Day-Care Center Exclusion of Sick Children: Comparison of Opinions of Day-Care Staff, Working Mothers, and Pediatricians

Day-care center staff are often faced with the decision of whether to send sick children home. Some pediatricians may question the criteria used by day-care centers to exclude children who have mild infectious illnesses. To determine whether there is a consensus on illness policy, we asked day-care center staff, mothers, and pediatricians which sick children in day care should be excluded. Randomly selected day-care center staff, mothers, and pediatricians in three North Carolina counties completed self-administered questionnaires. We asked how combinations of temperature and symptoms that occur with common childhood infections should affect the staff's decisions to "call the parent for immediate pickup." Response rates were 302 of 347 staff (87%), 134 of 200 mothers (67%), and 69 of 80 pediatricians (86%). A temperature of 37.2° to 37.7°C (99° to 99.9°F) was considered a fever by 35% of staff, 24% of mothers, and 6% of pediatricians (P < .01). At every level of elevated temperature from 37.2° to 38.9°C (99° to 102°F), day-care center staff were more likely to request immediate pickup than mothers or pediatricians (P < .01). For each of eight symptoms and for all three groups of respondents, the addition of a temperature of 37.8°(100°F) increased the proportion of children sent home (P < .01). Day-care center staff, mothers, and pediatricians differ in their reported exclusionary practices for ill day-care children. Public health practitioners should continue to educate all groups in terms of the epidemiology of common infections in day-care centers; communities should consider designing alternative child-care arrangements for mildlyillchildren.