Many Child Care Directors Unnecessarily Exclude Children

Wisconsin endorses national guidelines on exclusion, but many directors unaware they exist

MONDAY, April 19 (HealthDay News) -- Even though Wisconsin endorses American Academy of Pediatrics (AAP) and American Public Health Association (APHA) national guidelines on exclusion of children from child care centers, the state has high rates of unnecessary exclusions by child care directors, according to research published online April 19 in Pediatrics.

Andrew N. Hashikawa, M.D., of the Medical College of Wisconsin in Milwaukee, and colleagues administered a telephone survey to 305 randomly selected child care directors in metropolitan Milwaukee. The directors listened to five vignettes about children who had mild illnesses not requiring exclusion according to AAP/APHA guidelines (cold/upper respiratory infection, conjunctivitis, gastroenteritis, tinea capitis, fever).

The researchers found that the directors would inappropriately exclude 57 percent of children. Most (62 percent) were unaware of the existence of the AAP/APHA guidelines. Directors with more years of experience excluded fewer children, as did directors of larger centers. Directors of centers in areas where there were higher percentages of women identified as heads of household also excluded fewer children. Centers where 10 percent or fewer children were on state-assisted tuition excluded more children.

"The overall high rates of unnecessary exclusion decisions suggest that all directors, especially inexperienced directors, may need initial and ongoing training regarding AAP/APHA guidelines to reduce the high rates of unnecessary exclusion. Active translation of these AAP/APHA guidelines by using interactive or didactic methods may be needed to increase their use," the authors write.

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