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Excessive Emergent and Urgent Care for Children in Child Care

Summary and Comment |
August 13, 2014

Excessive Emergent and Urgent Care for Children in Child Care

  1. Katherine Bakes, MD

Mandating notes from doctors permitting an ill child's return to child care results in unnecessary medical visits.

  1. Katherine Bakes, MD

Guidelines from the American Academy of Pediatrics (AAP) recommend removing an ill child from child care only if the staff-to-child ratio is inadequate to provide needed care or the child cannot participate comfortably in activities. Medical evaluation before a return to child care is explicitly not recommended.

To understand the prevalence and characteristics of emergency department (ED) and urgent-care use for sick children unable to attend child care, investigators conducted a national survey of 640 parents of children 0 to 5 years of age in child care. Overall, 88% of parents would take their child to a medical provider if the child were sick and unable to attend child care. A total of 38% of parents required a doctor's note either for their child-care provider to allow the child to return or for their employer to allow them to take time off to care for the child; 33% of parents were concerned about loss of job or pay. In multivariate analyses, factors associated with ED or urgent-care use were need for a doctor's note (adjusted odds ratio, 4), African American race (aOR, 4), single or divorced status (aOR, 4), and work concerns (aOR, 3).

Comment

Aside from the obvious issue of lack of access to primary care, there is clearly a problem, which requires educating both parents and child-care providers about appropriate ED and urgent-care use. An excellent online training resource regarding appropriate child-care precautions is provided by the AAP's Healthy Child Care America program (http://www.healthychildcare.org). Mandating notes from medical providers is, at best, not supported by evidence, and at worst, discriminates against parents with limited options. This practice should unequivocally be abandoned.

  • Disclosures for Katherine Bakes, MD at time of publication Grant / Research support Department of Justice Editorial boards Elsevier Emergency Medicine Secrets

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