Risk of enteric infection associated with child day care.

Pediatricians may advise parents that diarrhea is a frequent occurrence among infants and toddlers in day care and that diarrhea is usually mild and self-limited. A child newly enrolled in a day-care facility is at a particularly high risk for developing a diarrheal illness within the first month after enrollment, but the risk has been found to decrease as children remain in the same setting. Children who have diarrhea, fever, or vomiting of infectious origin should be isolated from well children. Infants and toddlers may return to the day-care environment when their diarrhea subsides and they are feeling well. Transmission of enteric infection from the child attending day-care center to other members of the family is possible; therefore, family members should also routinely practice good hygiene. Child-care providers should enforce written guidelines that establish hygienic practices and outline the management of ill children. Parents should be encouraged to read these policies and observe practices within the child-care setting before deciding to enroll their child in any care setting. The National Standards for out-of-home child care scheduled for release in 1991 will be important reading and a comprehensive reference for pediatricians who choose to be a child health consultant to one or more day-care facilities.