Child care center staff contribute to physician visits and pressure for antibiotic prescription

Objective: To determine whether child care center (CCC) providers contribut e to unnecessary physician referrals and antibiotic prescriptions in young children with upper respiratory tract infections. Design: A survey using a structured telephone questionnaire between May 3, 1998, and July 27, 1998. Participants: Child care center providers from randomly selected licensed O ntario CCCs accepting diapered children. Main Outcome Measures: Knowledge, attitudes, and practices concerning physi cian referral; exclusion; and antibiotic use for children with upper respir atory tract infections. Indications for exclusion were compared with publis hed Canadian guidelines. Results: Contact was made with 42 eligible CCCs to obtain the requisite num ber of 36 participants (participation rate, 86%). Of the 36 centers, staff reported advising that children visit a physician for colored nasal dischar ge in 28 (78%), for productive cough in 23 (64%), and for unusual behavior in 9 (25%). Also of the 36 centers, staff reported excluding children for c olored nasal discharge in 20 (56%), for productive cough in 16 (44%), and f or unusual behavior in 15 (42%). Antibiotics were thought useful for nonspe cific upper respiratory tract infections to prevent the spread of infection in 9 (26%), to speed up recovery in 7 (21%), and to prevent bacterial infe ction in 13 (38%) of 34 centers. In the previous 6 months, 25 (69%) of 36 s taff members reported making an exception to exclusion because a child had an antibiotic prescription. Conclusions: Many children are referred by CCC staff to physicians contrary to established guidelines. As staff must act on behalf of parents, a low t hreshold for referral is not unreasonable. However, this survey confirms th at CCC staff recommend children to receive antibiotics and exclude children inappropriately. These practices are based on incomplete knowledge. Resear ch on appropriate management of upper respiratory tract infections by CCC s taff is needed. Education to correct specific knowledge deficits should be initiated.