As a childcare provider, you have wiped literally hundreds of runny noses. But how do you decide which children with runny noses can stay at childcare and which need to go home? Given how common runny noses and sniffles are, you need a basic understanding of their different causes and a sensible plan in place for dealing with them.

What Causes a Runny Nose?

The nose is lined by a delicate tissue called "mucosa"or mucus membrane. It produces sticky, slippery secretions called "mucus" to protect the nose. If this tissue is irritated, it swells and creates blockage with a lot of mucus. Sometimes a child may get frequent runny noses or permanent sniffles and a green nasal discharge, which is referred to as a chronic runny nose.

The common cold and allergies are the two most typical causes of a runny nose. With a cold, the runny nose is generally mild; the child often feels and looks well and usually gets better within a week. The runny nose is usually accompanied by a mild fever, and there may be other symptoms such as headache, sore throat, coughing, sneezing, watery eyes, and fatigue.

Allergies usually occur after age two, after the child has had several exposures to the substances (allergens) that can trigger allergic reactions in the body. Allergies may occur during a specific season or after a particular exposure--for example, after being around grass or animals. The child experiencing an allergic reaction also may have watery and itchy eyes, sneezing, wheezing, an itchy nose, and a discharge of clear mucus.

A bacterial sinus infection may occasionally develop from the common cold and keep a runny nose going. This infection tends to cause yellow-greenish mucus and sometimes pain in the facial area. However, yellow or green mucus alone does not always mean that a child has a sinus infection. It is normal for the mucus to get thick or change color as a cold progresses.

Is Green Mucus More of a Concern than Clear Mucus?

In most cases, green or yellow nasal mucus (usually found toward the end of the cold) is no more contagious than clear mucus and may be even less contagious. The runny nose usually starts with clear mucus, which then becomes whitish or greenish as the cold dries up and gets better. This happens because as the body mounts its defense against the virus, white blood cells enter the mucus and color it. Usually the colored mucus comes in smaller amounts and is thicker, a sign that the cold is "drying up" and ending.

A green, runny nose that is accompanied by fever, headache, cough, and foul-smelling breath, may be a sign of a sinus infection. The child should have a medical evaluation and may need antibiotic treatment.

When are Children Contagious?

Unfortunately, infected children spread viruses before they begin to feel ill. This is because the amount of the virus present in their bodies is usually highest two-three days before they develop symptoms of the illness and continues to be present for two to three days after symptoms begin. Germs may be spread to others by:

• Wiping the nose and then touching other people and objects.
• Sharing of mouthed toys by infants and toddlers.
• Coughing and sneezing into the air.
• Kissing on the mouth.
• Poor ventilation.

To prevent the spread of infection from colds and runny noses, follow these routine healthy practices:

• Avoid contact with mucus as much as possible.
• Make sure that all children and staff use proper hand washing practices, especially after wiping or blowing noses, after contact with any nose, throat or eye fluid, and before preparing or eating food.
• Do not allow food to be shared.
• Clean and disinfect all mouthed toys and surfaces on a daily basis.
• Wash forks, knives and spoons carefully in hot, soapy water, and then disinfect and air dry them. Use a dishwasher whenever possible. Use throwaway paper cups whenever possible.
• Make sure that the facility is well ventilated and that children are not crowded together, especially during naps on floor mats or cots. Open the windows and play outside as much as possible, even in the winter.
• Teach children to cough and sneeze into their elbows and wipe noses using disposable tissues, then throw the tissues into the wastebasket and wash their hands.

When Should a Child Stay Home?

Excluding children with runny noses, mild respiratory infections, and colds is generally not recommended. Use your program's illness policies to guide you, rather than excluding a child because of the color of his or her mucus. For example, you might decide to exclude any child who is too sick to participate, no matter what the cause or color of the mucus. As long as a child feels well, can participate comfortably, and does not require a level of care that would jeopardize the health and safety of other children, he or she can attend childcare.

When Should a Child Be Sent Home or Seen by a Health Care Provider?

You should contact a child's parents to take him home and recommend that the child be seen by a health care provider if any of the following conditions apply:

• The infant is less than four months of age and has any fever or other symptoms of illness. (The parent should contact the physician immediately.)
• The child has signs of severe illness such as unusual lethargy or irritability, difficulty breathing, or signs of significant pain.
• The child has a fever more than 101 degrees F (oral).
• The child has a rash with fever of any temperature.
• The child has uncontrolled diarrhea or vomiting.
• The child complains of an earache and/or is pulling at his or her ears, especially if accompanied by fever and fussiness (all are possible signs of an ear infection).
• The child has redness, sores, and crusting of the skin around the nose and mouth.

The childcare provider and parent also should consult a health care provider if a child does not get better in a couple of days or if the child's condition worsens.

By Rahman Zamani, MD, MPH
California Child Care Health Program

Health and Safety in the Child Care Setting: Prevention of Infectious Disease, published by the California Child Care Health Program, 800-333-3212, www.childcarehealth.org

National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, second edition, American Academy of Pediatrics; 800-433-9016; www.aap.org The text of this publication can be found on the National Resource Center for Health and Safety in Child Care's web site, nrc.uchsc.edu