title: Pediatrician attitudes to exclusion of ill children from child-care centers in Israel: pressure on ambulatory practices.
abstract: BACKGROUND
  The exclusion of ill children from child-care centers may be associated with high social, economic and medical costs.
  
  
  OBJECTIVE
  To assess the opinions of pediatricians working in an outpatient setting in Israel on the exclusion/return of children in child-care centers.
  
  
  METHODS
  A questionnaire on practices of exclusion/return of children in child-care centers, in general and according to specific signs and symptoms, was administered to a random computer-selected cross-sectional sample of 192 primary care community pediatricians in Israel.
  
  
  RESULTS
  One hundred and seventy-three pediatricians completed the questionnaires, for a response rate of 90%; 147 were board-certified and 26 were not. About half the pediatricians felt pressured by parents requesting antibiotic therapy to accelerate the return of their sick child to the child-care center. The majority also believed their practice was overloaded by often unnecessary demands for medical notes by the child-care centers before children could return. More than half based their decision to exclude children on "common sense" and the remainder, on accepted guidelines. Except for scabies and lice, there were no significant correlations between the physicians' stipulation for a note on return of the child and the specific illness guidelines.
  
  
  CONCLUSIONS
  This study shows that a high proportion of pediatricians based their exclusion practices on "common sense" and personal understanding instead of established guidelines, and that the guidelines did not affect their opinion on the duration of illness that warrant a note. Furthermore, half were subjected to parental pressure to employ inappropriate practices. These findings, combined with our earlier survey of child-care centers staff, indicate that better education of parents and day-care staff about ill child-care-center-exclusion policy in Israel would increase their common understanding with pediatricians.
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: Zeev
authors.initials: Z
authors.lastname: Horev
authors.forename: Zahi
authors.initials: Z
authors.lastname: Grosman
authors.forename: Herman Avner
authors.initials: HA
authors.lastname: Cohen
mesh_terms: D001291:Attitude of Health Personnel; D002656:Child Day Care Centers / Q000458:organization & administration*; D002675:Child, Preschool; D003140:Communicable Disease Control; D003430:Cross-Sectional Studies; D006291:Health Policy; D006801:Humans; D007223:Infant; D007557:Israel; D010372:Pediatrics