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Children's Health

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Misconceptions are common among child care center staff about the need for antibiotics for upper respiratory infections

About 41 percent of preschool children are cared for in organized child care settings at least part of the time. Many child care center staff members mistakenly believe that antibiotics are needed for viral upper respiratory infections (URIs). Yet, they don't report pressuring parents to seek medical attention or antibiotics for their children, according to a study supported by the Agency for Healthcare Research and Quality (T32 HS00063 and HS10247). This is good news, given the concern about growing rates of bacterial resistance to antibiotics stemming from overuse of the drugs, according to researchers from Harvard Medical School and Children's Hospital Boston.

The researchers surveyed staff at randomly selected child care centers in Massachusetts to assess knowledge regarding common infections. Over the course of 6 weeks, staff completed a record of absences each day, describing the reason for the absence and the advice given to the parents regarding exclusion, referral to a health care provider, and obtaining antibiotics. Overall, 80.5 percent of the staff surveyed incorrectly believed that antibiotics were indicated for bronchitis and for green nasal discharge in children. In addition, 27 percent and 25 percent, respectively, mistakenly believed that antibiotics speed recovery from colds and flu and are helpful for treating viral infections.

On average, 17 percent of children were absent from child care each day. In the majority (74.7 percent) of the 538 absences due to illness, parents rather than child care staff made the decision to keep a child home. Among the 136 (25.3 percent) instances in which children were excluded by child care staff, 45 (33 percent) were inappropriate based on guidelines available at the time from the American Public Health Association and the American Academy of Pediatrics. However, many cases were for gastrointestinal illnesses that do warrant exclusion under more recently released guidelines. More importantly, in only one case did a staff member report inappropriately recommending to a parent that they seek an antibiotic for their child before the child returned to the center. If these self-reports by child care staff reflect actual behavior, they suggest that child care staff are a less common source of pressure for unnecessary antibiotic use than is commonly assumed by clinicians.

See "Child care center policies and practices for management of ill children," by Jennifer F. Friedman, M.D., M.P.H., Grace M. Lee, M.D., M.P.H., Ken P. Kleinman, Sc.D., and Jonathan A. Finkelstein, M.D., M.P.H., in the September 2004 Ambulatory Pediatrics 4(5), pp. 455-460.

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