When is a child too sick for daycare?

It’s a common dilemma faced by many working parents: your child has a cough or a cold, do you send them to nursery?

Researchers from the University of Bristol have, for the first time, investigated the process of decision-making that parents go through when faced with this situation. The research, published in The Journal of Public Health, reports that parents viewed coughs and colds as less serious and not as contagious as sickness and diarrhoea symptoms. This resulted in many parents sending their child to daycare with a respiratory tract infection (RTI), which can result in the spread of similar illnesses in the wider community.

The Parents’ Choices About Daycare (PiCArD) study team, funded by the NIHR School for Primary Care Research (SPCR), interviewed 31 parents about the decisions they make when their children are unwell. The researchers explored parents’ attitudes towards illness, what they currently do if their child is unwell and due to attend nursery, as well as any changes that could affect the decisions they make.

Dr Fran Carroll, Research Associate in the University of Bristol’s Centre for Academic Primary Care and lead author of the study, said:

“Parents are aware that sending their child to nursery when they are unwell is not always the ideal thing to do, but there are often other factors meaning it is not possible to keep their child at home.

“However, there are some changes that nurseries could make which may help parents with their decisions and reduce the spread of infectious illnesses in both children and staff in nursery environments.”

Although some parents were aware of the content of the nursery sickness policies, they often felt the guidance was less clear on respiratory symptoms than for sickness and diarrhoea, or chicken pox, for example.

The research found that parents made decisions not only based on what the nursery illness policy was, but also on practical issues such as missing time from work, financial consequences, and the availability of alternative care.

Parents also named some nursery factors that could be changed to help them keep unwell children at home. These included a reduction in nursery fees if the child cannot attend, being able to swap sessions, and clearer guidance in nursery sickness policies.

The researchers hope that their work will inform the design and implementation of interventions to reduce the transmission of infectious illness and the associated burden on NHS services.

“Our findings may not be news to many parents, but this is the first time their decision-making processes in these situations has been documented,” said Dr Carroll. “By having this work published in a peer-reviewed journal, it gives an academic, methodologically sound basis for future work and interventions to try and reduce the spread of illnesses in these settings.”