Child care centers commonly bar parents from dropping off a child with a runny nose or other minor illness. And the result, a new study finds, can be needless trips to the emergency room.
That's because a doctor's note is often required for a sick child to return to child care -- or for an employee to stay home with an ill child. So working parents may rush the kid to an ER or urgent care center rather than wait for an appointment with their pediatrician.
"Parents are bringing their children in, not because they have a medical emergency, but because it's a socioeconomic emergency," said Dr. Andrew Hashikawa, the lead researcher on the study and a lecturer in pediatric emergency medicine at the University of Michigan's C.S. Mott Children's Hospital in Ann Arbor.
When a child can't go to day care or preschool, Hashikawa said, it puts parents in a tough spot. That's especially true for single or lower-income parents who can't afford a day off from work or who fear being fired.
Moreover, child care providers often insist that kids with mild illnesses like a cold or "pink eye" stay home -- despite guidelines from the American Academy of Pediatrics, which say children should not be barred from day care because of those common preschool conditions.
For the study, reported online June 23 in Pediatrics, Hashikawa's team surveyed 303 U.S. parents with a baby or child in day care or preschool.
According to parents, it was fairly common for child care centers to bar kids from coming when they had an upset stomach, pink eye, mild fever or ringworm (a fungal infection) affecting the scalp -- all conditions that the American Academy of Pediatrics says do not warrant an automatic day at home.
Twelve percent of centers did not allow children to attend when they had the common cold.
When that happened, 38 percent of parents had to get a doctor's note -- either so their child could return to child care, or so they could get time off from work.
Note requirement or not, most parents made a medical visit when their child was excluded from child care. And for one-quarter of them, that meant a trip to the ER or an urgent care center. Parents who needed a doctor's note were four times more likely to resort to emergency care than other parents were.
A couple of things could be happening, said Dr. Danette Glassy, who co-chairs the academy's Council on Early Childhood.
"When a child is excluded from child care, the parents might suddenly feel the illness is more serious than they'd thought," Glassy said.
But, like Hashikawa, she said job worries are probably a big driver.
One-third of parents in this study said they feared losing their job, or at least losing pay. And -- like parents needing a doctor's note -- those stressed-out moms and dads were particularly likely to seek emergency care.
Still, child care centers are not the bad guy, Hashikawa and Glassy said.
"This is not about pointing a finger at care providers," Glassy said. "I think they are doing the best they can."
One of the issues is that each U.S. state has its own regulations regarding child care, Glassy said. And state policies may conflict with the academy guidelines.
Child care providers also have to deal with parents. "There may be pressure from other parents who don't want any child with a runny nose to be allowed in," Hashikawa said.
Part of the solution, he said, will be to educate care providers and parents on the types of illnesses that warrant a child staying home.
"It should be based more on how a child is feeling and behaving," Hashikawa said. If a child is lethargic, for example, that's different from a day where he has a raised temperature but is acting like his usual self.
The academy has a free online course for child care providers and parents, at healthychildcare.org. Hashikawa also recommended that parents -- especially first-time parents -- talk to their pediatrician about day care and their child's health.