The battle is not hopeless, however, and there are things parents can do to keep their child well if they must be cared for outside the home.

Hand washing According to Jack Hutto, M. D., an infectious disease specialist at All Children’s Hospital, "Improper or infrequent hand washing is the number one spread of illness in daycare settings." Adults typically put their hands to their face at least three to four times an hour. Children are even worse! They are always putting their hands in their mouths, in other children’s mouths, down their diapers, and all over toys. Therefore, every child care setting should have a written procedure for hand washing that is strictly enforced.

Children should be taught how to wash their hands and caregivers should set a good example! According to a recent study published in the medical journal, Infectious Diseases in Children, one out of every four daycare staff members had fecal bacteria on their hands. Furthermore, one third of daycare facilities surveyed had "poor hand washing techniques and no policy for hand washing before eating or after playing outside." Therefore, how the daycare or preschool staff handles a child is just as important as the cleanliness of the room. Hand washing sinks should be next to each diaper changing area and child-size sinks, soap dispensers, and disposable paper towels made available near every toilet area. In addition, these sinks should never be used for food preparation. Dr. Hutto also recommends that parents teach their children proper hand washing before meal and snack time, and to discourage behavior such as nose picking, fingernail biting, pacifiers, toys or other objects in the mouth, etc.

Sanitize Environmental sanitation policies should include cleaning and disinfecting floors, covering sandboxes, and scrubbing play tables. Carpets and rugs harbor dust mites and bacteria, so they should be cleaned regularly. All other items in the room also need to be thoroughly sanitized each day. Toys should be cleaned daily with water and detergent and then thoroughly rinsed before handled by another child. Germ collectors, such as soft, non-washable toys should be discouraged. Day care workers should make it a special effort to clean underneath the tables where little kids frequently put their hands. The top side of tables is usually cleaned, but bacteria and viruses hide under the tables as well. "Opening a window on occasion is really not a bad idea either since the outside air is fresher than the air inside," according to Dr. Hutto. Children's clothing should also be easily washable and all kids should be provided with at least one change of clothes. Air filters should be changed monthly.

Diaper Changing Procedures. These areas should be sanitized between uses or covered with a paper pad and changed after each use. Diaper changes should be limited to a few staff personnel and the use of disposable diapers should be encouraged. Soiled diapers should be discarded immediately in secure containers. Thorough hand washing of both the child and the day care provider following diaper changing is mandatory.

Limit Group Size Children's group sizes within a center can also affect disease spread and parents should choose a day care center where the number of children is limited to three or four. With a smaller group illness can be more contained.

Report Illness to the Provider. When dropping off their child, parents should talk to the caregiver about how the child is feeling. If the youngster has symptoms of a possible infection, ask if the child should be excluded from child care that day. Prompt action when an infection is first suspected can often prevent its spread through the center. In addition, let the provider know you want to be called at work if the child becomes ill during the day.

Avoid a Passive Smoking Environment. Children who are exposed to secondhand cigarette smoke are three to four times as sick as those who are raised in a smoke free home. Never leave a child with a provider who smokes, even if they "light up" outside. As a rule of thumb, if one can smell cigarette smoke, the child is getting the harmful effects.

Immunizations and Well Child Care. Make sure your child has received all the recommended immunizations and well-child checkups.

Plan ahead. Arrange in advance for someone to care for your child when they become ill. Children being cared for outside the home will eventually get sick and need to stay home!