As I speak around the country about Germ Proofing kids and families, one of the most frequent questions I get involves how parents should pick a day care center for their kids. Day care centers are infamous amplifiers of infections – there are few germs of any genre that are not readily shared by kids in day care. Because many day care kids are not yet potty-trained, fecally-spread infections are among the most common. For much more on the types of school, day care, and community infections, as well as strategies to prevent and treat them, see: Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Family from Infections (ASM Press, Washington, D.C., 2008).
Here is my list of Top Ten Questions to ask, and Top Ten Answers to hope you receive when screening day care centers for your kids:
1. What are the policies regarding excluding kids and staff members for illness?
There are long lists of inclusion and exclusion criteria published by the American Academy of Pediatrics, the CDC, and many state and county health departments to minimize the risk of spreading day care germs. The important answer that you want to get to this question is that the center has a policy, that it is written, and that you can review it (and perhaps take it to your child’s doctor to also review)
2. When can kids come back after being home sick?
Return policies should be part of the inclusion/exclusion criteria of the center
3. Is there a separate room for kids who have colds, other mild infections?
Often kids arrive at the center in the morning and are only noticed to be sick later that day (sometimes desperate parents conceal the illness – I know, hard to believe…). Ideally, a center should have a separate room or area for kids with minor infections to protect the other kids in the center. Some centers advertise this feature, allowing parents to bring their sick kids to the center without having to hide the sniffles or diarrhea.
4. Do kids need to have up to date immunizations to attend?
Kids should not be permitted in the center if they do not have their age-appropriate immunizations. Only about half the states in the U.S. require immunizations for day care entry, but you should try to find a center in your state that requires vaccines even if the state itself does not.
5. Do kids need a physical by a doctor before enrolling?
As with summer camp, some day care centers require a doctor’s exam and approval prior to day care enrollment. This feature of a center attests to its fastidiousness and carefulness in protecting kids – but it is not a common trait among centers.
6. Are health records kept by the center?
Centers should ideally keep a log of infections, at least the “major” ones like chickenpox, measles, meningitis, and hepatitis in the event that they need to help local health departments trace an outbreak.
7. What are the hand washing rules for staff?
These rules should also be written and posted prominently. Personnel should wash their hands with soap and water, or an alcohol hand sanitizer, after every diaper change, potty visit, and nose drip wipe-up event. Washing should also be required before snack preparation and serving. There should be sinks near the diaper changing areas, and separate sinks should be available for food preparation and washing eating utensils
8. What are the hand washing rules for kids?
Kids must wash their hands before snacks, after the potty, after returning inside from a playground recess, and after touching pets or birds at the center. Policies for protecting kids from pet exposures should be followed (see “petting zoos” below).
9. How are toys, sleep mats, play surfaces, and diaper changing areas cleaned, and how often?
All washable toys and surfaces that kids come in contact with should be scrubbed down with a disinfectant (see above) every evening after the kids leave; this includes nap mattresses and pads. Diaper changing areas should be cleaned with disinfectant (bleach-containing solution is preferred) after each use or a disposable paper table cover should be disposed of after each use. Any surface contaminated with blood should be immediately cleaned with a 10% bleach solution; other blood precautions must be taken to prevent kids from contacting blood or blood-contaminated areas (see “personal hygiene” above).
10. How many kids are in the center each day, what are their ages, are potty-trained kids in contact with kids who are not potty trained, and what is the ratio of staff to kids?
Ideally, older kids should be kept separate from the younger ones to prevent the spread of fecal-oral germs. This is very difficult to accomplish, especially for smaller centers; the trade-off, however, is that smaller centers have fewer kids to spread germs to your kids. The lower the ratio of staff to kids, the better the chances for good hand washing and other hygienic measures. Kids not yet potty-trained should wear clothes over their diapers.