title: Emergency department and urgent care for children excluded from child care.
abstract: BACKGROUND
  Children in child care are frequently unnecessarily excluded for illness. We investigated parental use of urgent medical evaluation for sick children unable to attend child care.
  
  
  METHODS
  In May 2012, authors conducted a nationally representative survey of parents, who completed online questions regarding child illness causing absence from child care and their medical care-seeking behavior. Main outcome was parents' use of emergency department or urgent care (ED/UC).
  
  
  RESULTS
  Overall survey participation rate was 62%. Of participating parent cohort with children 0 to 5 years old, 57% (n = 357) required child care, of which 84% (n = 303) required out-of-home child care. Over 88% of parents sought acute medical care for their sick children unable to attend child care. Approximately one-third of parents needed a doctor's note for employers and/or child care. Parents sought medical evaluation (>1 option possible) from primary care (81%), UC (26%), or ED (25%). ED/UC use was most common for rash (21%) and fever (15%). Logistic regression indicated ED/UC use was significantly higher among single/divorced parents (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 2.5-13.5); African American parents (OR = 4.2; 95% CI: 1.2-14.6); parents needing a doctor's note (OR = 4.2; 95% CI: 1.5-11.7); and those with job concerns (OR = 3.4; 95% CI: 1.2-9.7).
  
  
  CONCLUSIONS
  A substantial proportion of parents whose sick children cannot attend child care seek care in ED/UC. Training child care professionals regarding appropriate illness exclusions may decrease ED/UC visits by lowering child care exclusions.
authors: Department of Emergency Medicine, drewhash@umich.edu.
authors: Andrew N
authors: AN
authors: Hashikawa
authors: Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and.
authors: David C
authors: DC
authors: Brousseau
authors: Child Health Evaluation and Research Unit, University of Michigan Medical School, Ann Arbor, Michigan;
authors: Dianne C
authors: DC
authors: Singer
authors: Child Health Evaluation and Research Unit, University of Michigan Medical School, Ann Arbor, Michigan;
authors: Achamyeleh
authors: A
authors: Gebremariam
authors: Child Health Evaluation and Research Unit, University of Michigan Medical School, Ann Arbor, Michigan;Institute of Healthcare Policy and Innovation and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan.
authors: Matthew M
authors: MM
authors: Davis
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002654:Child Care; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: and parents; child care; emergency care; illness; policy; survey; urgent care