Self-Report of Child Care Directors Regarding Return-to-Care. Pediatrics 2012 Dec;130(6):1046-52
Date
11/14/2012Pubmed ID
23147967DOI
10.1542/peds.2012-1184Scopus ID
2-s2.0-84870567889 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: The American Academy of Pediatrics (AAP) introduced revised return-to-care recommendations for mildly ill children in 2009 that were added to national standards in 2011. Child care directors' practices in a state without clear emphasis on return-to-care guidelines are unknown. We investigated director return-to-care practices just before the release of recently revised AAP guidelines.
METHODS: A telephone survey with 5 vignettes of mild illness (cold symptoms, conjunctivitis, vomiting/diarrhea, fever, and ringworm) was administered to randomly sampled directors in metropolitan Milwaukee, Wisconsin. Directors were asked about return-to-care criteria for each illness. Questions for return-to-care criteria were open-ended; multiple responses were allowed. Answers were compared with AAP return-to-care recommendations.
RESULTS: A total of 305 directors participated. Based on director responses to vignettes, the percentage of correct responses regarding return-to-child care management compared with AAP return-to-care recommendations was low: fever (0%); conjunctivitis (0%); diarrhea (1.6%); cold symptoms (12%); ringworm (21%); and vomiting (80%). Two illnesses (conjunctivitis and cold symptoms) would require the child to have an urgent medical evaluation or treatment not recommended by the AAP, as follows: Conjunctivitis-antibiotics for 24 hours (62%), physician visit (49%), any antibiotic treatment (6%), and symptom resolution (4%); and Cold Symptoms-physician visit (45.6%), antibiotics (10%), and symptom resolution (25%).
CONCLUSIONS: Directors' self-reported return-to-child care practices differed substantially before the release of revised AAP return-to-care recommendations. Active adoption of AAP return-to-child care guidelines would decrease the need for unnecessary urgent medical evaluation and treatment as well as unnecessary exclusion of a child from child care.
Author List
Hashikawa AN, Stevens MW, Juhn YJ, Nimmer M, Copeland K, Simpson P, Brousseau DCAuthor
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AbsenteeismChild Day Care Centers
Child, Preschool
Communicable Diseases
Convalescence
Cross-Sectional Studies
Data Collection
Female
Guideline Adherence
Home Nursing
Humans
Infant
Male
Policy Making
Referral and Consultation
Time Factors
Unnecessary Procedures
Wisconsin
