title: Exclusion of ill children from child-care centers in Israel.
abstract: The aim of the study was to examine criteria for ill children in child-care centers. A questionnaire on practices of exclusion/return of children according to specific signs and symptoms was mailed to the directors of care centers in central Israel. Thirty-six of the 60 questionnaires (60%) were returned by mail and the reminded were completed in personal visits to the CCCs achieving a response rate of 100%. About half (51.7%) used "common sense" and "personal feelings" to exclude children and to allow their return, and 29 (48.3%) used the guidelines of the Ministries of Education and Health or other authorities. The percentage of centers excluding children by signs/symptoms was as follows: high fever (>38 degrees C), 100%; low-grade fever, 76.7%; asthma exacerbation, 80.0%; heavy cough, 75.0%; eye discharge or conjunctivitis, 83.3%; diarrhea and vomiting more than twice per day, 100%; rash, 72.3%; otalgia, 46.7%; and infected skin lesion, 66.7%. Only four centers excluded children with head lice. Most centers required a physician's note on return of a child after high fever (76.7%), eye discharge or conjunctivitis (48.3%), and from 75 to 80%, respectively, for frequent vomiting and bloody or mucinous diarrhea. The results show that exclusion practices among child-care centers (CCCs) vary widely, suggesting the need for the establishment of a uniform exclusion and return policy in Israel, with distribution of clear, up-to-date guidelines on the prevention and control of communicable diseases to all day-care centers. In a simple way, this study identified attitudes concerning the exclusion/return of sick children in CCCs and was useful for the discussion of the related policy with CCCs responsible and national health and educational authorities.
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ekahan@post.tau.ac.il
authors.forename: Ernesto
authors.initials: E
authors.lastname: Kahan
authors.forename: Samuel
authors.initials: S
authors.lastname: Gross
authors.forename: Herman Avner
authors.initials: HA
authors.lastname: Cohen
mesh_terms: D000041:Absenteeism; D000288:Administrative Personnel / Q000523:psychology; D000328:Adult; D000818:Animals; D001291:Attitude of Health Personnel; D002648:Child; D002656:Child Day Care Centers / Q000458:organization & administration*; D003140:Communicable Disease Control / Q000592:standards*; D032921:Consensus; D003371:Cough / Q000517:prevention & control; D003967:Diarrhea / Q000517:prevention & control; D004433:Earache / Q000517:prevention & control; D005076:Exanthema / Q000517:prevention & control; D005334:Fever / Q000517:prevention & control; D019983:Guideline Adherence; D006801:Humans; D007557:Israel / Q000453:epidemiology; D010373:Lice Infestations / Q000517:prevention & control; D009017:Morbidity; D020380:Needs Assessment; D016134:Organizational Policy; D010374:Pediculus; D017410:Practice Guidelines as Topic; D012141:Respiratory Tract Infections / Q000517:prevention & control; D012536:Scalp Dermatoses / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000517:prevention & control