Knowledge of Daycare Illness Guidelines Lacking

NEW YORK (Reuters Health) - Parents, doctors and child-care providers alike often don't know when it's best for sick children to stay home from daycare, a U.S. study published Tuesday suggests.

Researchers found that many parents, care providers and pediatricians were unaware of at least some national guidelines for handling illness in daycare centers.

In general, parents and daycare staff thought children should stay home more often than recommended, while the opposite was true of doctors.

For example, the majority of parents and child-care providers thought that a persistently runny nose should keep a child home, although national guidelines say this is unnecessary. Most doctors said children with these symptoms could attend daycare.

On the other hand, about one third of doctors incorrectly said children could attend daycare if they had diarrhea or were vomiting, while parents and daycare staff were more likely to be correct on that guideline.

Overall, all three groups had opinions that differed with national guidelines about 40 percent of the time, according to lead study author Dr. Kristen A. Copeland of Cincinnati Children's Hospital Medical Center in Ohio.

She and her colleagues report the findings in the journal Ambulatory Pediatrics.

National guidelines for managing illness in daycare centers were first laid out in 1992, by the American Academy of Pediatrics and other professional groups. The guidelines include a list of symptoms that warrant keeping a child home, including uncontrolled coughing, wheezing, persistent crying or an oral temperature of 101 degrees or higher.

Conversely, symptoms that need not keep a child home include a rash without fever, a runny nose and red, watery eyes.

States generally do not require daycare centers to model their sick policies on these guidelines. Instead, they need only comply with state licensing standards, which offer vague guidance on when to keep a sick child home, Copeland noted in an interview.

It's not clear how often children may be unnecessarily excluded from daycare, or inappropriately allowed to attend, she said, but the national guidelines are intended to help clear up any confusion.

"We think it would be best for centers to follow the guidelines, because they're based on the best available evidence," she said.

For their study, Copeland and her colleagues surveyed 142 parents, 80 child-care providers and 36 pediatricians based in Baltimore. Most daycare staff said they had "seen" their center's written sick policies, as did 61 percent of parents. Only 47 percent of doctors had seen any guidelines on daycare sick policies.

Copeland suggests that parents who already have children in daycare make sure they are aware of the center's sick policies. Parents who are looking into daycare, she said, can ask each center what its policy is and if it complies with national guidelines.

If enough parents ask that question, Copeland noted, it might encourage centers to follow the national recommendations.

SOURCE: Ambulatory Pediatrics, November/December 2005.