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Emergency department and urgent care for children excluded from child care
Andrew N Hashikawa1, David C Brousseau2, Dianne C Singer3
1Department of Emergency Medicine, drewhash@umich.edu.
Insights
Many parents seek urgent medical care for sick children missing child care, often due to employer or child care policies. Improving illness exclusion guidelines for child care could reduce unnecessary emergency department visits.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Children in child care settings are frequently excluded due to illness, often unnecessarily.
- Parental behaviors regarding seeking urgent medical evaluation for sick children unable to attend child care were investigated.
Purpose of the Study:
- To investigate parental use of urgent medical evaluation for sick children who cannot attend child care.
- To identify factors associated with seeking care in emergency departments or urgent care centers.
Main Methods:
- A nationally representative online survey of parents was conducted in May 2012.
- The survey assessed child illness causing absence from child care and parents' medical care-seeking behaviors, focusing on emergency department/urgent care (ED/UC) utilization.
Main Results:
- Over 88% of parents sought acute medical care for children unable to attend child care.
- Emergency department/urgent care use was common for conditions like rash and fever.
- Factors associated with higher ED/UC use included single/divorced status, African American ethnicity, need for a doctor's note, and job concerns.
Conclusions:
- A significant number of parents utilize emergency departments or urgent care for sick children unable to attend child care.
- Training child care professionals on appropriate illness exclusion criteria may reduce unnecessary ED/UC visits.
Background:
Children in child care are frequently unnecessarily excluded for illness. We investigated parental use of urgent medical evaluation for sick children unable to attend child care.
Methods:
In May 2012, authors conducted a nationally representative survey of parents, who completed online questions regarding child illness causing absence from child care and their medical care-seeking behavior. Main outcome was parents' use of emergency department or urgent care (ED/UC).
Results:
Overall survey participation rate was 62%. Of participating parent cohort with children 0 to 5 years old, 57% (n = 357) required child care, of which 84% (n = 303) required out-of-home child care. Over 88% of parents sought acute medical care for their sick children unable to attend child care. Approximately one-third of parents needed a doctor's note for employers and/or child care. Parents sought medical evaluation (>1 option possible) from primary care (81%), UC (26%), or ED (25%). ED/UC use was most common for rash (21%) and fever (15%). Logistic regression indicated ED/UC use was significantly higher among single/divorced parents (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 2.5-13.5); African American parents (OR = 4.2; 95% CI: 1.2-14.6); parents needing a doctor's note (OR = 4.2; 95% CI: 1.5-11.7); and those with job concerns (OR = 3.4; 95% CI: 1.2-9.7).
Conclusions:
A substantial proportion of parents whose sick children cannot attend child care seek care in ED/UC. Training child care professionals regarding appropriate illness exclusions may decrease ED/UC visits by lowering child care exclusions.
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