Emergency Department and Urgent Care for Children Excluded From Child Care

作者：Hashikawa Andrew N^*; Brousseau David C; Singer Dianne C; Gebremariam Achamyeleh; Davis Matthew M

来源：Pediatrics, 2014, 134(1): E120-E127.

DOI：10.1542/peds.2013-3226

• child care
• illness
• urgent care
• emergency care
• policy
• survey
• parents

BACKGROUND: Children in child care are frequently unnecessarily excluded for illness. We investigated parental use of urgent medical evaluation for sick children unable to attend child care. %26lt;br%26gt;METHODS: In May 2012, authors conducted a nationally representative survey of parents, who completed online questions regarding child illness causing absence from child care and their medical care-seeking behavior. Main outcome was parents%26apos; use of emergency department or urgent care (ED/UC). %26lt;br%26gt;RESULTS: Overall survey participation rate was 62%. Of participating parent cohort with children 0 to 5 years old, 57% (n = 357) required child care, of which 84% (n = 303) required out-of-home child care. Over 88% of parents sought acute medical care for their sick children unable to attend child care. Approximately one-third of parents needed a doctor%26apos;s note for employers and/or child care. Parents sought medical evaluation (%26gt;1 option possible) from primary care (81%), UC (26%), or ED (25%). ED/UC use was most common for rash (21%) and fever (15%). Logistic regression indicated ED/UC use was significantly higher among single/divorced parents (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 2.5-13.5); African American parents (OR = 4.2; 95% CI: 1.2-14.6); parents needing a doctor%26apos;s note (OR = 4.2; 95% CI: 1.5-11.7); and those with job concerns (OR = 3.4; 95% CI: 1.2-9.7). %26lt;br%26gt;CONCLUSIONS: A substantial proportion of parents whose sick children cannot attend child care seek care in ED/UC. Training child care professionals regarding appropriate illness exclusions may decrease ED/UC visits by lowering child care exclusions.

• 出版日期2014-7