You're standing in the bathroom in the morning, your child has strange, honey-colored crusts around their nose and mouth, and your first thought is: can I actually bring my child to childcare today? Impetigo, or krentenbaard as it's known in Dutch, is one of the most contagious childhood illnesses that circulates at childcare. But when is your child actually contagious, and when can they safely rejoin the other children? In this article, we'll guide you through the facts, RIVM guidelines, and practical choices you face as a parent.
How do you recognize impetigo in your child?
Impetigo often starts as small red spots or blisters around the nose, mouth, or chin. These blisters burst quickly and form characteristic thick, honey- to brown-colored crusts. Your child may experience itching, but often doesn't feel very sick otherwise. Sometimes there's a mild fever, especially in the beginning.
It's important to distinguish impetigo from other conditions:
- Chickenpox: Spreads across the entire body, starts as spots and develops into itchy blisters with clear fluid. The blisters dry from the center outward, not just around the nose and mouth.
- Erysipelas (wondroos): A suddenly appearing, bright red, swollen skin area with clear borders, often accompanied by high fever and general illness. This is a more serious bacterial infection requiring immediate medical attention.
Not sure? Take a photo and send it to your GP or get in touch. When in doubt, it's always wise not to self-diagnose, especially when you need to make a decision about childcare the next day.
How contagious is impetigo exactly?
Impetigo is caused by bacteria (usually Staphylococcus aureus or Streptococcus pyogenes) and is highly contagious. Transmission occurs through direct skin contact, but also via contaminated towels, toys, or even by sniffing the same cuddly toy. Children scratch at the crusts, then touch other things, and the bacteria spread like wildfire — especially at a daycare center (kinderdagverblijf/KDV) or after-school care (BSO) where children play close together.
A tricky aspect: your child is already contagious before the crusts become visible. This makes prevention at childcare extra difficult. Once the blisters are open and weeping, the chance of infection is highest. That's why this moment is crucial for the question: can I bring my child?
When can your child go to childcare according to the RIVM?
The RIVM guideline for childcare is clear, but contains a nuance that surprises many parents:
- With open, weeping blisters or crusts: Your child may not go to childcare. This is the most contagious stage.
- With dry crusts, without moisture: Your child may go to childcare, provided the crusts are covered and your child otherwise feels well.
- After starting antibiotic treatment: When treated with an antibiotic ointment or tablets, your child may return to childcare after 24 hours, even if the crusts aren't completely dry yet.
This last rule is a relief for many parents. Start the ointment prescribed by your GP in the morning? Your child can go back to childcare the next morning, provided the blisters are well covered and your child no longer has a fever.
Note: The RIVM states that keeping a child with impetigo home does not fully prevent spread at childcare, since children are contagious before showing symptoms. Nevertheless, bringing a child with open, untreated blisters is irresponsible toward the other children and the childcare team.
What if the childcare has stricter rules?
This is where practice comes into play. The RIVM provides guidelines, but each childcare location may have its own house rules that are stricter. Some daycare centers, for example, apply a 'crust-free' rule: only when all crusts have completely fallen off may your child return. Others ask for a declaration from the GP or want to assess the skin themselves.
Why do they do this? Because impetigo spreads like wildfire in a group. An outbreak means multiple sick children, extra workload for the team, and worried parents. The childcare must balance the needs of your child (and your job) with the health of the entire group.
Our tip: Check the illness policy of your childcare when you register. On Kiddie.nl you can compare locations and view their specific rules around childhood illnesses, so you won't be caught off guard.
How do you treat impetigo at home?
Treatment for impetigo is usually simple and effective:
- Antibiotic ointment: For small areas, the GP often prescribes an antibiotic ointment, such as mupirocin or fusidic acid. Apply this thinly to the affected areas, as directed.
- Antibiotic tablets: For extensive impetigo, multiple spots, or if the ointment doesn't help sufficiently, the GP may sometimes choose a course of tablets.
- Hygiene is essential: Keep nails short, wash hands regularly with soap, use your own towel, and wash toys and bedding regularly at 60 degrees.
- Don't scratch: Explain to your child why scratching doesn't help, and keep plasters on the crusts if needed to prevent scratching.
Call your GP if the crusts don't improve after a week, if your child develops a high fever, or if the skin looks red and swollen. This could indicate a complication.
What should you do during an outbreak in the group?
When multiple children at childcare get impetigo, we speak of an outbreak. The Municipal Health Service (GGD) may then be involved to advise on extra hygiene measures. As a parent, you have a duty to report: inform the childcare as soon as you suspect your child has impetigo. The sooner the childcare knows, the better they can assess whether a pattern is emerging and whether other parents need to be warned.
In such cases, the childcare will often pay extra attention to hand hygiene, clean toys, and ensure children don't use each other's towels or clothing. Sometimes parents are asked to keep children with (suspected) impetigo home until a GP has examined them.
Preventing morning stress: a quick step-by-step plan
To quickly answer that morning question 'can I bring my child?':
- Check the skin: Are there open, weeping blisters or crusts? → Do not go to childcare.
- Has treatment already started? After 24 hours of antibiotic ointment, your child can usually go, provided covered.
- Are the crusts dry and covered? According to the RIVM, your child may go to childcare.
- Check your location's illness policy: Do they have stricter rules?
- Always report it: Inform the childcare, even if your child stays home.
Conclusion
Impetigo is annoying, but fortunately easy to treat. The most important thing as a parent is to recognize the stage of infection: open blisters mean staying home, dry crusts or 24 hours after starting antibiotics usually mean childcare can resume. Take into account the specific house rules of your childcare and always report honestly what's going on. This way you protect not only your own child, but also the other children and the childcare team.
On Kiddie.nl you can easily compare childcare locations in your neighborhood, including their illness policy and GGD inspection reports. This way you can confidently choose a childcare that fits your family.