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Nathalie Thibault's bachelor's degree in Microbiology and master's degree in Immunology make her a germ and immune system specialist. Since the birth of her two daughters, she has been particularly interested in the infections which affect children who attend daycare. She is a teacher, speaker, and author. The specialized documents and courses she conceives help those involved in early childhood outsmart germs. She writes for a magazine called La Culbute and the mamanpourlavie.com website.

Excluding a child from daycare: a taboo subject!

Excluding a child causes upset for everyone involved. Parents are unhappy and bothered by the situation. Excluding a child makes you feel uncomfortable. Here are a few tricks, but first, read the following several times:

When you must exclude a child, the parent will surely be bothered by the situation and it is normal. On one hand, you are disturbing him at work while he may be working on an important project. He may be unable to miss work without consequences. On the other hand, you are delivering bad news: his child is sick. Put yourself in the parent's position: he surely apprehends long hours in a waiting room, sleepless nights, antibiotics, etc. A sick child is cause for anxiety for parents. So, when you make the phone call to tell a parent he must come get his child, do not expect to be thanked! The parent will surely seem troubled and this is a normal reaction which is not your fault, do not take it personally!

On your end, if you feel guilty or uncomfortable in regards to the situation: breathe! You have a job to do. You have the obligation to offer a service to all the children under your care and you are the best person to know if a child is well or not or if he requires additional care, regardless of the parent's reaction! Early childhood is a period during which frequent infections are common and one must be prepared to face them.

Why exclude a child?

• For the child's own well-being.
• For the protection of the other children.
• To maintain the quality of the services offered to the other children.

When?

This is a difficult question to answer and there most likely will not always be clear and precise answers since there are several factors which must be taken into consideration. Medical reasons, available resources, and humane reasons must all be considered.

Medical reasons

For each infection, there are criteria which are dictated by the "Comité de Prévention des Infections dans les Centres de la Petite Enfance" which can be found on the Infections in daycares poster. You should already have received the 2006 version of this poster. I invite you to study it closely and display it in your daycare.

Available resources

Here, we must consider YOUR resources. Are you capable of taking care of the sick child without the services offered to the other children suffering? In certain cases, yes you can, and in other cases, no. Does the state of health of the sick child prevent you from going outside to play? Does the state of health of the sick child prevent you from serving lunch on time? Is the sick child disturbing your daily routine?

Humane reasons

Often, these are the reasons which cause problems. Of course, a sick child would be better off in his parents' arms; but to which extent? Here, the responsibility lies on your shoulders. You must trust yourself. You practically spend more time with the child than his parents (this is difficult for parents to accept, but it's the truth!). You know the child and you know when he just isn't himself. There are criteria you can use to evaluate such as his cries, appetite, fatigue, etc.

In general, the child must be able to follow the daycare's rhythm without affecting the quality of the services offered to the other children. This is not always easy to evaluate!

For the exclusion to cause less friction:

• Have clear exclusion instructions. Make sure they are known and accepted by the parents. Include them in your contract.
  
  
• Verify that parents have a reliable resource person who can come get their child if they are unable to and do not hesitate to use this third party.
  
  
• Concentrate your words around the child and his well-being instead of the internal policy, the contract, and the extra work the child is creating for you.
  
  
• Do not threaten, blame, criticize, or look down on parents in disapproval. Most parents want what is best for their child and do everything they can.
  

This text appeared in the La Culbute magazine, 2006.

Parents' attitudes which harm the collaboration which is required for the health of the children in your daycare:

• They minimize the seriousness of the symptoms.
  
  
• They give their own diagnosis or the reasons they have found to explain the symptoms (teething, overeating, bad mood, faking, antibiotics, etc.)
  
  
• Thinking that giving medicine to their child before taking them to daycare will magically make fever disappear! Simply burying their head in the sand.
  
  
• Avoiding the subject.
  
  
• Telling you that their child was feeling fine at home, why wouldn't he feel well at daycare?

Since we are not doctors, we must limit ourselves to observable facts. Whether the child is teething or not, or whether he ate too many berries, can he follow the group's activities? Is his state of health acceptable? You work in an educational daycare environment, not a pediatric hospital! It is up to you to set the limits and trust yourself!

In conclusion, exclusion criteria should be called child protection criteria! It is a part of your job which is unpleasant but necessary for the wellbeing of everyone involved! Remind yourself that the more you work towards the prevention of infections the less exclusion cases you will have to handle.

Nathalie Thibault 

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