{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T19:06:54Z","timestamp":1761764814992,"version":"3.40.5"},"reference-count":43,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,11,1]]},"abstract":"<jats:p>BACKGROUND. In 1992, the American Academy of Pediatrics and the American Public Health Association jointly published guidelines for temporary exclusion of sick children from child care. However, little is known about key stakeholders' compliance with these guidelines.<\/jats:p><jats:p>OBJECTIVES. The purpose of this work was to compare pediatricians', parents', and child care providers' compliance with American Academy of Pediatrics guidelines and determine predictors for higher rates of compliance.<\/jats:p><jats:p>METHODS. We conducted a cross-sectional survey of 215 randomly selected Maryland pediatricians, 223 parents, and 192 child care providers from 22 Baltimore, Maryland, child care centers from January to July 2004. Questionnaires contained the following 6 case vignettes depicting common child care illnesses: upper respiratory infection, conjunctivitis, gastroenteritis, mild febrile illness, tinea capitis, and atopic dermatitis. The instrument measured the correctness of exclusion and inclusion decisions (using American Academy of Pediatrics\/American Public Health Association guidelines as gold standard) according to varying levels of fever, disease severity (eg, clear versus yellow eye discharge), familiarity with the child, and parent work schedule flexibility.<\/jats:p><jats:p>RESULTS. Response rates were 71% for pediatricians, 56% for parents, and 85% for child care providers. Guideline compliance was higher for pediatricians (74%) than for child care providers (60%) and parents (61%). Only 23% of pediatricians and parents and 29% of child care providers reported familiarity with American Academy of Pediatrics\/American Public Health Association guidelines by name. In general, child care providers and parents had lower false-negative rates (allowed fewer children to attend who met criteria for exclusion) than pediatricians, suggesting that pediatricians may underexclude. Child care providers and parents correctly excluded in 65%\u201398% of cases requiring exclusion, whereas pediatricians correctly excluded 31%\u201386% of cases requiring exclusion, depending on the vignette. Yet pediatricians were much more specific about which children met criteria (pediatricians correctly included 61%\u201393% of cases requiring inclusion versus child care providers and parents who correctly included 20%\u201375% of such cases), suggesting that child care providers and parents may overexclude. Compliance rates varied significantly by stakeholder, vignette (disease), level of fever, and disease severity but did not vary with the stakeholder's familiarity with the child or the flexibility of the parent's work schedule.<\/jats:p><jats:p>CONCLUSIONS. Pediatricians, parents, and child care providers were unfamiliar with American Academy of Pediatrics\/American Public Health Association illness exclusion guidelines by name but moderately compliant with them. When noncompliant, child care providers and parents generally overexcluded, and pediatricians underexcluded. Stakeholder- and disease-specific predictors for noncompliance gleaned from this study suggest how educational interventions aiming to increase guideline compliance could be individually tailored to child care providers, parents, and pediatricians.<\/jats:p>","DOI":"10.1542\/peds.2005-2345","type":"journal-article","created":{"date-parts":[[2006,11,2]],"date-time":"2006-11-02T18:04:44Z","timestamp":1162490684000},"page":"e1369-e1380","source":"Crossref","is-referenced-by-count":14,"title":["Compliance With American Academy of Pediatrics and American Public Health Association Illness Exclusion Guidelines for Child Care Centers in Maryland: Who Follows Them and When?"],"prefix":"10.1542","volume":"118","author":[{"given":"Kristen A.","family":"Copeland","sequence":"first","affiliation":[{"name":"Division of General and Community Pediatrics Research, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily N.","family":"Harris","sequence":"additional","affiliation":[{"name":"Housestaff Department, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nae-Yuh","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tina L.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2006,11,1]]},"reference":[{"key":"2021120823190247900_R1","unstructured":"US Federal Interagency Forum on Child and Family Statistics. America's children in brief 2004. Available at: www.childstats.gov\/ac2004. Accessed July 18, 2005"},{"key":"2021120823190247900_R2","doi-asserted-by":"crossref","unstructured":"Churchill RB, Pickering LK. Infection control challenges in child-care centers. Infect Dis Clin North Am.\u20081997;11:347\u2013365","DOI":"10.1016\/S0891-5520(05)70360-3"},{"key":"2021120823190247900_R3","doi-asserted-by":"crossref","unstructured":"Wald ER, Guerra N, Byers C. Frequency and severity of infections in day care: three-year follow-up. J Pediatr.\u20081991;118:509\u2013514.","DOI":"10.1016\/S0022-3476(05)83370-0"},{"key":"2021120823190247900_R4","doi-asserted-by":"crossref","unstructured":"National Institute of Child Health and Human Development Early Child Care Research Network. Child care and common communicable illnesses: Results from the National Institute of Child Health and Human Development Study of Early Child Care. Arch Pediatr Adolesc Med.\u20082001;155:481\u2013488","DOI":"10.1001\/archpedi.155.4.481"},{"key":"2021120823190247900_R5","doi-asserted-by":"crossref","unstructured":"National Institute of Child Health and Human Development Early Child Care Research Network. Child care and common communicable illnesses in children aged 37 to 54 months. Arch Pediatr Adolesc Med.\u20082003;157:196\u2013200","DOI":"10.1001\/archpedi.157.2.196"},{"key":"2021120823190247900_R6","doi-asserted-by":"crossref","unstructured":"Churchill RB, Pickering LK. Infections in child care centers. Curr Opin Infect Dis.\u20081996;9:176\u2013180","DOI":"10.1097\/00001432-199606000-00009"},{"key":"2021120823190247900_R7","doi-asserted-by":"crossref","unstructured":"Slack-Smith LM, Read AW, Stanley FJ. A prospective study of absence for illness and injury in childcare children. Child Care Health Dev.\u20082002;28:487\u201394","DOI":"10.1046\/j.1365-2214.2002.00299.x"},{"key":"2021120823190247900_R8","unstructured":"Electronic Source: Maryland Department of Human Resources. The Child Care Administration, Office of Licensing. Available at: www.dhr.state.md.us\/cca\/license\/index.htm. Accessed January 31, 2003"},{"key":"2021120823190247900_R9","unstructured":"National Resource Center for Health and Safety in Child Care. Available at: http:\/\/nrc.uchsc.edu\/states.html. Accessed January 28, 2006"},{"key":"2021120823190247900_R10","doi-asserted-by":"crossref","unstructured":"McConnochie KM, Wood NE, Kitzman HJ, Herendeen NE, Roy J, Roghmann KJ. Telemedicine reduces absence resulting from illness in urban child care: Evaluation of an innovation. Pediatrics.\u20082005;115:1273\u20131282","DOI":"10.1542\/peds.2004-0335"},{"key":"2021120823190247900_R11","doi-asserted-by":"crossref","unstructured":"Landis SE, Earp JA, Sharp M. Day-care center exclusion of sick children: comparison of opinions of day-care staff, working mothers, and pediatricians. Pediatrics.\u20081988;81:662\u2013667","DOI":"10.1542\/peds.81.5.662"},{"key":"2021120823190247900_R12","doi-asserted-by":"crossref","unstructured":"Shapiro ED. Exclusion of ill children from day-care centers. Policy and practice in New Haven, Connecticut. Clin Pediatr (Phila).\u20081984;23:689\u2013691","DOI":"10.1177\/000992288402301207"},{"key":"2021120823190247900_R13","doi-asserted-by":"crossref","unstructured":"Chouillet A, Maguire H, Kurtz Z. Policies for control of communicable disease in day care centres. Arch Dis Child.\u20081992;67:1103\u20131106","DOI":"10.1136\/adc.67.9.1103"},{"key":"2021120823190247900_R14","doi-asserted-by":"crossref","unstructured":"Addiss DG, Sacks JJ, Kresnow MJ, O'Neil J, Ryan GW. The compliance of licensed US child care centers with national health and safety performance standards. Am J Public Health.\u20081994;84:1161\u20131164","DOI":"10.2105\/AJPH.84.7.1161"},{"key":"2021120823190247900_R15","doi-asserted-by":"crossref","unstructured":"Aronson SS. The science behind the American Public Health Association\/American Academy of Pediatrics National Health and Safety Guidelines for Child-Care Programs. Pediatrics.\u20081994;94:1101\u20131104.","DOI":"10.1542\/peds.94.6.1101"},{"key":"2021120823190247900_R16","unstructured":"American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care, ed. Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs. 2nd ed. U.S. Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau; 2002. Available at: http:\/\/nrc.uchsc.edu\/CFOC\/index.html. Accessed January 28, 2006"},{"key":"2021120823190247900_R17","doi-asserted-by":"crossref","unstructured":"Richardson M, Elliman D, Maguire H, Simpson J, Nicoll A. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools. Pediatr Infect Dis J.\u20082001;20:380\u2013391","DOI":"10.1097\/00006454-200104000-00004"},{"key":"2021120823190247900_R18","doi-asserted-by":"crossref","unstructured":"Chang A. American Public Health Association\/American Academy of Pediatrics National Health and Safety Guidelines for Child-Care Programs: An overview. Pediatrics.\u20081994;94:1107\u20131108.","DOI":"10.1542\/peds.94.6.1107"},{"key":"2021120823190247900_R19","unstructured":"American Academy of Pediatrics. Red Book: Report of the Committee on Infectious Diseases; 2003. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003"},{"key":"2021120823190247900_R20","unstructured":"American Academy of Pediatrics. Stepping Stones for Using Caring for Our Children. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003"},{"key":"2021120823190247900_R21","unstructured":"Aronson SS, Shope, TR. Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide. Elk Grove Village, IL: American Academy of Pediatrics; 2005"},{"key":"2021120823190247900_R22","doi-asserted-by":"crossref","unstructured":"Friedman JF, Lee GM, Kleinman KP, Finkelstein JA. Child care center policies and practices for management of ill children. Ambul Pediatr.\u20082004;4:455\u2013460","DOI":"10.1367\/A04-005R.1"},{"key":"2021120823190247900_R23","doi-asserted-by":"crossref","unstructured":"Pappas DE, Schwartz RH, Sheridan MJ, Hayden GF. Medical exclusion of sick children from child care centers: A plea for reconciliation. South Med J.\u20082000;93:575\u2013578","DOI":"10.1097\/00007611-200093060-00006"},{"key":"2021120823190247900_R24","doi-asserted-by":"crossref","unstructured":"Skull SA, Ford-Jones EL, Kulin NA, Einarson TR, Wang EE. Child care center staff contribute to physician visits and pressure for antibiotic prescription. Arch Pediatr Adolesc Med.\u20082000;154:180\u2013183","DOI":"10.1001\/archpedi.154.2.180"},{"key":"2021120823190247900_R25","doi-asserted-by":"crossref","unstructured":"Copeland KA, Duggan AK, Shope TR. Knowledge and beliefs about guidelines for exclusion of ill children from child care. Ambul Pediatr.\u20082005;5:365\u2013371","DOI":"10.1367\/A05-006R1.1"},{"key":"2021120823190247900_R26","doi-asserted-by":"crossref","unstructured":"Clark JA, Potter DA, McKinlay JB. Bringing social structure back into clinical decision making. Soc Sci Med.\u20081991;32:853\u2013866","DOI":"10.1016\/0277-9536(91)90241-4"},{"key":"2021120823190247900_R27","doi-asserted-by":"crossref","unstructured":"Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA.\u20081999;282:1458\u20131465","DOI":"10.1001\/jama.282.15.1458"},{"key":"2021120823190247900_R28","doi-asserted-by":"crossref","unstructured":"Kinchen KS, Cooper LA, Wang NY, Levine D, Powe NR. The impact of international medical graduate status on primary care physicians' choice of specialist. Med Care.\u20082004;42:747\u2013755","DOI":"10.1097\/01.mlr.0000132352.06741.d4"},{"key":"2021120823190247900_R29","doi-asserted-by":"crossref","unstructured":"Thamer M, Hwang W, Fink NE, et al. U.S. nephrologists' attitudes towards renal transplantation: results from a national survey. Transplantation.\u20082001;71:281\u2013288","DOI":"10.1097\/00007890-200101270-00020"},{"key":"2021120823190247900_R30","unstructured":"Stata Corp. Stata Reference Manual: Stata Release 8.0 [computer program]. College Station, TX: Stata Press; 2003"},{"key":"2021120823190247900_R31","doi-asserted-by":"crossref","unstructured":"Shapiro ED, Kuritsky J, Potter J. Policies for the exclusion of ill children from group day care: An unresolved dilemma. Rev Infect Dis.\u20081986;8:622\u2013625","DOI":"10.1093\/clinids\/8.4.622"},{"key":"2021120823190247900_R32","doi-asserted-by":"crossref","unstructured":"Hurwitz ES, Gunn WJ, Pinsky PF, Schonberger LB. Risk of respiratory illness associated with day-care attendance: A nationwide study. Pediatrics.\u20081991;87:62\u201369","DOI":"10.1542\/peds.87.1.62"},{"key":"2021120823190247900_R33","unstructured":"Helman C. Culture, Health, and Illness. 4th ed. Oxford, United Kingdom and Boston, MA: Butterworth-Heinemann; 2000"},{"key":"2021120823190247900_R34","doi-asserted-by":"crossref","unstructured":"Dresselhaus TR, Peabody JW, Luck J, Bertenthal D. An evaluation of vignettes for predicting variation in the quality of preventive care. J Gen Intern Med.\u20082004;19:1013\u20131018","DOI":"10.1007\/s11606-004-0003-2"},{"key":"2021120823190247900_R35","doi-asserted-by":"crossref","unstructured":"Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: A prospective validation study of 3 methods for measuring quality. JAMA.\u20082000;283:1715\u20131722","DOI":"10.1001\/jama.283.13.1715"},{"key":"2021120823190247900_R36","unstructured":"US Census Bureau. Who's minding the kids? Child care arrangements: Spring 1999. Available at: www.census.gov\/population\/www\/socdemo\/child\/ppl-168.html. Accessed December 9, 2004"},{"key":"2021120823190247900_R37","doi-asserted-by":"crossref","unstructured":"Polyzoi E, Babb J. The challenge of caring for mildly ill children: a Canadian national childcare study. Early Child Res Q.\u20082004;19:431\u2013448","DOI":"10.1016\/S0885-2006(04)00056-0"},{"key":"2021120823190247900_R38","doi-asserted-by":"crossref","unstructured":"Friedman JF, Lee GM, Kleinman KP, Finkelstein JA. Acute care and antibiotic seeking for upper respiratory tract infections for children in day care: Parental knowledge and day care center policies. Arch Pediatr Adolesc Med.\u20082003;157:369\u2013374","DOI":"10.1001\/archpedi.157.4.369"},{"key":"2021120823190247900_R39","doi-asserted-by":"crossref","unstructured":"Cordell RL, MacDonald JK, Solomon SL, Jackson LA, Boase J. Illnesses and absence due to illness among children attending child care facilities in Seattle-King County, Washington. Pediatrics.\u20081997;100:850\u2013855","DOI":"10.1542\/peds.100.5.850"},{"key":"2021120823190247900_R40","doi-asserted-by":"crossref","unstructured":"Cordell RL, Waterman SH, Chang A, Saruwatari M, Brown M, Solomon SL. Provider-reported illness and absence due to illness among children attending child-care homes and centers in San Diego, Calif. Arch Pediatr Adolesc Med.\u20081999;153:275\u2013280","DOI":"10.1001\/archpedi.153.3.275"},{"key":"2021120823190247900_R41","doi-asserted-by":"crossref","unstructured":"Carabin H, Gyorkos TW, Soto JC, Penrod J, Joseph L, Collet JP. Estimation of direct and indirect costs because of common infections in toddlers attending day care centers. Pediatrics.\u20081999;103:556\u2013564","DOI":"10.1542\/peds.103.3.556"},{"key":"2021120823190247900_R42","unstructured":"Centers for Disease Control and Prevention. Revised guidelines for HIV counseling, testing, and referral. MMWR Recomm Rep.\u20082001;50:1\u201357; quiz CE1\u201319a1\u2013CE6\u201319a1"},{"key":"2021120823190247900_R43","unstructured":"Evers DB. The pediatric nurse's role as health consultant to a child care center. Pediatr Nurs.\u20082002;28:231\u2013235"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/118\/5\/e1369\/1117165\/zpe011060e1369.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/118\/5\/e1369\/1117165\/zpe011060e1369.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,9]],"date-time":"2023-05-09T16:33:35Z","timestamp":1683650015000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/118\/5\/e1369\/69883\/Compliance-With-American-Academy-of-Pediatrics-and"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,11,1]]},"references-count":43,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2006,11,1]]},"published-print":{"date-parts":[[2006,11,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2005-2345","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"type":"print","value":"0031-4005"},{"type":"electronic","value":"1098-4275"}],"subject":[],"published":{"date-parts":[[2006,11,1]]}}}