Possible Consequence of Keeping Sick Kids Home from Daycare

Daycare restrictions for sick children may drive up visits to ER

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Most parents using out-of-home childcare are familiar with the list of illnesses that mean they can't bring their child to daycare that day. Yet such lists may be driving up healthcare use.

A recent study found that parents were much more likely to take their child to the ER if they needed a doctor's note for their employer or for the daycare facility.

In addition, single parents, black parents and parents with job concerns were all more likely to bring their child to the ER than other parents when their child was sick and prevented from going to daycare.

The authors suggested that some of these daycare illness exclusions are not necessary.

Better training regarding what kinds of illnesses are actually appropriate for keeping kids home might reduce ER use, the authors suggested.

"Ask daycare providers about their sick child policies."

The study, led by Andrew Hashikawa, MD, of the Department of Emergency Medicine University of Michigan Medical School in Ann Arbor, Michigan, looked at ER and urgent care use among parents whose ill children have been required to stay home from daycare.

The authors conducted an online survey in May 2012 with 630 parents whose demographics were representative of the US population.

Among these parents, just over half (57 percent) needed to use child care for their children, and of most these parents, or 48 percent of the total sample, used out-of-home child care.

Overall, 88 percent of the parents took their child to an medical care facility when their child was sick and unable to attend daycare.

Most (81 percent) took their child to a primary care or pediatrician's office, but a quarter of the parents (25 percent) took their child to an emergency room, and just over a quarter (26 percent) took their child to an urgent care facility.

The most common reasons children were brought into the ER or urgent care was having a rash or a fever.

One in five children (21 percent) went to the ER or urgent care for a rash, and one in seven (15 percent) were brought in for a fever.

Just over a third of the parents (38 percent) needed a doctor's note to provide either to their employers and/or to the childcare facility.

In fact, one in five parents (20 percent) needed a note to show their work, and just under a third (30 percent) needed a note to allow their child to return to daycare.

In addition, "One third of parents (33 percent) were concerned about loss of job or pay when taking time off of work to care for their sick children when those children were unable to attend child care," the authors reported.

The authors identified several other common characteristics among those who brought their children into the ER or urgent care facility.

Single or divorced parents, black parents and parents needing a doctor's note were more than four times more likely to bring their child in.

Further, those with job concerns were more than three times more likely to take their child to the ER or urgent care facility.

"A substantial proportion of parents whose sick children cannot attend child care seek care in the emergency department or urgent care," the researchers wrote.

"Training child care professionals regarding appropriate illness exclusions may decrease emergency department or urgent care visits by lowering child care exclusions," they wrote.

This study's findings also have possible economic ramifications, according to Adam Powell, a health economist and President of Payer+Provider Syndicate.

"This study sheds light on one of the factors that may be driving inappropriate emergency department and urgent care utilization," Dr. Powell said.

"Employer and care center policies requiring a doctor’s note encourage people to seek medical care in situations in which only self-care may be needed," he said.

"Requiring a visit with a doctor when one otherwise would not be needed increases medical costs," Dr. Powell explained. "One potential way to reduce this problem is to modify regulations so that a doctor’s note is required in fewer situations."

The study was published June 23 in the journal Pediatrics. The research did not use external funding. The authors reported no conflicts of interest.

Review Date: 
June 23, 2014
Last Updated:
June 23, 2014