Self-report of child care directors regarding return-to-care

Andrew N. Hashikawa, Martha W. Stevens, Young J. Juhn, Mark Nimmer, Kristen Copeland, Pippa Simpson, David C. Brousseau

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1046-1052
Number of pages7
Issue number6
StatePublished - Dec 2012


  • Child care
  • Mild illness
  • Readmission

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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