WebMD Health News
Laura J. Martin, MD
April 19, 2010 -- Many day care centers unnecessarily send children home
when they are suffering from very mild illnesses, a new study suggests.
That view comes from a study in Wisconsin in which researchers found that
child care directors often send children home because of sniffles and colds,
mild fevers, scalp infections, gastroenteritis, and pinkeye
The American Academy of Pediatrics (AAP) and the American Public Health
Association (APHA) don’t recommend excluding children from day care because of
such mild and common health problems.
Wisconsin endorses the AAP and APHA recommendations, but researchers still
found that day care directors there often were not very familiar with the
The study appears in the May issue of Pediatrics, which was published
online April 19.
Andrew N. Hashikawa, MD, of the Medical College of Wisconsin, and colleagues
surveyed 305 child care centers in metropolitan Milwaukee to determine whether
the recommendations of the health groups were being followed.
They found that day care directors who answered a survey would unnecessarily
exclude 57% of children with mild illnesses, contrary to the national
recommendations. Specifically, they found that:
Hashikawa suggests that sending children home for such common and mild
health problems may not be necessary and could be counterproductive.
Previous studies in states that haven’t accepted the health association
guidelines have shown exclusion rates varying from 33% to 100%.
In 2005, more than two-thirds of children in the United States under age 5
required non-parental care, and most were taken care of in a child care
setting, Hashikawa says in a news release.
Thus, he says, “children who are excluded from child care place a
significant economic burden on parents, businesses, and health care
In the study, child care directors in the Milwaukee area were surveyed by
telephone and asked which of the health conditions would cause them to send
children home immediately. None of the five scenarios presented should warrant
exclusion under the national guidelines, which have been endorsed by health
authorities in Wisconsin.
“The high rate of inappropriate exclusions persists despite state
endorsement of the national AAP and APHA guidelines,” Hashikawa says.
Among other things, the study found that:
“[O]ur study is the first to show that children who attend larger child care
centers are excluded less for the same symptoms of mild illness,” Hashikawa and
colleagues write. “One reason for this difference may be that larger centers
are more likely to have greater availability of resources, such as separate
sick or isolation rooms and extra child care staff available to care for and
monitor children with mild illness."
The study also found that:
The authors note that previous research has shown that urban child care
centers that used telemedicine reported a 63% decrease in absence from child
care as a result of illness.
They concluded that more training for directors may result in fewer
unnecessary exclusions of mildly ill children.
SOURCES:News release, Medical College of Wisconsin.Hashikawa, A. Pediatrics, May 2010; vol 125: no 5.
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