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Children's Health

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Day Care Dilemma: When to Send Sick Kids Home

Day Care Centers Often Unnecessarily Send Children Home Because of Mild Illnesses, Study Finds

Health Care Access Affects Decisions

Among other things, the study found that:

  • 97% of child care directors surveyed were female.
  • 33% of the child care centers were urban.
  • The exclusion rate in Wisconsin was about the same as that found in previous research in states that hadn’t adopted the AAP and APHA recommendations.
  • Directors with greater experience made fewer unnecessary exclusion decisions.
  • 86% of directors in the Wisconsin study had college-level experience.
  • The size of a child care center is associated with exclusion practices.

“[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:

  • Directors of centers with a smaller percentage of their children on state-assisted tuition had higher inappropriate exclusion rates.
  • Directors may take into account the lack of health care access when making exclusion decisions.
  • Centers with a higher proportion of female heads of households had fewer exclusions.

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.

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