Medical exclusion of sick children from child care centers: a plea for reconciliation

Area of Science:

• Pediatric Health
• Child Care Management
• Public Health Policy

Background:

• Child care exclusion policies impact parental work attendance and healthcare resource use.
• Variability in policies can lead to inconsistent child care access.
• Understanding current exclusion practices is crucial for public health.

Purpose of the Study:

• To assess current child care exclusion policies in Virginia.
• To identify variations in policies regarding fever, respiratory illness, and head lice.
• To compare existing policies with established medical standards.

Main Methods:

• Survey of a representative sample of 310 child care centers in Virginia.
• Data collection from 183 center directors on exclusion criteria and temperature thresholds.
• Analysis of policies for fever, common upper respiratory tract illnesses, and head lice.

Main Results:

• Wide variation in fever definitions (100.0-100.4°F) and inconsistent temperature measurement methods.
• Many centers excluded children with low-grade fever without behavioral changes.
• Policies could exclude afebrile children with minor symptoms or treated head lice.

Conclusions:

• Virginia child care exclusion policies exhibit significant variability.
• Current policies often deviate from accepted medical practice standards.
• Need for uniform policy implementation based on expert consensus to minimize unnecessary exclusions.