Going to daycare with a runny nose?

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In Germany, many parents are currently jealously squinting at Berlin, Lower Saxony and Baden-Württemberg: There children with runny noses and a little cough can go to childcare or school. What speaks for it and what against it? In the conversation: Dr. Tanja Brunnert, established pediatrician in Göttingen.

Dr. med. Tanja Brunnert

Dr. Tanja Brunnert is a resident pediatrician in Göttingen and press spokeswoman for the professional association of paediatricians e. V. in Lower Saxony.

Miss Dr. Brunnert, since July 17th, children with snuff noses have been allowed to go to daycare in Lower Saxony, but not in many other federal states. Why is that?

That's a brand new recommendation for us too. And we are working to ensure that this will soon be the rule across Germany. However, it is expressly an interim recommendation. It only applies as long as the number of infections remains low.

What do the recommendations in Lower Saxony say in concrete terms?

In the case of banal symptoms, i.e. a bit of a cold or cough, an otherwise unimpaired child can continue to be cared for in the community facility.

However, a runny nose and cough are possible coronavirus symptoms. Doesn't it make sense to test before you put the little ones back into care?

There are currently so few corona cases that the likelihood of infection is really very low.

But what speaks against testing small sniffles to be on the safe side?

One thing must be said clearly: a smear on a toddler is torture. The children do not open their beak voluntarily. They are already disturbed because we always work with masks here - and when the children are sick, even in full protection. And such a deep throat swab is quite uncomfortable, it is traumatizing for a scared three-year-old scared child. If you have to do this every two weeks because the child has a new snot, it just doesn't work.

When would a corona test for small children be announced in Lower Saxony?

When children are really significantly affected, when they have headache and body aches, dry cough, sore throat, loss of taste and fever. Then they should also be presented to the doctor. Based on the previous history and the family situation, he decides whether it makes sense to take a smear - i.e. if the child also had contact with a corona case, was recently in a risk area or there are other suspicions. If this is not the case, the parents can send their child back to care as soon as it has been symptom-free for 48 hours.

Without a doctor's certificate? Doesn't that tempt overburdened parents to cheat?

Such a curriculum is not worth the paper on which it is written. I can only write: “The parents told me that the child has been healthy for 48 hours.” But how do I want to control that?

They rely on parents to act responsibly.

The rules only work on the basis of trust. It has to be clear how important this is. It is not possible for the parents to give the child a suppository so that the fever goes down and then send him to daycare. That doesn't normally work because it harms your own child and also endangers the other children and carers in the daycare center. In times of a corona pandemic, that is certainly not possible! And to be honest, we can't even do that. I am happy if I can look at every sick child. I can't look at every healthy child to write a certificate.

Young children with coronavirus infection tend to develop mild symptoms or no symptoms at all. How do you want to ensure that there are no major outbreaks in daycare centers - especially if sniffing children are also cared for?

There are now very clear indications that children do not play as big a role in the chain of infection as we initially feared - namely that they pass on the virus as quickly as they do with influenza.

Studies that have examined the share of children in the spread come mostly from the lockdown, when children hardly had any contact outside of their families.

That is a valid criticism. It was then clear that it was the adults who brought the virus into the family. But even with the easing, we can see that the outbreaks that we have now in Germany are mainly caused by unfavorable living and working conditions - not by children in daycare.

But you don't know for sure.

We can now use the time with the low number of cases to observe whether our assumption that daycare centers will not become corona hotspots is confirmed.

Nevertheless, there are studies that show that of all the measures, closing schools and day-care centers had the greatest effect on curbing the incidence of infections.

When it comes to how many others an infected person infects, we probably have to differentiate between daycare children and younger school children on the one hand and older children, adolescents and adults on the other.

In discussions at the Robert Koch Institute, we therefore insisted that smear recommendations be issued that differ for those under the age of twelve from those for adults.

Younger children would therefore be tested less often?

Right. Unfortunately, the RKI has not yet made the decision to change the recommendations. It indicates that the final studies are still pending.

But then school is also canceled for the bigger ones.

But they have already gone through nine or ten years of immune training in kindergarten and school. They don't get sick as often as the younger ones.

What is currently on the minds of many parents in particular: What to do when their childhood illness days have been used up?

Honestly? No idea. That is the big problem, so we hope that the other federal states will now follow suit and introduce rules similar to ours. Otherwise it will be difficult. If the child has to stay at home for a week with every sniff, then the days are gone quickly without the child being sick at all.

Wouldn't more days of childhood illness be a solution in the pandemic?

It might take some relief in the short term, but it would actually be better if the parents didn't need them in the first place. Because we see how important it is for the children to be able to go to kindergarten and school. They are suffering from the pandemic because they no longer have their social contacts.

Quite apart from the fact that you might have to look at it economically and the companies get massive problems when all the parents are constantly in childcare from October to April.

If every cold child has to stay at home, that will be the second, indirect lockdown from autumn. Because then all working parents can no longer go to work all the time.

You can find detailed information on the subject of illnesses in daycare and school during the Corona period as well as important information pages and hotlines from the federal states in our text: "FAQ: What to do with children with colds in Corona times?"

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