Reopening and childcare: What are the risks of various options?

A small child and adult wearing masks and playing with toys

As many areas are starting to reopen services and workplaces following “Stay Home, Save Lives” orders, many families are needing to think about options for childcare. While many families have juggled work and childcare at home, increasing demands on productivity and the need to return to the workplace mean that childcare is an important part of family well-being and stability. This is leading to lots of worries and questions for families, especially those weighing the risks and benefits of different options.

What do we know about children and COVID-19?

Children continue to be positive for COVID-19 at lower rates than adults. When they are infected they continue to be much less likely to be hospitalized, and pediatric deaths from COVID-19 continue to be rare. If your child has chronic medical problems, they may be at higher risk. Call your child’s primary care provider or OHSU Doernbecher Children’s Hospital specialist to discuss their individual risk. We are happy to talk families through various options.

But what about MIS-C?

Learn more about MIS-C here

Information is continuing to come out about MIS-C (Multisystem Inflammatory Syndrome in Children), but the most important thing to remember is that it is very rare.

What about having a babysitter or nanny care for my child?

Overall, adding a single adult caregiver is low risk. Families should ask whether their caregiver has been observing physical distancing guidelines. When caring for the child, the caregiver should have careful hygiene practices like frequent handwashing, avoiding sharing food and not kissing the child’s face. Discuss mask wearing, especially when the caregiver is close to your child’s face. If they have symptoms (even if symptoms are mild), the caregiver should be encouraged to stay home and get tested for COVID-19. Agreeing to pay your caregiver for sick days may encourage them to stay home when needed.

What if the caregiver is high risk?

If the family’s caregiver is high risk, such as a grandparent or someone with chronic conditions, the arrangement is much higher risk to the caregiver than to the child. The caregiver should contact their doctor to discuss these risks. Families should also be open and discuss their other social contacts and risks with the caregiver. Families are encouraged to keep social contacts and outings very minimal even as things reopen if their child’s caregiver or a member of their household is high risk.

What about day care?

View additional COVID-19 resources for providers and families

In general, risks increase with the number of people the child has contact with. Sharing a babysitter or being in a small home day care would be lower risk, while being in a larger center-based setting would be higher risk. Families should ask about their day care’s policies to help reduce these risks. They should look for a day care that keeps the children in a small, stable group with consistent teachers. Ask about how the day care is approaching mask wearing (mask wearing should be encouraged for staff and for children older than 2), hand hygiene and cleaning practices. Policies that limit parents and visitors in the classrooms especially during pick-up and drop-off are also helpful. Day cares should screen employees and children for illness daily and should have clear sick leave policies for their employees and exclusion policies for children. Illness exclusion policies should be more stringent than before the pandemic. Children and employees with known or likely COVID-19 should be excluded from the center for a minimum of 10 days and should be fever-free for 72 hours before returning. Families will need to consider this when making their child care plans.

What about summer camps?

After months of virtual classes and being at home, many school-aged children and their families are looking forward to attending camps this summer. Having a child in camp may be an important step for parents who need to return to work; however, there is definitely the possibility for exposure to a much greater number of people at a summer camp.

Families should ask their child’s camp about the policies and procedures listed above and listen for steps that screen children and counselors, create stable, smaller groups of children and ensure hygiene is emphasized. Parents should also consider looking for situations where children are in a stable group and have the same counselors for many weeks, rather than a weekly rotation of campers and counselors.

Take home points

Every family’s situation is unique and childcare is an important part of family stability and child well-being. Weighing out the risks and benefits of each situation is important while remembering that overall, the risk of COVID-19 remains low for children. As a community, we can continue to save lives and protect one another by adhering to physical distancing recommendations.


Eliza Hayes Bakken, M.D. 
Associate Professor of Pediatrics
OHSU Doernbecher Children’s Hospital