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Medicineworld.org: When 'sick' children are unnecessarily sent home

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When 'sick' children are unnecessarily sent home




In a newly released study, scientists at the Medical College of Wisconsin and Children's Hospital of Wisconsin, working with Community Coordinated Child Care (4C's), have observed that a number of metropolitan Milwaukee child care directors would unnecessarily send children with mild illnesses home.

Andrew N. Hashikawa, M.D., and his colleagues surveyed 305 child care centers in metropolitan Milwaukee to see how closely directors followed national guidelines from the American Academy of Pediatrics (AAP) and the American Public Health Association (APHA) and to identify characteristics linked to unnecessary exclusion decisions. Their findings "Unnecessary Child Care Exclusions in a State That Endorses National Exclusion Guidelines," would be reported in the recent issue of Pediatrics (published online April 19).



When 'sick' children are unnecessarily sent home

Dr. Hashikawa is an instructor in pediatrics and a third year fellow in pediatric emergency medicine at the Medical College and practices at Children's Hospital.

In 2005, more than two-thirds of children in the United States who were under five mandatory nonparental child care, a vast majority of whom received care in a child care setting. "Children who are excluded from child care place a significant economic burden on parents, businesses, and health care resources." Dr. Hashikawa points out.

Mild acute illness accounts for the majority of child care exclusions, a number of of which have been described as not medically indicated. Prior studies in states without guidelines showed rates varying from 33 percent to 100 percent. The national AAP and APHA guidelines were developed to address this high rate of inappropriate exclusions.

To examine adherence to these guidelines, the scientists used five scenarios for children with mild illness consisting of a cold, conjunctivitis, gastroenteritis, fever and tinea capitis (a scalp infection). Child care directors were surveyed by telephone and were asked which of these children would be mandatory to go home immediately. None of these scenarios should warrant exclusion, as per national guidelines.

The scientists observed that overall, directors would unnecessarily exclude 57 percent of children with mild illnesses. Responses ranged from eight percent of directors unnecessarily excluding a child with a cold, to 84 percent of directors unnecessarily excluding a child with tinea capitis. Directors with greater child care experience and directors of larger centers made fewer unnecessary exclusion decisions.

"This high rate of inappropriate exclusions persists despite state endorsement of the national AAP and APHA guidelines," says Dr. Hashikawa.

Currently there are no formalized ongoing state training programs available for child care directors to learn about appropriate exclusion guidelines.

"The next step," Dr. Hashikawa suggests, "Is to develop formalized state training programs that child care directors could use to learn about appropriate exclusion guidelines for mild illness. Our meetings and focus groups with local day care directors indicate that they would overwhelmingly welcome the opportunity to take continuing education classes if they were made available by the state."


Posted by: JoAnn    Source




Did you know?
In a newly released study, scientists at the Medical College of Wisconsin and Children's Hospital of Wisconsin, working with Community Coordinated Child Care (4C's), have observed that a number of metropolitan Milwaukee child care directors would unnecessarily send children with mild illnesses home.

Medicineworld.org: When 'sick' children are unnecessarily sent home

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