Day Care Workers Prescribing Too Many Trips to the Doctor

From the WebMD Archives

Feb. 15, 2000 (Atlanta) -- A new study confirms what many working parents know to be true. Day care center staff too often pressure parents to take their child to a physician, get antibiotics, or just stay at home with their child without adequate reason. The Canadian study is published in this month's Archives of Pediatrics and Adolescent Medicine.

"It looks like there is poor knowledge on the part of the day care directors, and they tend to encourage antibiotics for attendees," corresponding author Elaine E.L. Wang, MD, tells WebMD. "There's no question they need better education."

Children experience many illnesses during childhood. Most childhood illnesses, such as the common cold, are caused by viral infections. Children normally recover from common viral infections when the illness has run its course. Antibiotics should not be used to treat viral infections.

Antibiotics do treat bacterial infections, however. Over time, bacteria can become resistant to antibiotics, and overuse of the medications is often a factor in that resistance. The authors note that "strategies are needed to reduce unnecessary antibiotic prescriptions, the major contributor to the escalating problem of antibiotic-resistant bacteria."

In the study, researchers conducted telephone interviews with providers in 36 day care centers in Canada. They questioned the providers on their knowledge and attitudes about antibiotic use for children and how often they referred children to physicians for examination.

From the interviews, the researchers found that more than 90% of the day care staff reported sending diapered children home if they had an infection and were not able to participate in center activities.

More than 75% of the staff members reported advising a physician visit when nasal discharge was colored, and more than 50% recommended a visit to a physician for children with coughs.

A majority also reported sending children home "to prevent the spread of infection" (67%) or if there was insufficient staff to care for the children (61%). On the other hand, most staff members (69%) kept children at the center who, they felt, needed to be home if the child had an antibiotic prescription and their parents could not stay home from work.

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.

"Another important thing raised by the study was that if children are not feeling well enough to participate, this must be provided for," Crowley says, in response to the finding that most of the staff reported sending diapered children home if they had an infection.

The National Center for Education Statistics (NCES) reports that six out of 10 -- nearly 13 million -- infants, toddlers, and preschool children are enrolled in day care. According to the NCES, nearly 88% of children whose mothers work full-time and 75% of children whose mothers work part-time are enrolled in day care.

For a listing of each state's child care licensing regulations, visit the web site of the National Resource Center for Health and Safety in Child Care at or call (800) 598-KIDS.

Vital Information:

  • A Canadian study shows that child care workers often pressure parents to get antibiotic prescriptions for upper respiratory tract infections, not knowing that the treatment will be ineffective.
  • Antibiotics are not effective against viral infections, do not prevent the spread of infection, and do not speed recovery, and the overuse of these medications leads to drug-resistant bacteria.