Daniel and Priya had a 7:40 flight and a house full of goodbyes when their au pair, Camila, found their six-year-old, Noah, sitting on the stairs in his school clothes, hot to the touch and very quiet. The plan for the week had been simple: parents travelling, Camila at home, school and football as usual. The plan for a sick child had never been discussed.
Camila did what a conscientious person does with no instructions. She sent Noah to school, because he had a maths test and she didn't want to be the reason he missed it. She texted Priya a thermometer photo at 10:15, while Priya was in a security queue. At 11:30 the school called, and Camila did not know whether she was allowed to say yes to "can you collect him?" or what to say when the nurse asked if he had had anything for the fever. She guessed. She guessed wrong on one of them.
Nobody was careless. Daniel and Priya had briefed her on allergies, bedtimes and the school run. What they had never written down was the plain Tuesday-morning question: the child is sick, so who decides what, and when do I call you? This guide helps you write that answer once, before the first cold of the season arrives.
🌍 This guide uses examples from both Germany and the US. School and daycare illness rules, and what an au pair may do, differ by country, school and agency, so check yours. This article is general information, not medical advice. Your pediatrician has the final word on any specific child.
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Why Sick Days Are the Hardest Day for an Au Pair
A sick child turns a routine day into a string of judgment calls. An experienced parent makes them without noticing. An au pair, often twenty-something and months into a foreign country, makes them with two handicaps: no history with this particular child, and a real fear of getting it wrong in either direction.
Two Failure Modes
Without a plan, au pairs tend to fall into one of two patterns:
- Over-calling: every sniffle becomes a message to a parent in a meeting, and the au pair learns that asking is annoying
- Under-reacting: the au pair doesn't want to make a fuss, waits, and passes on the one detail that mattered too late
Both come from the same place. The au pair has no idea where the line is, so they guess where they think it should be. A written protocol moves the line from their head onto paper, where you set it.
What This Guide Is (and Isn't)
This is the day-of playbook for a sick child. It deliberately does not repeat the neighbouring topics:
- The medication and allergy record is the standing health file. This guide uses it, rather than redoing it.
- The emergency preparedness guide covers the contact sheet, first aid basics and fire safety.
- Your au pair's own illness, insurance and doctor visits are covered in our health insurance guide.
What none of those cover is the decision sequence on an ordinary sick morning, and that is what a protocol is.
Step 1: Decide Who Decides
Before any thresholds, settle authority. Most sick-day confusion is not about fever numbers but about whose call it is.
Split the Decisions Into Three Owners
| Decision | Who owns it | Why |
|---|---|---|
| Is this an emergency? | Au pair, immediately, no permission needed | Delay is the risk |
| Does the child stay home today? | Parent decides, au pair gathers the facts | The parent knows the child, the school and the work calendar |
| Does the child see a doctor? | Parent decides, unless the au pair sees a "call now" symptom | The parent holds the medical history and the insurance |
| Does the child get medicine? | Parent decides, in writing, in advance | Dosing belongs to the pediatrician, not to improvisation |
The most useful sentence in the whole protocol is the first row. Say it out loud, and write it down: if you think it's an emergency, call emergency services first and us second, and you will never be in trouble for that.
Key takeaway: An au pair should never have to decide whether it's worth bothering you. Give them a list of things that always warrant a call, and a short list of things that never do.
Name a First Call and a Second Call
Parents are not always reachable. A nurse in surgery, a parent on a flight and a parent in a meeting with their phone off are all normal Tuesdays. Write a call order:
- Parent one, by phone, not text
- Parent two, by phone
- A named backup adult nearby, such as a grandparent, a neighbour or a close friend who knows the child
- The pediatrician's office or nurse line, for medical questions the au pair can't resolve
Add one line: if neither of us answers within fifteen minutes, call the next person on the list. You do not have to wait for us.
Step 2: The Morning Decision, Stay Home or Go to School
Most sick-child protocols fail at 7:15 am, in the doorway, with a coat half on. This is where you save the most stress by deciding in advance.
Start With the School or Daycare's Own Rule
Many schools and daycares publish their own rule, so your first move is to get it in writing and put it in the protocol. Two examples of the kind of rule you'll find:
- Germany: the Infection Protection Act (§ 34 IfSG) bars children with certain infectious diseases from daycare and school until a doctor says the risk of passing it on has passed. For children under six it also covers infectious gastroenteritis, including suspected cases. Facilities usually add their own wording on fever and vomiting.
- US: there is no single national rule. Schools and childcare centres set their own, and a common version is "fever-free for 24 hours without fever-reducing medicine" before return, plus a vomiting or diarrhoea clause. Check the handbook rather than assuming.
Whatever the rule says, your au pair needs the page itself, not your summary of it.
A Simple "Home Today" Checklist
Give your au pair a short list of signs that mean the child stays home even if the child insists they feel fine:
- Fever: your pediatrician's or school's threshold, written as a number you chose
- Vomiting or diarrhoea: at least once in the morning, or in the night before
- Rash that is new and unexplained
- Too ill to take part: the child can't realistically manage the day, whatever the thermometer says
- A school rule that applies: a named illness your school excludes for
And a list of what is usually fine for school, so you don't get a text every time someone coughs: a runny nose with no fever and normal energy, for example. You set that list. A parent with an asthmatic child will draw it differently from one with a robust teenager.
Who Tells the School?
Make it a one-line rule: the au pair informs the school by the usual route, with the parent copied. Write down the route (phone, an app, a form), the name of the person to call and the deadline, often 8:00 or 8:30. In Germany, some schools also expect a written excuse from the parents afterwards, which the au pair cannot sign. Say who does that.
Key takeaway: Decide the stay-home rule on a calm evening, not in the doorway at 7:15. Then the morning decision is "check the list," not "negotiate with a child who wants to go."
Step 3: Fever, Medicine and the Line the Au Pair Doesn't Cross
This is the section parents worry about most, and it's where the most careful wording pays off. Two principles keep it safe.
Principle One: The Au Pair Gives Only What Is Written Down
No improvising and no remedies from a friend. The same logic applies to anything the au pair has brought from home. The permission list lives in the child's health record, and our guide to the medication card and permission rules shows exactly how to build it. For sick days, make three things explicit:
- Which products your au pair may give, by name, for which symptoms
- The dose and the minimum gap between doses, written by you from your pediatrician's instructions (this article deliberately gives no dosing, because the right amount depends on the child's weight and age)
- A log: time and amount, every time, so the next adult knows exactly what has been given
Some programmes ask for written host-family permission before an au pair gives any medication. Check yours and sign the paperwork before the first sick day, not during it.
Principle Two: Fever Is a Prompt to Look at the Child, Not Only the Thermometer
The pediatric guidance is consistent on this. The American Academy of Pediatrics notes that how a child acts matters as much as the number, and that a child who plays and interacts after getting medicine for discomfort is a good sign (AAP, Fever and Your Child). The NHS says something similar: a high temperature is the body's natural response to infection, and you should not cool a child by undressing or sponging them (NHS, fever in children). Your au pair can follow that without knowing any medicine.
Practical rules you can write straight into the protocol:
- Where the thermometer is, how to use it and which reading method you trust
- Fluids first: small, frequent sips, and a note of who is drinking
- Light clothing and a comfortable room: not wrapped up in blankets
- Check back on a schedule: for instance every hour, and write down what you see
Step 4: The Escalation Ladder, Who to Call and When
This is the part au pairs most want from you, and it should read like a traffic light. Keep it to one page, and keep the wording in plain, observable terms.
The Three Tiers
| Tier | What the au pair sees | What the au pair does |
|---|---|---|
| Call emergency services first | Trouble breathing, a seizure, a child who cannot be woken or is unresponsive, blue or grey lips, a rash that does not fade under a pressed glass | Call the local emergency number, then the parents |
| Call the doctor and parents now | See list below | Phone the pediatrician, then update the parents |
| Message the parents, no rush | A fever without any red flag, a child with a poor appetite, a sniffle that's worsening | Text the update, log it, check again in an hour |
Symptoms That Mean "Call Now"
The reference points below come straight from published pediatric advice, so you aren't inventing thresholds from memory. The AAP says to call the child's doctor right away if a fever comes with any of these:
- The child looks very ill, is unusually drowsy or is very fussy
- A stiff neck, severe headache, severe sore throat, severe ear pain, breathing difficulty, an unexplained rash or repeated vomiting or diarrhoea
- The child is younger than 3 months and has a temperature of 38.0°C / 100.4°F or higher
- The child has had a seizure, or has a condition affecting the immune system or the heart
The NHS adds signs that need an immediate emergency call: a stiff neck, a rash that does not fade when you press a glass against it, a child who is drowsy and hard to wake, has difficulty breathing, or has blue, grey or very pale skin, lips or tongue. Put whichever list your own pediatrician endorses on the page, and print it at the same size as everything else, not tucked into a footnote.
The Numbers Are Yours to Set
You will notice this guide does not hand you a single "call at this temperature" figure for all children. That is intentional. Where to set the line depends on the child's age, history and your pediatrician's view, and other published guides give differing numbers. Ask at the next check-up: "At what temperature, and with which other symptoms, should our au pair call you?" Write the answer on the page with the date.
Key takeaway: For a young caregiver, an escalation ladder with three clear tiers is more useful than a perfect medical manual. The goal is that nobody has to decide, in the moment, whether they are overreacting.
Step 5: The Update Habit
Sick days go smoothly when the information flow is boring and predictable. Agree on one.
What a Good Update Contains
Ask your au pair to send the same four items every time, so you can read it in five seconds:
- Temperature and time
- What the child has had: medicine and amount, drinks, food
- How the child is acting: playing, resting, miserable, asleep
- Anything new: a rash, vomiting, a complaint of pain
Ask for these at set times, such as on waking, at midday and mid-afternoon, plus immediately for anything from the "call now" list. A predictable rhythm means you aren't wondering at 2 pm, and your au pair isn't wondering whether to text.
One Thread, Not Five
A fever update scattered across a family group chat, a private message and a voicemail is easy to lose. Keep the sick-day thread in one place. If you use AuPairSync, a dedicated message thread keeps the temperatures and times in order, so the afternoon parent can read the morning's story without asking again.
Step 6: Handover, Back-up Care and Caring for the Carer
A sick child is also a scheduling problem, and that is where good intentions hit the calendar.
Plan the Day, Not Just the Child
If a child stays home, somebody's day changes. Decide in advance:
- Who is the primary carer on a sick day, and does that change the au pair's hours?
- Which backup adults could take over, for example a grandparent, a neighbour or a babysitter?
- What if the au pair is the one who falls ill after nursing the child? That is a separate plan, covered in our guide to when your au pair needs a doctor.
Sick days can push an au pair past their normal working hours. Agree upfront that the family will treat extra time as extra time, and note it in the shared schedule. The working-hours rules still apply when a child is ill.
Look After the Person Who Looks After the Child
Nursing a sick child for a day is tiring, and the au pair is exposed to everything the child has. A short note at the end of the protocol goes a long way: thank you; here is the number for our pediatrician and for yours; rest if you need to; tell us if you start to feel unwell.
What to Put in the Protocol (Template)
Keep the finished document to a single page, kept where your au pair can find it in ten seconds, and in a form that works at 3 am on a phone.
- Emergency line: "If in doubt, call emergency services first" and the local number
- Contacts in call order: parents, backup adult, pediatrician, nurse line, with phone numbers
- The pediatrician's escalation answer: your agreed thresholds and the date they were set
- Stay-home list: the school's rule, plus your own signs
- Medicine permissions: product, reason, dose and minimum gap, in your handwriting or the pediatrician's
- Update schedule: the four items and the times
- Who tells school: the route, the person and the deadline
- Backup care: names and numbers
If you keep child profiles in a shared family app, the pediatrician, medications and emergency contacts can live in each child's profile, so the same record is on the au pair's phone when the fever starts. Our guide to setting up child profiles shows what to include.
Your Sick-Day Checklist
Once, before the season starts:
- Ask the pediatrician where the call-now lines are, and write them down with the date
- Get the school or daycare illness policy in writing
- Write the medicine permissions, with product, dose and minimum gap
- Agree the call order and the fifteen-minute rule
- Check your agency's rules on au pairs giving medicine, and sign anything required
On a sick morning:
- Run the stay-home list
- Inform the school by the agreed route
- Take the temperature and log time and reading
- Agree the update times for the day
During the day:
- Check on the child on a schedule, and log what you see
- Anything from the "call now" list means a call, not a text
- Pass the log on at handover
The Bigger Picture
A sick-kid protocol is a small document, but it carries a larger message. It tells your au pair that you trust them with your child, that you have thought about what that trust requires, and that asking for help is expected rather than an imposition. That is the feeling that keeps a young person confident in a foreign country at 3 am with a hot, miserable child.
Noah was fine by the weekend: a virus, nothing more, and a school nurse who thought the au pair had done a decent job with no instructions. Daniel and Priya wrote the one-page protocol on the flight home. The next time, Camila knew who decided what, and the text she sent said, in five seconds, everything her parents needed to know.
Getting your family ready for the cold season? Download AuPairSync to keep each child's pediatrician, medication permissions and emergency contacts where your au pair can find them in seconds.
