Your child vomited twice during the night. At six in the morning, you're standing there with a laundry basket full of bedding, a pale little one, and a full calendar. The question that immediately comes to mind: can my child go to childcare today? For most parents, stomach flu is the most common reason to keep their child home – and the biggest puzzle to combine work and care. In this article, I'll clearly outline the RIVM guidelines, address the grey areas, and give you practical tools for communicating with your childcare provider.
What exactly does the RIVM say about vomiting and diarrhea?
The RIVM guideline for childcare is clear: for both vomiting AND diarrhea, exclusion of at least 48 hours after the last episode of vomiting or the last loose stool applies. This means your child can only return to childcare after two full days without symptoms. The reason? Contagiousness is highest during the acute phase, but viruses such as norovirus can still be spread through stool for days afterwards.
For vomiting without diarrhea only, the RIVM applies a slightly milder rule: 24 hours symptom-free after the last episode of vomiting. The same applies for diarrhea without vomiting. But beware: many daycare centers (kinderdagverblijf/KDV) and after-school care (BSO) locations still apply the stricter 48-hour rule as a precaution. They want to prevent outbreaks in the group, especially among babies and toddlers who are still in nappies and where hygiene is particularly difficult to maintain.
Just as with fever in your baby or toddler, the childcare provider doesn't only look at the guideline, but also at how your child is feeling. A child who is still lethargic, not eating, or sleeping extra is often not recovered enough for the bustle of a group.
Viral or bacterial: does it make a difference for childcare?
In practice, the cause of stomach flu rarely makes a difference for the return date. Most stomach flu in young children is viral – think rotavirus, norovirus, or adenovirus. These cause sudden vomiting, watery diarrhea, and sometimes mild fever. They are extremely contagious and spread through direct contact, surfaces, and even through the air when vomiting.
Bacterial stomach flu, such as salmonella or campylobacter, is less common but can be more severe with high fever and blood in the stool. A longer exclusion period often applies here, sometimes until the Municipal Health Service (GGD) or GP explicitly gives permission. If your child is prescribed antibiotics, always discuss this with the childcare provider – some locations apply an additional observation period.
The tricky part: you rarely know immediately which virus or bacterium it is. The GP usually only tests for severe or prolonged symptoms. My advice: assume the strictest rule until you are sure your child is truly recovered.
The grey areas: only diarrhea, only vomiting, or 'a bit snuffly'
The biggest frustration for working parents lies in the grey areas. Your child vomited once, but then plays happily on. Or there was one loose stool in the morning, but nothing more for the rest of the day. Can they go then?
Here applies: one episode of vomiting is vomiting. The RIVM guideline makes no exception for 'but they must have eaten something wrong'. Only if you are sure that vomiting was caused by coughing or swallowing (so-called 'functional vomiting') can you discuss this with the childcare provider. In doubt: keep them home. The chance that your child is still contagious is simply too great.
For diarrhea, a similar nuance applies. Toddler's diarrhea – chronic loose stools in otherwise healthy toddlers due to lots of fruit juices or fibre – is not a reason for exclusion. But the childcare provider may assess this. Discuss it beforehand with the practitioner and provide a GP's certificate if necessary.
Just as with hand, foot, and mouth disease or chickenpox, with stomach flu the question is: is your child contagious AND do they feel well enough for the group? Sometimes the RIVM says staying home is not strictly necessary, but the childcare provider may have its own house rules to prevent outbreaks.
How do you communicate with your childcare provider about stomach flu?
A good relationship with your childcare provider makes everything easier. Report your child sick as early as possible – ideally before 07:30, so the location can adjust group staffing. Give concrete information: when did symptoms start, how often vomiting/diarrhea, is there fever, and is your child still eating/drinking?
Explicitly ask about the return date that the location applies. Some childcare organizations work with a fixed '48 hours after last symptom' rule, others strictly follow the RIVM advice of 24 hours for single symptoms. Record this in an app or email, so you won't be surprised.
Important: the childcare provider may apply own house rules that are stricter than the RIVM advice, but not milder. If a location is consistently lax with illness policy, that is actually a reason to be alert – just as with other red flags at childcare.
Practical tips for working parents
Stomach flu never comes at a convenient time. With these strategies, you can keep it manageable:
- Arrange a back-up plan: discuss with your partner who is on standby, ask grandparents, or consider a flexible childminder/host parent (gastouderopvang) for emergencies. Some parents build up a small 'sickness buffer' with their employer.
- Check your contract: can you cancel your child's place without costs? How far in advance? Some childcare organizations charge anyway if cancellation is not timely enough, even for illness.
- Hydration above all: with vomiting and diarrhea, dehydration is the greatest risk. Give small sips of water, ORS, or breastfeeding frequently. Only when your child keeps fluids down for six hours without vomiting are they really on the road to recovery.
- Disinfect thoroughly: norovirus is persistent. Use bleach solution (cleaning alcohol doesn't work) for toilets, door handles, and toys. Wash towels and bedding at 60 degrees.
- Be cautious with medication: loperamide (Imodium) is usually not suitable for young children. Consult your GP if in doubt about medication.
When do you call the GP?
Most stomach flu passes on its own within one to three days. Call your GP for:
- Blood in stool or vomit
- High fever lasting more than 24 hours
- Signs of dehydration: dry mouth, no tears when crying, urinating less than three times a day
- Intense stomach pain or a swollen belly
- Vomiting for more than 24 hours, so your child cannot keep fluids down
- Your child is younger than six months
In babies, dehydration quickly becomes life-threatening. Don't hesitate to call if you have any doubts.
Conclusion: better a day too early at home than a day too early back
Stomach flu is unpleasant for your child, stressful for you as a working parent, and a challenge for childcare. The RIVM guidelines offer guidance, but in practice it comes down to common sense and good agreements. Keep your child home for 24 to 48 hours symptom-free, communicate openly with your childcare provider, and seek help for doubtful symptoms.
At Kiddie.nl, you don't just compare childcare locations on location, price, and pedagogical vision, but also on practical matters such as illness policy and flexibility. This way, you find a place that suits your work situation – even when stomach flu strikes unexpectedly.
