Child care center policies and practices for management of ill children.
OBJECTIVE
The objectives of this study were to 1) describe child care staff knowledge and beliefs regarding upper respiratory tract infections and antibiotic indications and 2) evaluate child care staff reported reasons for a) exclusion from child care, b) referral to a health care provider, and c) recommending antibiotics for an ill child.


METHODS
A longitudinal study based in randomly selected child care centers in Massachusetts. Staff completed a survey to assess knowledge regarding common infections. For six weeks, staff completed a record of absences each day, describing the reason for an absence, and advice given to the parents regarding exclusion, referral to a health care provider, and obtaining antibiotics. Exclusions for the specific illness/symptom were defined as appropriate or inappropriate based on national guidelines.


RESULTS
A large proportion of child care staff incorrectly believed that antibiotics are indicated for bronchitis (80.5%) and green rhinorrhea (80.5%) in children. For 82.2% of absences, the circumstances or reasons for the absence were discussed with a child care staff member. Of 538 absences due to illness that child care staff discussed with parents, there were 45 inappropriate exclusions (8.4% of illnesses discussed), 91 appropriate exclusions (16.9% of illnesses discussed), and 402 cases (74.7%) in which no recommendation for exclusion was made.


CONCLUSIONS
Misconceptions regarding the need for antibiotics for URIs are common among child care staff. However, day care staff do not pressure parents to seek medical attention or antibiotics.
Friedman
Jennifer F
JF
Harvard Pediatric Health Services Research Fellowship Program, Children's Hospital Boston, Boston, MA, USA. Jennifer_Friedman@Brown.edu
Lee
Grace M
GM
Kleinman
Ken P
KP
Finkelstein
Jonathan A
JA
D000041:Absenteeism; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002656:Child Day Care Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D002675:Child, Preschool; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D016134:Organizational Policy; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents