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Day Care Directors Are Playing Doctor, and Parents Suffer

But a lot of pink eye is caused by viruses, which are unaffected by antibiotics.

Even when pink eye is caused by a bacterial infection, antibiotics have a limited effect. They slightly increase the chance that a child will feel better within two to five days. But there’s no promise of a cure the “next day,” as most day care centers seem to believe, and no lessening of infectiousness.

[Read more about children and health at NYT Parenting.]

This is not just an American problem. A study of child care centers in Ontario found workers often recommended that parents visit the doctor for a runny nose or cough; they also said antibiotics would be useful for colds (they are not). More than two-thirds had allowed children to return if they were on antibiotics. Studies in England have also found that about half of policies required antibiotics for pink eye, and that such policies influence clinicians’ decisions about whether to prescribe them.

The American Academy of Pediatrics, along with some other major health organizations, has published recommendations on when children should be kept from child care centers. Two main criteria should drive considerations, according to the recommendations. If children are so sick that they cannot participate in activities, they should stay home. If they need more attention than the staff can provide, they should stay home, too.

Otherwise, it should depend not on whether they are sick, but on how sick. Clearly a very ill child should stay home, but each child experiences illness differently. Fever requires staying away only if it causes changes in activity participation or if it’s accompanied by other symptoms like a sore throat or rash. Vomiting requires staying away if it occurs more than once.

Multiple studies have shown that the optimal strategy for managing pink eye is to delay antibiotics — to see if it resolves on its own. There’s certainly no reason to require antibiotics, or to delay a child’s return until they’re on them.

Many schools will probably be too worried about the spread of infections to follow these guidelines. But children are often infectious before they show any symptoms, and we’re never going to be able to prevent all transmission of illness.

Our best bet is still focusing on hygiene, like proper hand washing, covering your mouth when you cough or sneeze, and not sharing food and drink with others.

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