The Dos and Don'ts of Good Child Care Health

Melissa Kossler Dutton
Noah Yeager, 4, uses tongs to take a sandwich from the basket during snack time at Christ Lutheran Children's Center

When children go to day care or preschool, they are going to get sick.

"Parents should recognize the fact that young children are going to come in contact with viruses when they get in with each other," said Dr. Robert Murray, president-elect of the Ohio Chapter of the American Academy of Pediatrics. "Be aware - you are now, essentially, sharing viruses and bacteria with all the children in that child care center."

Still, there are precautions that centers and parents can take to keep children healthy, he said. When evaluating centers, parents should ask questions about what policies are in place to minimize the spread of illness. Murray said a prime indicator of whether a center is focused on good health practices is its policy on hand washing.

"It's still the single most important thing people can do," he said.

That's why Christ Lutheran Children's Center requires that children wash their hands as soon as they arrive in the morning, said center director Renee Cloyd.

"It's just a good routine," said Cloyd, whose center is located in Bexley and serves children between the ages of 2 and up through 5 years old.

Centers should have policies that address serving food, diapering babies and sanitizing toys.

When touring a facility, check out the "orderliness of the place," Murray said. "Are things clearly separated? Is the food kept separate from the diaper changing area? Is that area separate from the play area?"

A good center is one that is "doing its best to optimize cleanliness and safety," he said.

The center also should have policies about washing toys and sanitizing things children put in their mouths, added Dr. Katalin Koranyi, a professor of clinical pediatrics at Ohio State University and Nationwide Children's Hospital.

How a center treats sick staff members is another indicator of its efforts to promote good health, Koranyi said. She recommends asking how many sick days workers receive and whether they are encouraged to use them.

A center also should have procedures for handling children who become sick during the day, she said. Ideally, the center should have a place where the child can be isolated from the other children but still be supervised.

Christ Lutheran Children's Center in Bexley has such a spot. Staff are trained to watch for signs of illness, Cloyd said. Parents will be called to pick up their son or daughter if the child has a fever or vomits or has diarrhea.

She sometimes calls parents to alert them that their child is acting sick but doesn't have a fever. That way they can keep an eye on them in the evening or be more prepared if the child becomes ill, Cloyd said.

"We like to give them a heads-up," she said.

The number of children and the range of ages in a classroom also can make a difference, Koranyi said.

Fewer children in the room means fewer opportunities for illness to spread, she said, and it's also helpful to separate kids by age. Older children can carry a virus without exhibiting symptoms and unknowingly expose little ones.

Parents also can play a role in keeping children healthy, Murray said.

"Sleep is a critical thing," he said. Children who aren't well rested may be more prone to getting ill. He also recommends having children wash their hands before leaving day care to help prevent them from bringing germs home.

It's also important that parents keep sick children home. Sending an ill child to day care puts all the other children at risk.

"Parents collectively need to be vigilant for each other," he said.

To reduce the risk of disease in child care settings, as well as schools, the facility should meet certain criteria that promote good hygiene. Some questions to ask:

Are there sinks in every room, and are there separate sinks for preparing food and washing hands? Is food handled in areas separate from the toilets and diaper-changing tables?

Are the toilets and sinks clean and readily available for the children and staff? Are disposable paper towels used so each child will use only his own towel and not share with others?

Are toys that infants and toddlers put in their mouths sanitized before others can play with them?

Are the child care rooms and equipment cleaned and disinfected at least once a day?

Is breast milk labeled and stored correctly?


Are children and their caregivers or teachers instructed to wash their hands throughout the day? Important times include:

  • When they arrive at the facility
  • Before and after eating, handling food or feeding a child
  • After using the toilet, changing a diaper or helping a child use the bathroom (Following a diaper change, the caregiver's and child's hands should be washed and the diaper-changing area should be sanitized.)
  • After helping a child wipe his nose or mouth or tending to a cut or sore
  • After playing in sandboxes
  • Before and after staff members give medicine to a child
  • After handling wastebaskets or garbage
  • After handling a pet or other animal