Day Care Dilemma: When to Send Sick Kids Home

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

Medically Reviewed by Laura J. Martin, MD on April 19, 2010
From the WebMD Archives

April 19, 2010 -- Many day care centers unnecessarily send children home when they are suffering from very mild illnesses, a new study suggests.

That view comes from a study in Wisconsin in which researchers found that child care directors often send children home because of sniffles and colds, mild fevers, scalp infections, gastroenteritis, and pinkeye (conjunctivitis).

The American Academy of Pediatrics (AAP) and the American Public Health Association (APHA) don’t recommend excluding children from day care because of such mild and common health problems.

Wisconsin endorses the AAP and APHA recommendations, but researchers still found that day care directors there often were not very familiar with the guidelines.

The study appears in the May issue of Pediatrics, which was published online April 19.

Sending Sick Kids Home

Andrew N. Hashikawa, MD, of the Medical College of Wisconsin, and colleagues surveyed 305 child care centers in metropolitan Milwaukee to determine whether the recommendations of the health groups were being followed.

They found that day care directors who answered a survey would unnecessarily exclude 57% of children with mild illnesses, contrary to the national recommendations. Specifically, they found that:

  • 8% of directors would unnecessarily send home a child with a cold.
  • 84% would exclude a child with tinea capitis, better known as a fungal scalp infection.
  • 60% would send home children who had pinkeye.
  • 65% would send home children with gastroenteritis, a stomach problem that often causes diarrhea.
  • 67% would send home children who had fever, but no other symptoms

Hashikawa suggests that sending children home for such common and mild health problems may not be necessary and could be counterproductive.

Previous studies in states that haven’t accepted the health association guidelines have shown exclusion rates varying from 33% to 100%.

In 2005, more than two-thirds of children in the United States under age 5 required non-parental care, and most were taken care of in a child care setting, Hashikawa says in a news release.

Thus, he says, “children who are excluded from child care place a significant economic burden on parents, businesses, and health care resources."

In the study, child care directors in the Milwaukee area were surveyed by telephone and asked which of the health conditions would cause them to send children home immediately. None of the five scenarios presented should warrant exclusion under the national guidelines, which have been endorsed by health authorities in Wisconsin.

“The high rate of inappropriate exclusions persists despite state endorsement of the national AAP and APHA guidelines,” Hashikawa says.

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.

Show Sources


News release, Medical College of Wisconsin.

Hashikawa, A. Pediatrics, May 2010; vol 125: no 5.

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