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April 2003

Acute Care and Antibiotic Seeking for Upper Respiratory Tract Infections for Children in Day Care: Parental Knowledge and Day Care Center Policies

Author Affiliations

From the Harvard Pediatric Health Services Research Fellowship Program (Drs Friedman and Lee), Division of General Pediatrics (Dr Finkelstein), and Division of Infectious Diseases (Dr Lee), The Children's Hospital, Boston, Mass; and Departments of Ambulatory Care and Prevention (Drs Kleinman and Finkelstein) and Pediatrics (Drs Friedman, Lee, and Finkelstein), Harvard Medical School, Boston. Dr Friedman is now with Brown University, International Health Institute, and Department of Pediatrics, Hasbro Children's Hospital, Providence, RI.

Arch Pediatr Adolesc Med. 2003;157(4):369-374. doi:10.1001/archpedi.157.4.369

Background  Children who attend day care are high consumers of antibiotics. Studies suggest that physicians prescribe unnecessary antibiotics for upper respiratory tract infections (URIs) for children who attend day care on the basis of perceived pressure from parents and/or day care centers.

Objective  To determine both parental and day care–level predictors of acute care and antibiotic seeking for children who attend day care.

Methods  We conducted a day care center–based cross-sectional survey of parents and day care center staff. Two hundred eleven parents of children attending 36 day care centers in Massachusetts completed a survey. Day care center staff completed a separate survey addressing their day care center's policies for ill children.

Results  Few parents reported day care staff pressure to seek care from a physician (3.9%) or antibiotics (1.9%). In multivariate models, higher parental knowledge about URIs was related to decreased acute care seeking for 3 upper respiratory symptoms (clear rhinorrhea, green rhinorrhea, and cough) in the absence of fever (odds ratios and 95% confidence intervals: 0.45 [0.31-0.65], 0.66 [0.52-0.85], and 0.57 [0.45-0.72], respectively). Parent-reported acute care seeking was not related to a day care center's polices for exclusion or physician clearance for these illnesses. Similar results were also found for the parental belief that antibiotics expedite return to day care for these symptoms.

Conclusion  Although it has been suggested that inappropriate day care center policies for exclusion motivate parental acute care and antibiotic seeking, this study suggests that parental knowledge is a more important predictor of these reported behaviors than are day care center policies.