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Knowledge and beliefs about guidelines for exclusion of ill children from child care
Kristen A Copeland1, Anne K Duggan, Timothy R Shope
1Division of General and Community Pediatrics Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA. copeland@cchmc.org
Insights
Child care providers, parents, and pediatricians show gaps in knowledge of national illness exclusion guidelines. Many incorrectly applied guidelines, with providers and parents overexcluding children, while pediatricians under-excluded them.
Area of Science:
- Pediatric Health
- Infectious Disease Control
- Child Care Policy
Background:
- National child care illness exclusion guidelines were established by the American Academy of Pediatrics in 1992 and 2002.
- No prior studies assessed the knowledge and beliefs of child care providers (CCPs), parents, and pediatricians regarding these guidelines.
Purpose of the Study:
- To compare the knowledge and beliefs of parents, pediatricians, and center-based child care providers (CCPs) concerning national child care illness exclusion guidelines.
Main Methods:
- A cross-sectional survey was conducted in Baltimore City in 2000.
- Participants included 80 CCPs, 142 parents, and 36 pediatricians.
- Key outcome measures were familiarity with, knowledge of, and beliefs about the effectiveness of exclusion guidelines.
Main Results:
- Response rates varied: 85% for CCPs, 58% for parents, and 59% for pediatricians.
- A significant portion of all groups had not seen written guidelines (16% CCPs, 39% parents, 53% pediatricians).
- CCPs and parents tended to overexclude children compared to national guidelines, while pediatricians tended to underexclude. Knowledge scores were similar across groups (61-64%). CCPs and parents more strongly believed exclusion controlled infection and benefited the child.
Conclusions:
- CCPs, parents, and pediatricians demonstrated a lack of recognition of national guideline recommendations for managing common childhood conditions.
- CCPs were more inclined than pediatricians to support exclusion for infection control and child welfare reasons.
Background:
The American Academy of Pediatrics published national child care illness exclusion guidelines in 1992 and 2002. To our knowledge, no published studies have examined child care providers', parents', and pediatricians' knowledge or beliefs about these guidelines.
Objective:
To compare parents', pediatricians', and center-based child care providers' (CCPs) knowledge and beliefs about exclusion guidelines.
Design:
Cross-sectional survey conducted in 2000 of 80 CCPs, 142 parents, and 36 pediatricians in Baltimore City. Main outcome measures included familiarity with and knowledge of exclusion guidelines and beliefs about exclusion effectiveness among these groups.
Results:
Response rates were 58% for parents, 59% for pediatricians, 85% for CCPs. Sixteen percent of child care providers (CCPs), 39% of parents, and 53% of pediatricians had not seen any written exclusion guidelines. Compared with national guidelines for 12 common symptoms, responses from CCPs and parents indicated overexclusion, while pediatricians indicated underexclusion. The groups scored similarly in number of correct answers on knowledge items (CCPs 63%, parents 64%, pediatricians 61%, P = .44). More CCPs and parents than pediatricians believed that exclusion effectively controlled infection spread and that sick children should be excluded because they spread disease, would be more comfortable, and recover faster at home (P < .001).
Conclusions:
This survey found CCPs, parents, and pediatricians all failed to recognize how national guidelines recommended managing 4 out of 10 common conditions on average. CCPs were more likely than pediatricians to believe that exclusion was warranted to control infection or for the child's personal needs.
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