As a result, children may be excluded for harmless conditions that do not meet national criteria, such as colds and allergic conjunctivitis, while being allowed to return to child care for some conditions that warrant staying home, such as uncontrolled coughing or persistent diarrhea, according to Kristen Copeland, M.D., a pediatrician at Cincinnati Children's and lead author of the study.
The study, published in the November-December issue of Ambulatory Pediatrics, found that child care providers, parents and pediatricians knew guideline recommendations for 12 common childhood ailments only 60 percent of the time.
"Inappropriate exclusions from child care can have a significant economic impact," says Dr. Copeland. "When their child attending child care becomes ill, parents have limited options. It's easy to see how exclusion can become a contentious issue between parents who may think child care providers are inconsistent and unreasonable in their application of guidelines and those child care providers who resent some parents' attempts to subvert the guidelines."
Temporary exclusions are designed to prevent the spread of disease and enable children to obtain the care and attention they need. The American Academy of Pediatrics and the American Public Health Association jointly published national illness exclusion guidelines in 1992 and revised them in 2002. These guidelines stipulated when sick children must be sent home from child care centers and were based on the best available scientific evidence and expert opinion from the pediatric, infectious disease and early childhood education communities.