As the new school year begins, children trek off to school, returning in the evening with their artwork, stories about their day -- and possibly a few germs and viruses to share with the family.
"It's never too early to worry about your child picking up germs in day care," said Dr. Tanya Remer Altmann, a pediatrician with the Community Pediatric Medical Group in Westlake, Calif. "In fact, the first day of day care they can catch a cold."
"Typically, when kids start day care or preschool, within a few days to a week, we see them coming into our office with new colds they've picked up," she said. "With my own boys, I see this."
But while sicknesses may be ubiquitous among the playground set, parents who are sending their children to day care typically don't have the luxury of keeping them out.
Pediatricians say there are better ways to solve the germ problem than keeping children in a bubble. There are several steps parents can take, they say, to help cut down the number of germs and viruses a child picks up.
As a parent, pediatrician and the owner of a day care center, Dr. Laura Jana has seen the problem of children getting sick in day care from all angles.
"People send their children to child care in part to learn how to share, and it's just not just limited to their toys, they also share their germs," she said.
The only way to minimize the number of infections that are transmitted, she said, is to make reducing the infections part of the daily routine. That includes the prominent placement of sinks in the classrooms and having policies for regular handwashing and cleaning of toys.
"Germs are going to spread, but you can significantly lessen it," she explained. "If you try to tell people that it's a good idea ... and it's not part of the child care center's routines, it's as likely as not to be overlooked in the course of a busy day."
Regular handwashing, pediatricians agree, is one of, if not the most, important step in preventing the spread of germs. And that goes for day care providers as well.
"It's not just kids when you talk about the spread of infection in day care," said Jana.
She said staffers were also reminded to wash their hands after cleaning or changing a diaper.
And many adults could probably use the reminder for handwashing as well. A 2005 University of Minnesota study showed that 18 percent of adults in the U.S. do not wash their hands after using the restroom.
Having children wash their hands regularly, explained Jana, helps develop their lifelong routines.
Vaccinations are the other major step pediatricians say parents should take to keep their kids healthy.
In July, the CDC issued its recommendations for this flu season, saying that all children over the age of six months should be vaccinated against influenza.
Altmann recommended receiving a shot or, in children over two, FluMist -- a nasal spray comparable to the flu shot.
"Last year, the flu mist showed to be more effective in the children than the flu shot, at least in my part of the country," she said. "That's what I'm going to give my three year old this year.
"Once they're a little older, they often do prefer the flu mist. Sometimes, the fact that there's no needle involved gives an added benefit."
But Altmann also stresses that vaccines children should have go beyond the flu.
"Parents want to make sure that their child is up to date on all their vaccines, including the flu vaccines," Altmann said.
Altmann advises parents to ask their day care provider what percentage of the children in their care are up to date on their vaccinations.
"We are seeing some of these infections that previously hadn't been around popping back up and emerging because parents aren't protecting their kids," she said.
Even if a child has had an immunization shot, Altmann said, they could still contract the illness, either because their shot was not effective or because they have not finished the series of shots necessary for immunity.
"They can still be at risk if the other children around them aren't vaccinated," Altmann said. "Even though it's a slight risk, it could still be there. Most of the very serious cases of whooping cough were in infants who were too young to get vaccinated or had only had the first dose in the series of the vaccine."
Other steps pediatricians recommend include basics, like making sure children eat healthy and get enough sleep, and, to prevent spreading illness, keeping toddlers home when they are ill.
Jana explained that keeping a child home for at least 24 hours after symptoms appear is a good rule of thumb, but parents still need to monitor their children, since the symptoms won't always tell the whole story.
If a child is symptom-free, but only because of medication, she said, he or she is probably not ready to go back to school.
On the other hand, she said, "If you have to chase a child around the park to take their temperature, chances are you don't need to do anything about it."
In addition to their own steps, pediatricians recommend that parents speak to day care providers on several issues to check the likelihood of their child getting sick.
These questions include seeing what additional measure they take to avoid spreading germs, finding out the policy for how long sick children must stay home, and determining how often the teachers clean the classroom surfaces and toys.
Keeping surfaces clean is no small matter. In 2004, a University of Arizona study concluded that over half of the surfaces and objects in homes and day care centers had strains of the influenza virus on them during the flu season.
"The toy-cleaning is not trivial," Jana said.
In the case of her day care, she said she knew her policies were being followed when one of her center's charges was found to have an undiagnosed case of salmonella for several weeks, but it had not spread to any of the workers or other children.
From changing diapers to serving food, Jana said she has policies to cover all of her day care operation, and parents should ensure that the place where they send their children has those types in place.
"I have more policies than you want to know about, but I believe in them," she said.