Here's the dilemma: You are one of the many American parents with a kid in day care. The kid gets a sniffle or a cold. The day care calls you to take them home. You have to take a sick day. And now, you have to get a doctor's note just to get your kid back into day care.
The need for that note is sending a lot of parents to the emergency room or urgent care unnecessarily, says Dr. Andrew Hashikawa, an emergency doctor at the University of Michigan. And those barely sick kids? There's no need to keep them out of day care.
"There's actually very little benefit from excluding a child with really mild illness," he says.
Hashikawa just completed a study of parents with children in day care, looking at how the need for that doctor's note affects the way parents seek health care.
What he's found is that the very parents that need child care the most - parents who are single, who don't have families to help with child care, or who don't get sick time at work - are the ones most punished by the policy. They have little choice but to use the emergency room or urgent care to get the note that gets their kid back into day care, and gets them back to work.
"Parents who work different hours, different shifts, have a really hard time getting into their primary care provider," he says. "If they do stay home with their sick child, often that means not getting a paycheck. It means they may lose their job because they are out of days off."
Hashikawa says he saw this as a young doctor, and wanted to see if the anecdotes had any data behind them. Parents would come into the emergency room late at night with a kid in tow, he says. The kid would have a cold, or something mild. The child care center would send him home with parents, saying he couldn't come back until a doctor said he was well. The parents would need to get back to work too. And they couldn't get a same-day appointment with their regular doctors. So, a socio-economic emergency, an emergency of bad timing and lack of resources, became a health care emergency.
Suddenly here was another way that people found themselves using the ER for non-emergencies, he says, even if they have insurance.
Hashikawa surveyed more than 600 families who are part of the large-scale National Poll on Children's Health. Parents with young kids in child care were asked a series of questions, including how many times their kids had been excluded from day care, and if a note was needed for them to return.
More than a quarter of the parents who said they took their children to a doctor when they were unable to go to day care said they used either the emergency room or urgent care. About one-third of the parents who had children in day care were worried about their jobs and paychecks when they had to take a day off to care for a sick youngster. African-American parents were more likely to use the ER to get the clearance for their kid to return to day care than either Hispanic or White parents.
For a while now, the American Academy of Pediatrics has said that a doctor's note isn't necessary - kids get exposed to whatever is going around whether they are in day care or not. He says that there is no consistent training that puts child care workers and medical providers in the same room, talking about infectious disease.
The Michigan Department of Human Services does provide some infectious disease guidelines to child care providers, says spokesman Bob Wheaton. While the department can't tell any of the more than 10,000 child care providers in Michigan what to put in their exclusions policies, he says all providers are required to have a policy. In-home day care providers are supposed to notify parents and seclude children who may have come in contact with an infectious disease.
But with some estimates that 80% of American children under age 6 will eventually spend time in child care settings, more is needed, Hashikawa says. The guidelines are clear - if the kid is participating in normal activities, if the child care staff isn't having to spend a ton of extra time caring for the kid, they really shouldn't be sent home.
"For kids with a cold or cough that are acting well - there's no fever - these kids don't necessarily need a medical evaluation. They don't need to be sent home," he says. "Oftentimes, children are excluded unnecessarily because child care providers aren't aware of the guidelines that exist."