My child often gets ill at nursery. How can we help at home?

There is a lot you can do at home: teach handwashing, keep to the sleep hours for your child's age, clean the things that go in their mouth, keep them home while they have a high temperature, and know the signs that mean seeing a doctor. Getting ill often in the first months at nursery is common, and it usually becomes less frequent with time. A Finnish study by Schuez-Havupalo and colleagues found that days with cough, runny nose or similar symptoms rose from about 4 a month before children started centre-based daycare to more than 10 a month two months after starting, then fell over the following months.

Is it normal for a child to get ill often after starting nursery?

It is one of the most common worries for parents in the first year of nursery. Studies that followed children over time show a clear pattern: more days unwell around the start, then fewer as the months go on.

What a study from Finland recorded

Researchers in Turku, Finland, recruited 1,827 children and followed them to the age of 2, with parents keeping a diary of symptoms and daycare. They compared children in centre-based daycare (299), family daycare with a childminder (245) and home care (350), from 6 months before to 9 months after the start of daycare.

The study also found that the days parents stayed off work rose and fell in a similar way, and that starting family daycare had a smaller effect than starting a larger centre. The authors concluded that it is important to support families around the beginning of daycare. The figures come from parents' diaries in one region of Finland, so the exact numbers may be different elsewhere.

What a study from Canada followed for 8 years

A study by Côté and colleagues followed 1,238 children born in Quebec, Canada, in 1998 until they were 8 years old, using mothers' reports. Children who started large group child care before the age of two and a half had breathing-related illness 1.61 times as often as children cared for at home during that early period, but about 0.79 times as often during the early primary school years (ages 5 to 8). This was an observational study based on what mothers remembered, so it shows a pattern rather than proof of cause.

More days a week, more absences

A study by Slack-Smith and colleagues recorded absences in 11 daycare centres and 130 family daycare homes in Perth, Australia. Children who attended more days a week were more likely to have at least one absence because of breathing-related illness (odds ratio 1.40), while children who spent more hours a day in care were less likely to be absent (odds ratio 0.88). The difference between centres and family daycare was not clear. In other words, the type of care did not clearly differ, but the number of days a week was linked to absences.

Why do germs spread so easily at nursery?

Close contact while playing

A paediatrician from the Department of Paediatrics at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, explains that germs at nursery spread through coughs and sneezes and through toys, plates, bowls and clothes. Most nurseries keep things clean and give each child their own personal items, which helps, but the hardest part to control is contact while children play together.

Hands and toys go in the mouth

Germs from runny noses and saliva can stay on toys and surfaces. When a child puts their hand or a toy in their mouth, the germs can get into the body. Germs from the gut can also spread through nappies and unwashed hands, to other children and to carers.

The first months are when it happens most

In the Finnish study, days with symptoms were highest in the first months after children started daycare and then fell. In the Canadian study, children who started large group care early had breathing-related illness more often in that early period, but not more often in the early primary school years.

What can we do at home each day?

Make handwashing a habit

The US CDC describes five steps: wet the hands with clean running water, apply soap and lather, scrub for at least 20 seconds, rinse well under running water, and dry with a clean towel or air dryer. To time 20 seconds, the CDC suggests humming the "Happy Birthday" song from beginning to end twice.

For young children, the CDC's advice on handwashing as a family activity is to wash your own hands with them, because young children learn by copying adults, to make it fun with a song or a game, and to expect to remind them often at first, for example after using the toilet, before meals, after playing outside and after coughing or sneezing.

If soap and water are not available, the CDC says an alcohol-based hand sanitiser with at least 60% alcohol can be used. The Ramathibodi paediatrician suggests alcohol gel for children who are a little older.

Keep to the sleep hours for their age

The CDC lists these sleep hours, based on the American Academy of Sleep Medicine, and lists getting sick less often as one of the benefits of enough sleep.

Nursery days can be tiring and naps at nursery may be shorter than at home. A regular bedtime, a calm wind-down without screens and the same wake-up time on most days make it easier to reach these hours.

Clean toys and things that go in the mouth

The Ramathibodi paediatrician advises washing toys and personal items with soap and water and letting them dry every day, or once a week for toys that are not played with often. Do the same at home for toys, cups and spoons that your child shares with brothers and sisters.

Let in fresh air

The CDC lists washing hands regularly, cleaning commonly touched surfaces and taking steps for cleaner air among everyday ways to stop germs spreading. At home, open windows when the air outside allows. The Ramathibodi paediatrician advises nurseries to keep rooms well ventilated and to clean air conditioners regularly, and you can do the same at home.

When should my child stay home from nursery?

Keeping a child at home while they are unwell lets them rest and reduces the spread to other children.

Guidance from the NHS

The NHS also advises telling the school or nursery on the first day that your child is off and why.

Follow your nursery's rules

The Ramathibodi paediatrician explains that nurseries in Thailand should check children before they come in each day, and that a child with a fever and runny nose who goes to nursery may pass germs on. If your child is unwell, take them to a doctor or let them rest at home, and check their temperature. Ask your nursery what its rules are before your child is ill, so you know in advance.

When should I take my child to see a doctor?

When to get medical advice soon

The NHS advises getting medical advice if:

• your baby is under 3 months old and has a temperature of 38°C or more
• your baby is 3 to 6 months old and has a temperature of 39°C or more
• your child has a high temperature and other signs of illness, such as a rash
• a high temperature has lasted 5 days or more
• your child shows signs of not drinking enough, such as nappies that are not very wet, sunken eyes or no tears
• your child does not want to eat or is not their usual self and you are worried

When to get emergency help

The NHS advises getting emergency help if your child has a stiff neck, a rash that does not fade when you press a glass against it, finds light hurts their eyes, has a fit for the first time, has unusually cold hands and feet or unusual skin colour, has trouble breathing, or is unusually drowsy or hard to wake. In Thailand, the emergency medical number is 1669.

Medicines

At home, the NHS advises giving plenty of fluids and checking on your child regularly, including at night. If you give a medicine, the NHS advises checking the label to see whether it is suitable for children, and asking a pharmacist or doctor if you are not sure. When you ask, tell them your child's age and weight, and never give a child medicine made for adults. For when to keep your child off nursery, see the section above.

How can parents look after themselves through this stage?

Plan for days off

The Finnish study found that parents' days off work rose along with children's days unwell. If you can, agree in advance who will look after your child on sick days, such as a grandparent or a partner taking turns, so you are not deciding in a rush on the morning your child is unwell.

Your own sleep and hands count too

Parents often catch what children bring home. Wash your own hands after wiping noses and changing nappies, and try to protect your sleep. For more on this, see Why do I get ill easily after several nights of short sleep? and Worn out from parenting and it keeps piling up. What helps?

It usually gets easier

In the Finnish study above, the number of days unwell fell over the months after children started. If your child seems to be ill much more than other children, has symptoms that do not settle, or you are simply worried, talk to your child's doctor.