Daycare Syndrome And Frequent Infections

A Pediatrician Explains Why Daycare Kids Get Sick A Lot—And What You Can Do

Sick child and mom cuddling
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Q. My daughter was in daycare from the time she was about 10 weeks old until she was one year old. She was always sick, so I took her out of daycare. However, she is now two years old, and due to my schedule, I have been forced to put her back into daycare. She has been back in daycare for three months and has been sick once a month since then. I feel like she is always sick. During the year that she was out of daycare, the illnesses subsided, but it still seemed like she was sick once every three months. Should I be worried that she has some underlying illness that is causing this, or is it completely normal for a child who is in daycare to literally be sick once a month? —Melanie; Pembroke Pines, FL

A. You are describing a very classic case of what's called daycare syndrome.

Young children who are in daycare very often get frequent upper respiratory tract infections, including colds and secondary ear infections.

In fact, experts estimate that the average child gets six to eight viral upper respiratory tract infections each year. And since that is the average, that means that some kids are getting more and some are getting less. It seems likely that it is the kids who are in daycare who are getting more infections since they tend to be exposed to more people and more germs.

They can also get one to two episodes of gastroenteritis—which can include vomiting and/or diarrhea—each year, too.

Fortunately, the longer that kids are in daycare, the fewer infections they usually get. And by the time they start kindergarten, children who were in daycare seem to get sick much less often than children who weren't in daycare.

In other words, your child is likely to get sick a lot at some point in his or her early life—so if it doesn't happen during the daycare years, then it's likely to happen during kindergarten and first grade. 

Daycare Syndrome Versus an Immune System Problem

Although parents and pediatricians often get frustrated when a child gets sick over and over, if the child is in daycare and is otherwise growing and developing normally, and if the child hasn't had any serious infections (like pneumonia or other infections that required hospitalization), then it isn't very likely that he or she has any kind of problem with her immune system.

According to the Jeffrey Modell Foundation, warning signs of a primary immunodeficiency can include:

  • eight or more new ear infections in one year
  • two or more serious sinus infections in one year
  • two or more months on antibiotics with little effect
  • two or more pneumonias within one year
  • failure of an infant to gain weight or grow normally
  • recurrent, deep skin or organ abscesses
  • recurrent thrush in mouth or elsewhere on skin, after age one
  • need for intravenous antibiotics to clear infections
  • two or more deep-seated infections
  • a family history of primary immunodeficiency

If you believe that your child does have a primary immunodeficiency, ask your pediatrician about performing tests to look for immune system problems.

Avoiding Infections

Since keeping a child out of daycare isn't a practical option for many parents, some other things to consider to help your child stay as healthy as possible include:

  • getting your kid a yearly flu vaccination and making sure that your child's other vaccinations are up to date
  • avoiding other daycare-type situations, such as a gym daycare or church daycare, so that your child isn't exposed to a lot of different groups of kids who might be sick
  • discouraging thumb sucking or using a pacifier as your infant gets older, as a contaminated finger, thumb, or pacifier can be a good route for germs 
  • teaching your child to frequently wash his or her hands as she gets older

Most importantly, understand that frequent infections are very common in the first year or two of daycare and are usually not a cause for concern. If and when your child gets sick, call your pediatrician to figure out the best course of action. Also, try to maintain as much flexibility in your work schedule as possible and try to hang onto as many sick days as you can, since your child may have to stay home sick from daycare a lot. 


American Academy of Pediatrics. Clinical Practice Guideline: Management of Sinusitis. Pediatrics. Vol. 108 No. 3 September 2001, pp. 798-808.

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