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Knowledge and Beliefs About Guidelines for Exclusion of Ill Children From Child Care

  • Kristen A. Copeland
    Correspondence
    Address correspondence to Kristen Copeland, MD, 3333 Burnet Ave, MLC 7035, Cincinnati, OH 45229
    Affiliations
    From the Division of General and Community Pediatrics Research (Dr Copeland), Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; the Department of Pediatrics (Dr Duggan), Johns Hopkins University, Baltimore, Md; and Department of Pediatrics (Dr Shope), Naval Medical Center, Portsmouth, Va
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  • Anne K. Duggan
    Affiliations
    From the Division of General and Community Pediatrics Research (Dr Copeland), Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; the Department of Pediatrics (Dr Duggan), Johns Hopkins University, Baltimore, Md; and Department of Pediatrics (Dr Shope), Naval Medical Center, Portsmouth, Va
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  • Timothy R. Shope
    Affiliations
    From the Division of General and Community Pediatrics Research (Dr Copeland), Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; the Department of Pediatrics (Dr Duggan), Johns Hopkins University, Baltimore, Md; and Department of Pediatrics (Dr Shope), Naval Medical Center, Portsmouth, Va
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      Background.—The American Academy of Pediatrics published national child care illness exclusion guidelines in 1992 and 2002. To our knowledge, no published studies have examined child care providers', parents', and pediatricians' knowledge or beliefs about these guidelines.
      Objective.—To compare parents', pediatricians', and center-based child care providers' (CCPs) knowledge and beliefs about exclusion guidelines.
      Design.—Cross-sectional survey conducted in 2000 of 80 CCPs, 142 parents, and 36 pediatricians in Baltimore City. Main outcome measures included familiarity with and knowledge of exclusion guidelines and beliefs about exclusion effectiveness among these groups.
      Results.—Response rates were 58% for parents, 59% for pediatricians, 85% for CCPs. Sixteen percent of child care providers (CCPs), 39% of parents, and 53% of pediatricians had not seen any written exclusion guidelines. Compared with national guidelines for 12 common symptoms, responses from CCPs and parents indicated overexclusion, while pediatricians indicated underexclusion. The groups scored similarly in number of correct answers on knowledge items (CCPs 63%, parents 64%, pediatricians 61%, P = .44). More CCPs and parents than pediatricians believed that exclusion effectively controlled infection spread and that sick children should be excluded because they spread disease, would be more comfortable, and recover faster at home (P < .001).
      Conclusions.—This survey found CCPs, parents, and pediatricians all failed to recognize how national guidelines recommended managing 4 out of 10 common conditions on average. CCPs were more likely than pediatricians to believe that exclusion was warranted to control infection or for the child's personal needs.

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