fetch him for generally not being "quite right" and both times they were spot on and after a visit to the Dr it turned out he'd got ear infections. I trust them and their instincts, but we have the luxury of a retired MIL to sit with him if he's ever too poorly to attend. Some families don't have that and if they're reliant on their pay check, having DC's off nursery poorly doesn't register on their daily routine.

It's not right, but I do understand why parents might send a child in who wasn't 100% recovered. As Trilby mentioned, hopefully now that spring is on it's way their run of ill health will be over.

I've got 2 kids (20&18) and was a nursery supervisor and I have never heard of the advice to keep children off for 24 hours after a fever has returned to normal. The 48 hours after D&V is standard advice, but if a child is ill with it over the weekend and the parents bring them back on the Monday, for example, and don't tell you there is nothing you can do.

DS2 was constantly on antibiotics and in and out of hospital from when he was about 9 months old. He wasn't at nursery, some children do seem to pick up everything, unfortunately.

Back in my nursery-using days, neither I knew would give Calpol to a child unless it was for a well-specified reason, unconnected with infections (eg following minor injury).

I'd look for another nursery, tbh. I wouldn't assume that parents are going to become liars if a nursery has a policy that small children who need pain relief to get through the day should be at home.

DinoSnores - I will check the Ofsted guidance on Monday!

However, I think that generally, if a young child needs calpol to get through a nursery session or day, then parents need to think very carefully about whether they are really well enough to be there.

Our nursery has 48hr exclusion policy following D&V and a week exclusion from the first appearance of spots from chickenpox.

If children were kept off school/nursery following every high temp/cold/cough etc then they would never go! One of my children gets a raging temperature every time she gets so much as a sniffle. She feels fine though - it's just her body's reaction to viruses. My other daughter rarely gets an abnormal temperature but feels dreadful when she has a cough or cold.

If a child gets a temperature and is feeling unwell in themselves at my kids' nursery, they ring the parents and ask if they want the child to have a dose of Calpol (nursery keeps their own supply) to try and bring it down. If that doesn't work and the child still feels ill/unhappy then we have to collect them. Nursery will only give ONE dose of Calpol and any other meds have to be prescribed by the GP. They will also only allow children to attend nursery with antibiotics if they have already taken them for 24hrs (just in case there's an adverse reaction).

Most children attending nursery for the first time will go through a few months of adjusting to the exposure to other people's germs/viruses. It is extremely common for them to pick up oodles of ear infections/coughs/colds during those first 6 months or so. Bear in mind that children also need to be exposed to these germs because it's what they need for their immune system to build up properly.

This period of illness will frequently happen when children move rooms within the nursery as they get older, and again when they start school/move up to the next class.

I think the GP and nursery policy are not inconsistent. Keep a child off with a high temperature but fine to send them in with calpol for a mild fever if they are otherwise ok.

I work on the theory that if the kids are ill it's probably a bug picked up from school/nursery so their classmates have already been exposed to it. It doesn't therefore make much difference if our kids go when they're not 100%. Nursery generally distracts them if they're a bit under the weather. If it doesn't then we pull them out and take annual leave to look after them.

I'm not sure what to think as my nursery has similar policies (I think they're all fairly standard) and my DD has never been really sick beyond the relentless snot nosed colds all winter. That's to be expected though as the same thing happens in my office where humans are shut together in small spaces.

I work on the theory that if the kids are ill it's probably a bug picked up from school/nursery so their classmates have already been exposed to it.

That is just not true though is it? Not all children get all illnesses particularly if the parents are careful and keep their own children off when ill. It's quite a selfish viewpoint as other children may have low tolerance and you sending your child in may land another child in hospital (speaking from bitter experience).

I am eternally grateful that our nursery takes an entirely pragmatic approach. That will take them with a mild fever (under 39) and will administer calpol,if it is signed in on the day with an agreed dose and time (signed in triplicate!). They are of the view, and it's one I share, that we all get bugs and as long as the child is happy enough then they should be there - after all, I go to work with a mild cold having taken paracetamol, surely it's the same.

They do,operate 48 hours after D&V and 5 days after chicken pox emerge.

That said, it is the only one round here to do so, friends are constantly picking up children with mild colds.

My DS's nursery will not administer Calpol but takes them with colds/coughs. They do have a policy of sending them home for 24 hours if they have a high temperature for more than a couple of hours (only happened twice - once nothing, once hand foot and mouth).

The nursery ds attends will not administer medicine incl calpol, so you can't send them if I'll, they do say don't send if dc has a temp, but they are a small independent nursery? I think you and your gp are right and I'm amazed people would send their children to nursery unwell, as you say if they didn't things wouldn't be passed around so easily. I'd be. Tempted to look at cleanliness of nursery too, very young children and babies mouth toys a lot and these should be being cleaned not just popped back in a box, I would want to be reassured on cleanliness and in your situation would probably be investigating alternatives.

I'd look for a childminder for your children. Being in contact with a smaller group of children would mean your two catching less bugs..

When DD1 and 2 were at nursery they would administer 1 dose of calpol either sent in with the child or from the nurseries bottle. If the child needed more or it hadn't responded the child was sent home.

I now realise most were dosing with nurofen and when that wore off the nursery gave a dose of calpol and the child remained at nursery most of the day. This is an outstanding nursery

DS goes to a SN nursery who are very strict on meds and illness (rightly so). It hasn't decreased the amount of illnesses DS has compared to DDs though.