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Pink eye: Do I need to keep my kid home from child care?

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You’re anticipating a busy day at work and hustling to get your toddler off to child care. But then you notice she has crusting and redness around her eye — pink eye (conjunctivitis). Can she go to child care? Or will you have to rearrange your schedule to take her to a clinic and then pick up prescription eye drops?

The best way to think about pink eye is that it’s a “cold in the eye,” with discharge from the eye being similar to having a runny nose. While the condition can be contagious, just as a common cold is contagious, neither a doctor visit nor prescription eye drops usually are necessary. After all, kids have runny noses all the time and are allowed to be in child care — and hardly anyone thinks twice about it.

Q: What causes pink eye?

A: Viruses are the main causes of pink eye. It also can be caused by bacteria or allergens such as chemicals, smoke and dust.

Q: What symptoms should I look for in my child?

A: The symptoms vary, depending on the cause of pink eye. According to Marcie L. Billings, M.D., an assistant professor of pediatrics at Mayo Clinic in Rochester, Minnesota, “Redness is pretty consistent across all types of conjunctivitis. The classic differentiation is that with viral and bacterial conjunctivitis, the eye is going to be kind of drippy all day long. Allergic conjunctivitis is associated with intense itching and irritation.”

The following signs and symptoms can help raise suspicion that the cause of pink eye is:

Viral

  • Redness in one or both eyes
  • Watery eye discharge that may crust around eyelids
  • Burning or gritty feeling in eye
  • May initially involve only one eye and often spreads to the other eye in 1-2 days
  • Symptoms usually get worse over the first 3-5 days then gradually improve

Bacterial

  • Redness in one or both eyes, often including the eyelids
  • More commonly associated with thick white, yellow or green eye discharge throughout the day
  • Sometimes occurs with an ear infection

An allergen or irritant

  • Usually occurs in both eyes
  • Can produce intense itching, tearing and swelling in the eyes
  • May occur with signs and symptoms of allergies, such as an itchy nose, sneezing, a scratchy throat or asthma

Q: How do I know if my child’s pink eye is contagious?

A: If your child has symptoms of a virus or bacteria, the pink eye likely is contagious. But that comes with a caveat. Says Dr. Billings, “Conjunctivitis has been stigmatized in a way, and it’s really no more transmissible than a common cold.” Pink eye caused by an allergen or irritant definitely isn’t contagious.

Q: My child’s symptoms suggest a virus or a bacterial infection. Should I make an appointment with the pediatrician?

A: Not necessarily. According to Dr. Billings, “Like a cold, the symptoms may get worse for the first couple of days, then stabilize and finally get better over time.” Children should see a doctor if they have eye pain, eye sensitivity to light, blurred vision, intense eye redness, symptoms that get worse or don’t improve, a weakened immune system, or a preexisting eye condition.

Q: If my child’s pink eye was caused by an infection, will the pediatrician prescribe an antibiotic?

A: Probably not. Most mild cases of bacterial conjunctivitis go away on their own, without medication, in 3 to 7 days. Says Dr. Billings, “We’re trying to be good stewards with use of medications, and the challenge with giving antibiotics is that resistance to these drugs can develop if we give them when they aren’t needed.”

Q: Should I keep my child out of child care or school until the symptoms of pink eye subside?

A: If your child has a fever or is so unhealthy that he or she can’t participate in regular activities, then staying home might be a good idea. Otherwise, kids with pink eye don’t need to be excluded from child care or school. “Pink eye is like a runny nose of the eye. If a child has a mild case and no fever, child care or school is fine,” says Dr. Billings.

Q: Our child care provider requires that any child who has pink eye use prescription eye drops for 24 hours before coming back. Is that necessary?

A: Not really. In some — but not all — states, there is no law requiring that children with pink eye be kept out of child care or school and be treated by a health care provider before they can return to those settings. But some child care providers still do require prescription eye drops.

If that’s the case, you may need to visit a health care provider to determine if treatment is necessary. If no treatment is needed, the provider can give you a note to take to the child care facility or school explaining the recommendation. Topical therapy may lower the risk of transmission of a bacterial infection but it’s not helpful if your child has a viral infection.

Q: What can I do to help my child cope with pink eye?

A: Artificial tears that are available without a prescription are fine to use because they coat and soothe the eye. However, avoid eye drops that are intended for getting the redness out because they can cause more irritation. You can also try applying a warm or cold compress to the eye (whichever feels better to your child). Soak a clean, lint-free cloth in water and wring it out before applying it to the closed eyelid. If the pink eye is in only in one eye, avoid touching the other one to prevent spread. Children who wear contact lenses may need to stop wearing them until the symptoms are gone. Good hygiene is important, too. Encourage your child to wash hands often or use hand sanitizer with at least 60% alcohol if soap and water aren’t available. Don’t reuse washcloths, and change pillowcases often.

Marcie L. Billings, M.D.

Dr. Billings is a pediatrician in the Division of Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester.

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