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Self-Report of Child Care Directors Regarding Return-to-Care
Andrew N Hashikawa1, Martha W Stevens, Young J Juhn
1Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA. drewhash@umich.edu
Insights
Child care directors
Area of Science:
- Pediatrics
- Public Health
- Child Care Management
Background:
- The American Academy of Pediatrics (AAP) updated child return-to-care guidelines in 2009 and 2011.
- Practices of child care directors in states lacking clear guideline emphasis were unexamined.
- This study assessed director practices before revised AAP guidelines were released.
Purpose of the Study:
- To investigate child care director practices regarding return-to-care for mildly ill children.
- To compare these practices with American Academy of Pediatrics (AAP) recommendations.
- To identify discrepancies in return-to-care decision-making.
Main Methods:
- A telephone survey was conducted with 305 randomly sampled child care directors in Milwaukee, Wisconsin.
- Directors responded to 5 mild illness vignettes (cold, conjunctivitis, vomiting/diarrhea, fever, ringworm).
- Return-to-care criteria were open-ended and compared against AAP guidelines.
Main Results:
- Director responses showed low adherence to AAP return-to-care recommendations across most illnesses.
- Correct response rates were 0% for fever and conjunctivitis, 1.6% for diarrhea, 12% for colds, 21% for ringworm, and 80% for vomiting.
- Practices for conjunctivitis and cold symptoms often involved unnecessary medical evaluation or treatment.
Conclusions:
- Significant discrepancies existed between child care directors' self-reported practices and AAP return-to-care guidelines prior to the revised recommendations.
- Adopting AAP guidelines could reduce unnecessary medical interventions and child exclusions from care.
- Standardizing return-to-care practices is crucial for appropriate child management in care settings.
Background:
The American Academy of Pediatrics (AAP) introduced revised return-to-care recommendations for mildly ill children in 2009 that were added to national standards in 2011. Child care directors' practices in a state without clear emphasis on return-to-care guidelines are unknown. We investigated director return-to-care practices just before the release of recently revised AAP guidelines.
Methods:
A telephone survey with 5 vignettes of mild illness (cold symptoms, conjunctivitis, vomiting/diarrhea, fever, and ringworm) was administered to randomly sampled directors in metropolitan Milwaukee, Wisconsin. Directors were asked about return-to-care criteria for each illness. Questions for return-to-care criteria were open-ended; multiple responses were allowed. Answers were compared with AAP return-to-care recommendations.
Results:
A total of 305 directors participated. Based on director responses to vignettes, the percentage of correct responses regarding return-to-child care management compared with AAP return-to-care recommendations was low: fever (0%); conjunctivitis (0%); diarrhea (1.6%); cold symptoms (12%); ringworm (21%); and vomiting (80%). Two illnesses (conjunctivitis and cold symptoms) would require the child to have an urgent medical evaluation or treatment not recommended by the AAP, as follows: Conjunctivitis-antibiotics for 24 hours (62%), physician visit (49%), any antibiotic treatment (6%), and symptom resolution (4%); and Cold Symptoms-physician visit (45.6%), antibiotics (10%), and symptom resolution (25%).
Conclusions:
Directors' self-reported return-to-child care practices differed substantially before the release of revised AAP return-to-care recommendations. Active adoption of AAP return-to-child care guidelines would decrease the need for unnecessary urgent medical evaluation and treatment as well as unnecessary exclusion of a child from child care.
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