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    Day Care Workers Prescribing Too Many Trips to the Doctor


    In children who were suspected of having an upper respiratory infections, nearly 40% of the officials at the centers said they believed antibiotics would be helpful in preventing bacterial infection, 26% thought antibiotics were useful to prevent infection spread, and 21% believed antibiotics could speed up the child's recovery.

    "Few knew that antibiotics aren't effective in speeding recovery or preventing the spread of viruses associated with upper respiratory tract infections," says Wang. Wang is vice president of clinical and medical affairs for Aventis Pasteur, Canada -- a pharmaceutical firm -- and is also an associate professor in the departments of pediatrics and public health sciences at the University of Toronto.

    Although the organization of child care facilities is different in the U.S., the study in Canada points to two problems faced by parents whose children are in centers during the day: children are being forced to stay home from the center when they may not need to, and they're receiving advice on health from those unqualified to give it. These problems are further complicated in the U.S. by differences in day care center regulations from state to state and from different child care center chains.

    "The consensus of people who develop child care standards is that it isn't the job of child care workers to make medical recommendations. This is up to the parents and their doctors," Ruth Neil, PhD, tells WebMD. Neil is the project coordinator for the National Resource Center for Health and Safety in Childcare (NRCHS). The government-funded NRCHS develops health and safety standards for child care providers in collaboration with the American Public Health Association and the American Association of Pediatrics.

    Angela Crowley, PhD, says, "There is a need for additional training of child care workers in this area. The standards provided by NRCHS are a useful framework to base this on." Crowley, an expert on child care health and safety issues, commented on the study for WebMD. She is an associate professor of nursing at Yale University.

    "The study design was strong," says Crowley. Although this study was conducted in Canada, Crowley says the results are representative of the U.S., where her staff has also conducted day care studies. "We found similar findings in South Carolina in child care staff and parents. The [child care staff] tended to overexclude [children]. There is a lot of confusion about when to appropriately exclude children.

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