title: Self-Report of Child Care Directors Regarding Return-to-Care.
abstract: BACKGROUND
  The American Academy of Pediatrics (AAP) introduced revised return-to-care recommendations for mildly ill children in 2009 that were added to national standards in 2011. Child care directors' practices in a state without clear emphasis on return-to-care guidelines are unknown. We investigated director return-to-care practices just before the release of recently revised AAP guidelines.
  
  
  METHODS
  A telephone survey with 5 vignettes of mild illness (cold symptoms, conjunctivitis, vomiting/diarrhea, fever, and ringworm) was administered to randomly sampled directors in metropolitan Milwaukee, Wisconsin. Directors were asked about return-to-care criteria for each illness. Questions for return-to-care criteria were open-ended; multiple responses were allowed. Answers were compared with AAP return-to-care recommendations.
  
  
  RESULTS
  A total of 305 directors participated. Based on director responses to vignettes, the percentage of correct responses regarding return-to-child care management compared with AAP return-to-care recommendations was low: fever (0%); conjunctivitis (0%); diarrhea (1.6%); cold symptoms (12%); ringworm (21%); and vomiting (80%). Two illnesses (conjunctivitis and cold symptoms) would require the child to have an urgent medical evaluation or treatment not recommended by the AAP, as follows: Conjunctivitis-antibiotics for 24 hours (62%), physician visit (49%), any antibiotic treatment (6%), and symptom resolution (4%); and Cold Symptoms-physician visit (45.6%), antibiotics (10%), and symptom resolution (25%).
  
  
  CONCLUSIONS
  Directors' self-reported return-to-child care practices differed substantially before the release of revised AAP return-to-care recommendations. Active adoption of AAP return-to-child care guidelines would decrease the need for unnecessary urgent medical evaluation and treatment as well as unnecessary exclusion of a child from child care.
authors.affiliation: Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA. drewhash@umich.edu
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Hashikawa
authors.forename: Martha W
authors.initials: MW
authors.lastname: Stevens
authors.forename: Young J
authors.initials: YJ
authors.lastname: Juhn
authors.forename: Mark
authors.initials: M
authors.lastname: Nimmer
authors.forename: Kristen
authors.initials: K
authors.lastname: Copeland
authors.forename: Pippa
authors.initials: P
authors.lastname: Simpson
authors.forename: David C
authors.initials: DC
authors.lastname: Brousseau
mesh_terms: D000041:Absenteeism; D002656:Child Day Care Centers / Q000458:organization & administration*; D002675:Child, Preschool; D003141:Communicable Diseases / Q000453:epidemiology* / Q000628:therapy*; D003289:Convalescence; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D019983:Guideline Adherence; D006701:Home Nursing / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D011050:Policy Making; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013997:Time Factors; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D014922:Wisconsin