Compliance With American Academy of Pediatrics and American Public Health Association Illness Exclusion Guidelines for Child Care Centers in Maryland: Who Follows Them and When?

Abstract

Pediatricians, parents, and child care providers were unfamiliar with American Academy of Pediatrics/American Public Health Association illness exclusion guidelines by name but moderately compliant with them. When noncompliant, child care providers and parents generally overexcluded, and pediatricians underexcluded. Stakeholder- and disease-specific predictors for noncompliance gleaned from this study suggest how educational interventions aiming to increase guideline compliance could be individually tailored to child care providers, parents, and pediatricians.

Emergency Department and Urgent Care for Children Excluded From Child Care

“…9 Consistent with previous studies, parents in our national survey reported self-excluding their children from child care, suggesting a lack of knowledge regarding AAP national child care guidelines by parents. 1,8 We were surprised by the proportion of parents who reported they would seek medical care for mild upper respiratory symptoms, with almost one-fifth of parents reporting they would seek primary care provider evaluation for their child. Given the large number of children in child care settings, parents with sick children unable to attend child care seeking acute medical evaluation may profoundly impact available primary care resources.…”

“…For this reason, we designed the survey at a Flesch-Kincaid reading level of 3.1 (third grade); additionally, the vignette items have been previously and successfully used in a survey for parents. 8 Finally, the fifth vignette presented a situation that may potentially represent a bias toward parents in professional job settings. The scenario, however, was intentionally nonspecific (parent faced with an important meeting the next day) so that the scenario could still occur for parents employed in minimum wage or job-training settings and not just in professional settings.…”

“…Five hypothetical vignettes about a child with illness symptoms (cold symptoms without fever, conjunctivitis, gastroenteritis, mild fever, and ringworm), adapted from Copeland et al 8 and previously used by the authors, 9,21 were presented to each respondent (Fig 1). For each of the illness vignettes, parents chose whether the child would be a) sent to child care despite symptoms; b) excluded by child care because of illness; or c) kept at home even if the child was allowed at child care.…”

“…[4][5][6][7] Previous research demonstrates that ill children are routinely excluded from child care unnecessarily given that most child care-related illnesses are minor in severity. [8][9][10][11] Unnecessary exclusions place a substantial burden on working families, businesses, and health care resources. 1,9,[12][13][14][15][16][17][18] Nationally, an estimated 44 million workers lack any paid sick leave benefits to care for sick children, disproportionately affecting poor and minority families.…”

“…Several studies demonstrate that child care provider adherence to the guidelines is low, however, and training is unavailable in most states. 8,9,21,22 Consequently, child care providers unaware of AAP national child care recommendations may increase parents' perceived need for urgent medical evaluations for nonurgent conditions to avoid loss of wages or missed time from work. [23][24][25][26] An estimated 50% to 80% of the 25 million pediatric visits to the emergency department are for nonurgent conditions.…”