Balancing child care needs and infectious diseases

Sick kids and daycareOne night in the emergency department back when I was in medical school, I noticed a mom there with her young children around midnight. One of her children appeared to a have a cold and symptoms of mild pink eye. Curious, I wondered what brought the family to the ED in the middle of the night. When I asked her, she said, “I need to get my child seen by a doctor so he can get back into child care and I can go to work.”

Ever since that moment, I’ve been intrigued by the dynamic of child care and visits to the Emergency Department or urgent care facilities. We recently published a study in Pediatrics that found a substantial number of parents use the Emergency Department or urgent care when their child is sick and may be prevented from attending child care. We also found that ED or urgent care usage was higher among parents who are single, divorced, African American, have job concerns or need a doctor’s note for the child to return to child care.

Some child care facilities require a sick child to get a note from a doctor before a child can return. We see these children in the ED or urgent care because they can’t get an appointment to see their regular healthcare provider or the office isn’t open at convenient times and mom and dad need the child to go to child care so they can work. According to the American Academy of Peditarics child care illness guidelines, not every child in child care with cold or fever requires a physician note or medical evaluation to return to child care. The United States is one of the few countries in the world that does not have a national child care system and because of that, child care as a whole has been largely ignored by policy makers and politicians resulting in regulations and health policies that vary substantially from state to state and are often minimally regulated.

In an effort to do the right thing, child care facilities often create their own policies for sick children that are not always based on research or guidelines. The American Academy of Pediatrics (AAP) does have a set of national child care illness exclusion guidelines based on the best available evidence that we encourage child care facilities to use, but many child care providers are not even aware that the guidelines exist.

We physicians must help teach child care providers about these AAP guidelines. In order to train the next generation of pediatricians to help educate child care providers, I am working with the U-M pediatric residency program to help pediatricians-in-training learn how to give effective community-based lectures to child care providers on how to safely manage infectious diseases in child care settings. We help child care facilities understand which kids can stay and which should be sent home. For the most part, their previous healthcare education has been focused only on CPR or blood borne pathogen training. Our goal is to help them understand infectious diseases in child care.  The audiences we speak to are always eager to learn and want to do what’s right for all the children.

I love this area of study and work. The child care providers I work with want what’s best for the kids and we are working hard to help them understand the AAP guidelines so they can do their best to keep the children from spreading illness while at the same time providing the child care parents need so they can work. It is my hope that through research like this and through collaboration with community child care providers and parents, we can find mutually beneficial solutions that better address family needs while still safeguarding the wellness of our children.

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Andrew Hashikawa MDAndrew Hashikawa, MD, graduated from the Mayo Clinic College of Medicine and also completed his residency in pediatrics at the Mayo Clinic. He did a fellowship in pediatric emergency medicine at the Medical College of Wisconsin. He is a pediatric emergency medicine physician at C.S. Mott Children’s Hospital in the Department of Emergency Medicine and Children’s Emergency Services.


best children's hospitalsUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.