Too sick/healthy enough for kindergarten?

My first appeal is that paediatricians need to decide much less often whether a child should go to kindergarten, because they are often not in the best position to decide, or parents and educators can do this perfectly well themselves.

The issue is difficult because there are few clear facts or symptoms that are decisive. For example, there are mild symptoms such as a slightly watery, greasy eye, a runny nose or a few noticeable patches of skin. In my opinion, these are not reasons not to allow an otherwise healthy child to attend nursery.

But there are also "hard facts", including fever: if the body temperature is above 38.5 degrees, the child should not go to nursery and should stay at home the next day. Children who have vomited should stay away from nursery for 48 hours. The same applies to diarrhoea, although it is not always easy to tell whether it is diarrhoea or simply soft stools in a small child.

This example shows that you can't just rely on the "hard facts". The crucial point is to look at the child with common sense and ask yourself how they are feeling. A child who lies down after an hour at nursery or sits on the teacher's lap and wants a cuddle is not doing well and should go home.

The situation is different for a child who has a body temperature of 38.2 degrees and a runny nose, but is otherwise completely fit: they can stay in kindergarten.

My observation is that parents are increasingly overstepping the mark out of social stress and bringing children to kindergarten who don't belong there because they're not feeling well. However, nursery teachers often don't act sensibly either and send children home who don't actually have any symptoms that would make them leave nursery.

I also get the impression that nurseries are desperate to prevent infections or chains of infection, especially since the coronavirus pandemic. Of course, this is sensible and correct for certain diseases such as noroviruses or measles. However, the whole thing is completely unrealistic in the case of banal illnesses such as hand-foot-and-mouth disease, which every kindergarten child is sure to experience sooner or later.

For these reasons, my conclusion is that I would very much like to be confronted with this question less often as a paediatrician. In my opinion, this is possible if nursery teachers and parents come into contact and exchange ideas more often. They can discuss this with each other much more often, so that ultimately the parents can decide whether the child is fit enough or not.

Important question at the end: When is a previously ill child well enough again? Our recommendation: If your child was at home and at the end of the day you think they were fit enough - then the next day is exactly the right day to go back to nursery.