Should nannies take care of sick kids? A nanny agency's expert advice
What’s the protocol for nannies when kids are sick in 2026? Are you expected to work, and what’s the right way to talk to parents about it?
With 17 years in the nanny agency business, we’ve seen it all – here is our top advice for you in navigating sick days, your nanny job contract, and a clear script for how to talk to your nanny family about your comfort level when a kid gets sick.
It’s a basic fact of life: kids get sick. And they get sick a lot. On average, preschool aged kids get six to eight infections a year - anything from a common cold to stomach bugs and RSV. This leaves parents with the exhausting, never-ending task of negotiating who can take care of them while they’re sick.
Daycares, preschools, and schools have formal guidelines for when sick kids can and cannot go come in. In the meantime, parents have to take PTO, unpaid time off, or try to work from home during these days. For many parents, one of the reasons they hired a nanny instead is so they do not have to worry about missing work if their kids get sick. But as a nanny, do you have to show up to an infectious household?
Do nannies work when kids are sick?
In general, as a nanny you are expected to show up when the kid is sick. If they are home from school, you will take care of the sick child and adjust the day’s tasks accordingly. This is particularly true if you are a full-time nanny or work with the family regularly.
If this means your normal routine of dropping off siblings somewhere gets complicated, some team work with the parents may do the trick. Maybe the parent stays home an extra hour to work near the child while the nanny goes to drop-off, or perhaps the parent is able to bring the child to school on the way to work, etc. (Click here for a comprehensive guide on working as a nanny during during cold and flu season)
When not to nanny for sick kids
There are a few instances where you are not expected to nanny for sick kids – and a few where you are advised not to. You have the right to be mindful of your health and safety and that of those around you, which sometimes requires a balance of accommodating the family and setting your boundaries. The post-pandemic world also looks different than how we might have approached this before.
For instance, if the child has a contagious, viral disease that you have not had and which may be more severe in adults without immunity, you should be careful. Such diseases include chickenpox and hand foot and mouth disease. If you have had them, however, you have pretty solid immunity and will either not get sick at all or just mild symptoms.
Inside scoop: RSV, which can quickly become quite severe in infants, usually barely registers as a cold in adults, as nearly every person has had the illness and gotten some immunity. Therefore, unless you also work with an infant in another family, there’s usually no problem in working with a child who has it.
There are a few illnesses that are severe enough that typically nannies are not expected to show up for work. Those include illnesses that need medical attention or may involve what we’ll delicately call “a lot of clean up”. Symptoms of this may include:
Active, high fever
Vomiting or diarrhea
Contagious respiratory illnesses with significant symptoms, like COVID-19 and influenza
If you work part time with several families,you need to be even more aware of symtoms and risk of contagion. You don’t want to be the sitter that spreads RSV to ten families in the neighborhood.
What goes around comes around
One thing to take into account is what a contagious illness may mean beyond the child being sick for a day or two. Any contagious illness will likely make its way to the nanny if they come in in the thick of it. For parents, this means that though they may have help while the child is sick, they risk not having any while the nanny is going through the same illness.
As a nanny - as for anyone working in childcare - you have probably already come to terms with the fact that you run the risk of contracting more infectious diseases than your peers working in an office setting. You may even get sick less eventually because of a robustly trained immune system. But you still want to be sure that you are covered for those days.
By making sure a family has backup childcare and you as a nanny have paid sick days, everyone can feel more comfortable taking a gamble on the nanny potentially catching whatever cold virus is floating around. Some parents offer their nanny a bonus PTO day for each day they come in to care for a sick day, just in case they get sick themselves as a result.
Refer back to your nanny contract
There is one way to ensure the practical details of a child getting sick doesn’t get in the way of a smooth week or working relationship: draw up a solid nanny job contract to refer back to.
By spelling out all the expectations and agreements beforehand, everyone knows what to do when the first sneeze arrives - and no one has to make an emotional gametime decision based in stress and duress.
A nanny contract can help spell out:
Expectations for when a child is sick
Paid time off and sick days for the nanny
Expectations on communication from parents regarding illness
Any nuances regarding illness, such as:
Illnesses where the nanny is not expected to come in (COVID-19, viral stomach flu/norovirus)
Illnesses where the nanny is expected to come in (common cold, RSV, bacterial stomach flu/food poisoning)
A nanny job contract offers peace of mind for both parents and nannies, and ensures that everyone knows what is expected of them when the flu hits the fan. This way once the viruses are gone, there’s not a whiff of resentment to linger in their wake (but maybe a bit of a sniffle).
If you don’t currently have a sick day clause in your contract, it’s a perfect time to renegotiate and revise! Here’s all about how to renegotiate your nanny contract.
Communication between nannies and families is key
We’ve said this before and we’ll say it again: as with so many other things that arise in the nanny-family working relationship, communication is key. That’s why it’s important to talk about these things early on, so you and the family are aligned in expectations of when to tell you about a child’s illness and symptoms.
Communication is also what will save your working relationship in case you are not able to come in and work while the child is sick. If it’s a childhood disease you haven’t had or you’re being mindful not to spread germs to other families, being clear and professional will help get everyone on the same page.
Sample scripts for talking about sick days
“I’m sorry to hear [Child] is sick! Since I haven’t had chickenpox, it would most likely make me severely ill to be exposed to it and I’d be out for a longer time. As per our contract, I will stay home until no one in the house is contagious. I have a backup sitter I could suggest, if you need coverage?”
“Oh no! I hate to hear that [Child] isn’t feeling well, and thanks for the heads up. As you know, I work with so many families, and a contagious illness like this could really spread quickly. Since I don’t have guaranteed weekly hours with you, and as per our nanny contract, no need to pay me for that shift, and let me know when [Child] is starting to feel better and we can get back on the schedule!”
“Thanks for letting me know! Hopefully the pink eye isn’t too bad – I believe [Child] won’t be contagious 48 hours after starting antibiotics, so I’m happy to come back Thursday, and that only means I’d miss Wednesday’s shift. Is that what your doc told you too?”
If you’re on a guaranteed weekly income, no need to harp on that now. If the family tries to not pay you for a scheduled day when you were out, that’s the time to bring up the nanny contract and what it says about payment.
When should a nanny come back after a child’s illness?
Most preschools and schools have protocols for when kids can come back after illness, and perhaps those would be helpful to apply here as well. If the agreement is that you don’t work while the child is contagious, a good benchmark is returning after the child is fever-free for 24 hours.
If the illness is being treated with antibiotics, the child will often no longer be contagious even though there are symptoms. In that case, ask the parents to check with their pediatrician for guidelines.
Need advice on how to talk to a family about what to do in case of illness? Want a nanny job where the expectations are outlined up front and you get professional help in construction the nanny job contract? At our nanny agency, we view nannies and babysitters are professional childcare providers and treat the job as such. With us, you get all the backing of the industry’s best practices, and our two decades of helping families and caregivers find each other. Apply today to see how we can help you!
Frequently asked questions about nannying through a sick day
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In most positions, caring for a mildly sick child is considered part of a nanny’s regular responsibilities and is covered by their normal hourly rate or salary. However, if the sick day requires you to work extra hours or manage more children than your position normally entails, you should be compensated for the additional work.
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Nannies are typically not expected to work when a child has a highly contagious or medically serious condition. These often include illnesses such as COVID-19, influenza, norovirus, and any condition involving persistent vomiting, uncontrolled diarrhea, or a high fever. However, families and nannies may agree in advance on permissible symtoms/illnesses vs. not.
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A strong sick-care clause clearly defines which illnesses the nanny is comfortable working through, which ones are excluded, how much notice will be given when a child is sick, and whether additional pay or PTO will be provided for higher-risk care. It should also include what happens if the nanny becomes ill, the use of protective measures (such as masks or ventilation), and whether backup care will be arranged for contagious conditions. If you need help writing a sick-care clause for your nanny contract, working with a nanny agency like Smart Sitting can help you get the wording and details right.