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Sharing isn't always caring: 5 common daycare diseases

At daycare, our children learn that “sharing is caring,” and sharing germs is no exception. Children from infancy to age five will share toys and food, they hold hands and spend eight-plus hours a day together. The perfect combination for spreading viruses and infection. If you’ve seen a fluorescent-colored sign on the door of your childcare center, it’s time to take them seriously as they often are used as a warning to announce the current daycare disease(s) going around.

There are several illnesses that go around child care centers, here are five of the most common. Note, many of these have the same early symptoms, so it is important to monitor your child closely when you start to see them.

Hand-foot-mouth disease

Hand-foot-and-mouth disease is a viral infection that is common in young children and highly contagious. It is caused by the Coxsackie virus and can be passed along through contact with infected people’s nasal and throat discharge, salvia, fluids from blisters, coughing and sneezing and in the stool. Hand-foot-and-mouth disease can last from 7 to 10 days and it is most likely seen in the summer and fall due to climate conditions. Our border states, South Carolina and Virginia both saw an uptick of outbreaks the summer of 2017. According to the Mayo Clinic, hand-foot-and-mouth disease is seen most frequently in child care centers because of constant diaper changes and potty training.

  • Symptoms: In most instances, hand-foot-and-mouth disease starts with a fever. Mouth sores and hand/feet rash follow a couple days later. Given the discomfort, it may also cause your toddler to be irritable, feel unwell and lose their appetite.
  • Treatments: This disease is not known to be serious and can be treated with Tylenol or Motrin to help with the pain. Given it mostly affects children, it is important to consult with your pediatrician prior to giving these medications. This disease does not warrant an antibiotic as the body’s immune system will fight off the infection. Note, if you notice signs of dehydration (dry mouth, lots of vomiting and diarrhea), call your doctor immediately.

Strep throat

Strep Throat is caused by the streptococcus bacteria and is spread through contact with droplets after an infected person coughs or sneezes. It is not as common in young children but can easily be passed along through siblings and parents. The CDC says that if a person touches anything with droplets on it, they can catch strep throat. Ways that the infection is spread, especially in daycare, are touching body parts (nose, mouth, eyes) and/or the sharing of toys and food.

  • Symptoms: Strep throat causes a fever and a sore throat. The difference from hand-foot-and-mouth noted above is that the throat pain worsens when the individual swallows. Strep throat also can cause swollen tonsils, sometimes with visible white patches and lymph nodes.
  • Treatments: If you believe your child may have strep throat, it is important to contact your pediatrician. They will likely order a “strep test,” and if positive, will prescribe antibiotics. The antibiotics can reduce complications, the period of symptoms and prevent the spread of the infection.


RSV, which stands for respiratory syncytial virus, causes symptoms of a common cold and cough. Across North Carolina and the rest of the southeast, RSV is most likely to spread from November-January. According to the American Lung Association, this virus is known to survive for hours on hard surfaces such as tables and crib rails, making daycare the ideal environment for RSV to live. This is why children are most likely to catch RSV out of the home. The virus lasts anywhere from 3-8 days, although it is important to note that young children with developing immune systems can be contagious for up to four weeks. Like many of the other daycare diseases noted, RSV is also spread through direct contact with an infected person, such as coughing, sneezing, handholding or kissing.

  • Symptoms: RSV symptoms mirror those of the common cold – runny nose, coughing, sneezing, loss of appetite, wheezing and even fever. In some children, the wheezing can result in bronchiolitis. Many children, especially at older ages, with bronchiolitis, do not need to see a doctor. Babies 6 months old or younger should be seen by a provider. Wheezing, especially difficulty breathing require a visit to your provider, regardless of age.
  • Treatments: The best treatment for RSV is hydration. It is important to consistently give your child fluids. If your toddler (under 2 years old) has trouble breathing through the nose, it is suggested to clear the mucus with a bulb syringe. This may also help them feel more comfortable to consume liquids. The fever can be treated with Tylenol or Motrin. Mild infections do not require any further treatment, however, if you notice signs of dehydration (noted above), contact your pediatrician as soon as possible. 

Pink eye

The medical term is conjunctivitis. This common illness is one that can travel through the household and daycare like a common cold, as it is easily spread through human contact and the touching of an individuals’ eyes. There are three types of pink eye – viral, bacterial and allergic. All of which have slightly different symptoms. Viral pink eye is the most common. Both viral and bacterial are highly contagious, with viral pink eye being the most common. The American Academy of Ophthalmology states that this form of pink eye is caused by the same virus that causes the common cold.

  • Symptoms: Across all types of pink eye, common symptoms include red, burning, watery eyes. Serious symptoms requiring urgent medical attention include puffy eyelids, blurry vision, and sensitivity to light. Here are a few symptoms to help differentiate between the types of pink eye:
    • Viral – Red, burning eyes with watery discharge
    • Bacterial – Sore, red eyes with pus (cloudy yellow or green discharge)
    • Allergic – Itchy, red and watery eyes
  • Treatments: Treatments for pink eye differ based on the type but a warm compress over the eyes can make your child feel more comfortable. Given the different types of pink eye, especially in children, consult your physician if you notice any of the above symptoms. Note, bacterial pink eye is the only one that can be treated with an antibiotic. Some daycare centers will not allow your child to attend for the first 24 to 48 hours of pink eye. If there is swelling of the eyelids, the child must be seen by a provider, in person.


To round out the common daycare diseases, we can’t leave off the stomach bug. This illness can be caused by several different viruses, including norovirus. In daycare settings, children are most frequently exposed through unwashed hands. Harvard Health shares the following scenarios that spread the stomach flu: children touching a dirty diaper (either theirs or playmates), forgetting to wash hands after using the bathroom, dirty fingers in the mouth and dirty toys that have been touched. Children are more susceptible given their immune systems are not fully developed yet.

  • Symptoms: The symptoms of the stomach bug are well-known – nausea, vomiting, diarrhea, and fever. In children, it is important to also watch out for irritability, lack of appetite and dehydration.
  • Treatments: The best treatment to a stomach virus is time, rest and hydration. If your child has mild symptoms they can continue their routine diets. A trick to keep your child hydrated is to give clear fluids a little at a time versus all at once. Consult your pediatrician on the best solution. Many times, they will recommend some sort of electrolyte solution such as Pedialyte.

Each childcare center likely has a different return policy for each of the diseases listed above. A common rule of thumb is ’24-hour fever-free’. Based on the illness, daycares may also request that children are symptom-free. It is important to consult both your physician and the childcare provider before sending your child back. Doing so will reduce the spread of the infection or virus further.


Across all five of the ‘daycare diseases’ noted above, they all mention the spread is a result of encountering an infected person. As a parent, the best prevention method is to teach good hygiene. While it is not fool-proof, it should help.

Here are a few of our best prevention tips:

  • Hand washing - Make it a routine to wash hands with soap and water after sneezing/coughing, toilet, meals, diaper changes, play hour.
  • Cover mouth and nose - Teach your children to always cover their mouth and nose when sneezing and coughing.
  • Clean up - Rinse and sanitize toys at home and make sure your child’s daycare center has a strict daily sanitization policy. It is also important to keep the house disinfected – especially bathrooms, countertops, and utensils.
  • Do laundry - When your child comes home with soiled clothing or with any of the symptoms noted above, start laundry immediately. It is also important to wash any sheets, towels, pajamas or other clothes they may have used recently.
  • Limit contact - If one child in your home comes down with something, limit their contact to siblings. This will reduce the likelihood the illness is spread in your home and through daycare classrooms.

When it comes to our children’s health, we don’t want to take chances. Of the illnesses listed, it is recommended to consult your provider. Your provider may recommend home and over the counter treatments and if it is a bacterial infection, antibiotics. 

Here at Blue Cross NC, we understand that sometimes it can be difficult to get a same-day appointment with your provider.  Learn more about Telehealth here. Most online evaluations for common health concerns are covered.

Joe Oleniacz, MD
Joe Oleniacz, MD

Associate Medical Director

Joe is an associate medical director for Blue Cross NC. He spent nearly 35 years practicing pediatrics prior to joining Blue Cross NC. He practiced in the USAF and at East Tennessee Children’s Hospital, Kaiser Permanente and Chapel Hill Pediatrics. 

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