title: Medical exclusion of sick children from child care centers: a plea for reconciliation.
abstract: BACKGROUND
  Policies for excluding ill children from child care can affect parental absenteeism from the workplace and the utilization of pediatric health care resources.
  
  
  METHODS
  We surveyed a representative sample of 310 child care centers throughout Virginia to assess policies for excluding children with fever, common upper respiratory tract illnesses, or head lice.
  
  
  RESULTS
  Of the 183 center directors (59%) who returned completed surveys, 119 (69%) considered a temperature of 100.0 degrees F to 100.4 degrees F to represent fever, but methods for measuring temperature varied widely. Most centers excluded children with low-grade fever, even in the absence of changes in their behavior. Other low-threshold policies could exclude afebrile children with white nasal or eye discharge and children with hair nits, even after treated with a pediculicidal shampoo.
  
  
  CONCLUSIONS
  Exclusion policies among child care centers in Virginia vary widely and often are inconsistent with current standards of medical practice. More uniform implementation of exclusion policies established by national consensus panels of experts is needed to reduce unnecessary exclusion of children from child care centers.
authors.affiliation: Children's Medical Center of the University of Virginia, Charlottesville, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Pappas
authors.forename: R H
authors.initials: RH
authors.lastname: Schwartz
authors.forename: M J
authors.initials: MJ
authors.lastname: Sheridan
authors.forename: G F
authors.initials: GF
authors.lastname: Hayden
mesh_terms: D002656:Child Day Care Centers; D002675:Child, Preschool; D015817:Eye Infections; D005334:Fever; D006801:Humans; D010344:Patient Advocacy; D012141:Respiratory Tract Infections; D011795:Surveys and Questionnaires; D014768:Virginia