A: Cindy, it can be exhausting dealing with a baby’s frequent illnesses. Between colds, ear infections, conjunctivitis, vomiting and diarrhea, infants can average a dozen illnesses a year. In the first year of life, babies are exposed to many germs for the first time. But as they recover from each illness they build up immunity to protect them from that virus or bacteria the next time they’re exposed to it. So when your baby is 2 he’s likely to have about half as many illnesses; and when he’s between 3 and 5 years old he’ll likely have half as many again.

Children are more likely to get sick when they begin childcare. Children in childcare are generally exposed to larger numbers of children and germs, and they average about two to three times as many colds, ear infections and episodes of diarrhea as children cared for at home. The increase in illness is more pronounced for infants, since their immunity is lower. It’s also worse in the winter when colds, ear infections and pinkeye (conjunctivitis) are more common. But if it’s any consolation, the increase in illnesses is mostly just in their first year of childcare. Those illnesses help build children’s immunity so they actually experience fewer illnesses at preschool to elementary school ages than children who did not attend childcare.

Although frequent illness is an inevitable part of early childhood and childcare, there are many things your childcare provider can do to reduce the spread of illnesses:

• Immunizations: The childcare program should require that children stay up-to-date on their immunizations. Be sure your baby stays on schedule for his well-baby checks and immunizations at 2, 4, 6, 9, 12, 15, 18, and 24 months of age. Even if your baby has a mild illness, he can still get his immunizations on schedule. These will help protect him from serious illnesses.
• Hand washing: The caregiver should wash her hands and your baby’s with soap and running water after diapering and before meals. She should also wash her hands after wiping a child’s nose and before touching another child.
• Sanitary diapering: The changing table must be away from the food preparation and serving areas. This is important to prevent the spread of germs that cause vomiting and diarrhea.
• Cleaning and disinfecting: The caregiver should use a diluted bleach solution (1 tablespoon bleach in a quart of water) or other disinfectant to clean the tables after meals, and the changing table after each diaper change. Toys that children have put in their mouths should also be cleaned and disinfected either with the bleach solution or in the dishwasher.
• Fresh air: Fresh air helps blow away germs that cause colds. The indoor space should be well-ventilated, and the children should be taken outdoors to play every day, weather permitting.
• Health policies for illness: The childcare program needs health policies that specify when a child is too sick to attend childcare and needs to stay home. This is important to ensure that ill children receive the individualized attention and care they need, and that they don’t spread their illness to other children.

Talk with your childcare provider about your concerns. Try not to blame her, but encourage her to do everything she can to keep the children healthy. You might say something like, “I know that frequent illnesses are inevitable for babies, but let’s make sure we’re doing everything we can to keep the children healthy.” Encourage her to examine the above disease prevention practices. For more information, visit the American Academy of Pediatric website for Healthy Child Care America, www.healthychildcare.org, and check out the information for families and parents as well as childcare providers.

Also, talk with your baby’s doctor about your concerns. Over the next year, you’ll pro