A runny nose shouldn’t keep a toddler home from the child care center. But a survey of 305 child care center directors in Milwaukee, Wis., found many would send children with mild illnesses home sick.

The study, “Unnecessary Child Care Exclusions in a State That Endorses National Exclusion Guidelines,” published in the May issue of Pediatrics (published online April 19), found directors would unnecessarily exclude 57 percent of children with mild illnesses. In a telephone survey, researchers read five vignettes that featured children with mild illness – a cold, conjunctivitis, gastroenteritis, fever and tinea capitis (a scalp infection) – and asked whether the child should be excluded. All of the vignettes described scenarios that should not warrant exclusion according to guidelines from the American Academy of Pediatrics (AAP) and American Public Health Association (APHA). Responses ranged from 8 percent of directors unnecessarily excluding a child with a cold, to 84 percent of directors unnecessarily excluding a child with tinea capitis. Directors with greater child care experience and directors of larger centers made fewer unnecessary exclusion decisions.

Currently there are no formalized state training programs available for child care directors to learn about appropriate exclusion guidelines. Study authors suggest child care directors, especially inexperienced ones, may need ongoing, state-endorsed training regarding guidelines for exclusion.

The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.