Expert Advice -- Colds: Frequent colds and contagiousness

My 15-month-old goes to a family day care. The provider has asked me to keep him home when he has a croupy cough and a runny (yellow or green mucus) nose. She said he has an infection and is contagious when coughing and having this runny discharge. Whenever my son gets a cold -- and he had about ten last winter -- he gets a cough and thick nasal secretions. If I kept him home during these times he would never go out. Is this an unreasonable expectation?

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Mutiple colds during the winter months are often quite a burden both on the children who get them and the parents who care for them. The number of colds only multiplies when the child is in a day-care setting. Unfortunately, this a major down-side to daycare. Therefore, the number of colds your child has experienced is not at all unusual.

As a general rule, children are most contagious when their viral cold is in the first days of onset. This is just before and during the onset of fever, congestion, coughing, etc. However, the symptoms like runny nose and cough may last for over a week after the child is no longer contagious. Remember, I said this is a general rule. The truth is we really don't know exactly when a child is no longer contagious, and different day cares have different rules governing their infection control practices.

Thick nasal secretions are commonly associated with viral infections. Green mucus from the nose becomes a concern if it lasts for more than 10 days, is associated with persistent fever, or a cough which lasts for more than 10 days and is generally worse at night. These symptoms may be a sign that the simple viral infection requiring no antibiotics may have been complicated by a sinus infection which does require antibiotics. However, simple sinusitis is not contagious and should not keep your child home from daycare.

The croupy cough, which is specifically characterized as a barky seal-like cough, occurs when the child is probably still infectious. However, dry, hacky coughs may linger for many days after the infection has past because the damage to the airways caused by the virus takes time to repair, and this will cause a cough to linger.

I'm afraid I don't have hard and fast answers for you. Your day care does seem to have rather strict rules, but they have the childrens' best interests in mind. I suggest you have your child examined by your physician. Assuming your child is indeed not infectious, a note from your doctor will hopefully help in your discussions with day care.

 

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