Nanny and Au Pair Health Care Series
By Anne Merchant, Author of The Nanny Textbook

Anytime nannies have questions or concerns about the health of the children left in their care, caregivers should discuss it with medical professionals or pediatricians.

If the concerns are related to teething pain or a minor rash, the children’s parents or a relative may be able to help evaluate the situation. But, since each person has a unique chemical composition, side effects and each individual’s reaction to medication cannot be anticipated, so nannies typically should not follow the advice of a friend, neighbor, or relative regarding the treatment of children. Nannies are responsible to seek the best advice from trained medical professionals and not merely from a convenient source.

Concerns such as difficulty breathing or an elevated temperature require the input of the pediatrician immediately. If caregivers are not certain whether children are seriously hurt, they should always have the children be seen by a physician or at least call the pediatrician to discuss the situation.

It is always best for nannies to follow-up on any concerns or questions they have with the appropriate professionals. Nannies should never attempt to diagnose or treat an illness or injury on their own.

The following information is intended for the purpose of increasing caregiver level of knowledge. It should never be used instead of seeking the advice of the pediatrician. The terminology incubation, range, and isolation are under the following illness headings. The definitions of those terms are below.

INCUBATION PERIOD refers to the time when the illness is contagious. Unfortunately symptoms usually do not present themselves until after the incubation period. Be cautious exposing siblings of ill children to the other children in the family since siblings may be in the incubation period of the same illness.

RANGE is the average length of the illness.

ISOLATION is the time period that the illness is contagious while symptoms are present. Isolate sick children from other children.

Incubation period:
14- to 20-days.
Range: 12- to 21-days.
Isolation: until skin is clear.
Cough, headache, and chills are common symptoms of chickenpox which appear approximately 14- to 18-days after exposure to chickenpox. The chickenpox rash usually develops one- to two-days after other symptoms have started. One of the most common complications of chickenpox is skin infection because the rash is itchy. Babies typically have an easier time because they still have some immunity from their mother. Adults often require hospitalization. Children with chickenpox are contagious even before the rash appears. It is very difficult to stop the spread of chickenpox once it has started. Daycare centers, schools, and other highly populated areas are most prone to the spread of chickenpox. A vaccine is available. As children recover from chickenpox, watch for lethargy which may be the first sign of Reyes syndrome.

two- to five-days.
Croup is most common in children six-months to four-years-old. It is a virus that affects the throat and airway, causing a cough that sounds like a bark and difficult, noisy breathing. Use a humidifier to keep the air moist. Call the pediatrician immediately for advice. Croup usually develops after children have had a cold. The cough can be worse at night and may seem better during the day. If children’s rooms are adjoined to bathrooms caregivers can open the door and turn on the hot water in the shower to generate steam, if humidifier is not available.

Congestion, fatigue, fever, and pain when swallowing are common symptoms of cold and sore throat. Children may have runny noses and eyes too. Encourage fluids and rest periods with quiet play. Use paper tissues to reduce spread of illness. Do not allow children to drink out of same glasses or use the same utensils when children are sick. Wash hands frequently. Report back to doctor if children do not improve or symptoms become worse in two- to three-days, (such as difficulty breathing).

Incubation period:
one- to three-days.
Isolation: in acute stage.
Immunization is recommended because new strains of the flu present themselves regularly. Take children’s temperature four times a day. Give sick children Tylenol or ibuprofen if their temperature is over 102º Fahrenheit after consulting with a physician. Record the child’s fluid intake and output. Give fluids generously. Children with influenza should be kept quiet and comfortable. Watch for a cough since influenza may lead to pneumonia.

Incubation period:
five- to seven-days.
Good hygiene and hand washing are required after touching the eye. Watch that children do not touch or rub their eyes. Also watch children carefully after application of antibiotic ointment because vision is blurred for about five minutes after application. Keep children off their feet and under supervision to prevent falls.

Reyes syndrome affects primarily six- to 12-year-old children. It is rare to see Reyes syndrome in anyone older than 18-years-old. In fact, this illness has become quite rare in United States. It is most often seen after children have recovered from a viral infection. There have been numerous instances where aspirin was given to children during an illness and subsequently those children developed Reyes syndrome. That is why it is recommended that people under 20-years-old never take aspirin. Reyes syndrome is not contagious, its cause is unknown, and if caught early enough children can make a complete recovery.

Incubation period:
two- to five-days.
Isolation: respiratory precautions.
An isolation precaution for about two-days after treatment has started. Caregivers should wash linens for the same length of time. Give prescribed medications and control fever with acetaminophen or ibuprofen. Watch for peeling about five-days after onset. Scarlet fever was very common prior to the development of antibiotics. Symptoms, course, and treatment are nearly identical to that of Strep throat.


  1. Thanks for sharing this info over the past few days. One of the little boys I watch was sick this week and we went to the doctor. I took the directions given by dr and wrote them down very specifically for the parents so there is no confusion. No one else ever shared info about range and incubation before. Very good advice. I will purchase the book now and look for the new one.

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