Care for Mildly Ill Children: Background & Models Prepared by Diane Adams Wisconsin Child Care Resource & Referral Network, Inc.

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TIPS - Table of Contents

Background:

In Wisconsin, over 300,000 young children are cared for by individuals, other than their parents, while the parents are employed. Approximately 165,000 of these children are in the care of licensed or certified child care programs and providers, with the remainder cared for by relatives, friends or informal caregivers. Almost all children become ill at some point in their child care experience, with younger ages experiencing more days of illness on average than older children. The issues surrounding care for these children are complex. This paper will focus on that common condition frequently reported to the child care program or provider: "She's not feeling well today." (We will not deal here with the chronic, serious illnesses of children that require respite care and special training, and the special support services needed by their families)

As children grow and develop, they put things in their mouths, they explore, climb, rub their hands on germ-filled objects and then put them in their mouths, and mingle with people. These natural growth activities provide many opportunities to become ill!

When children who are scheduled for child care feel a "little bit under the weather," parents probably want to be home to be available to comfort their children and take appropriate action if the illness grows worse. When children have suddenly become ill, or when an illness is serious or highly toxic, the "right solution" for the family can be that a parent stays home. However it appears that few parents have enough flexibility in their jobs to be absent from work for days on end when their children are mildly ill or recovering from an illness.

In Wisconsin, a mild illness is defined as one that is a common, temporary illness, non-progress in nature, which is not on the DPH Communicable Disease Chart. As used in this tip sheet, the term "mildly ill" will refer to this definition.

The problem of creating alternative options for children who are mildly ill is that, while models abound (from on-site services in the child care program, to hospital-based services, to in-home caregivers), no model completely addresses the reassurance needs of young children. When a child is mildly ill, there's no substitute for the comfort of familiar people and surroundings! This tip sheet will report on models for care of ill children attempted around the United States, citing resources and issues. Other sections of the paper will focus on exclusion policies and their implications for child care providers, offered by Maternal and Child Health experts.

The care of ill children is not a new problem. The 1930 White House Conference on the Health and Protection of Children was attended by 1,200 interested people who were experts in children's education and health. One of the recommendations was that sick children should be excluded from the public schools and that a doctor's written permission be required for readmission (Work/Family Directions, 1986). Licensing rules for child care programs around the country have followed much of this earlier advice, but as years have gone on, groups such as the Centers for Disease Control, the American Academy of Pediatrics, and the American Public Health Association have offered important new information on health in child care and exclusion policies for child care providers.

The models listed below are simply illustrations of how communities created care for ill children. This is not an exhaustive list, and many communities are creating new models for what is a pervasive problem, so that new solutions are arising every year.

Models for Care of Mildly Ill Children:

• Care at the Child's Regular Center: Actually, this is probably the most frequently used model. Licensing rules in Wisconsin outline the recommended isolation procedures and comfort needs of the children, while waiting for parents to take children home. Some centers have expanded their resources in order to accommodate ill children, stressing hygiene techniques and individual programming. Some child care programs have a "sick bay," staffed by providers who have special expertise in health.
  
  
• Care in a Family Child Care Home: Another model is to establish one or more family child care homes available for the exclusive care of sick children from one center. The center helps support the child care provider by assuring slots are paid for, whether or not there are mildly ill children present. A second model is to have a home that serves mildly ill children from the general community - not from just one center. There can be community contributions that provide the basic support when the family child care home is not full. In a child's regular family child care home, care usually continues even when children are mildly ill, as described in the center's policies.
  
  
• In-Home Care: In this model, a central agency (a health consortium, a child care resource and referral agency (CCR&R), such as the one in Tucson, or a United Way agency) recruits, trains, supervises and backs up caregivers who are sent out to care for children in their own homes. Training and bonding such individuals is an enormous task, and the agency must decide whether to specialize in the care of mildly ill children or in generic work in homes. A spin-off on this model is to create training on in-home care for the regular child care center staff, who then may accompany children to their homes and remain with them until parents come home. Wage and hour laws make this a complicated option, however.
  
  
• Care in an "Infirmary": Care for ill children in a hospital setting has come to be on the agenda for hospital associations around the country, and there are several examples in Wisconsin. In this model, parents bring ill children to a hospital wing set up to provide child care for them. Typically, this model is the most expensive, for nursing personnel staff the "sick bay." There are several examples of corporate support for both the "hospital-based sick child care" program and the in-home model. The hospital model, while expensive, also can cater to the needs of the chronically ill child, and meet the special needs of a child with a long and serious illness who may enjoy the "child care" aspects found in the program.
  
  
• Other Models: The Frank Porter Graham Child Development Center, having done the most research in the country on upper respiratory infections and young children, integrates mildly ill children into the regular child care class room, with staff who are trained in hygiene and contagion control. Under Wisconsin Licensing rules, each center develops its own exclusion guidelines, taking into account the DPH Communicable Disease Chart. This kind of "other model" was developed to meet the needs of ill children in child care and focuses on the needs of the children.
  Their primary concern is to remember that:
  • Needs will be different from child to child and from age to age
  • Health needs of ill children are fairly simple: to be quiet, to have plenty of fluids, and to have the right amount of food and nutrition, along with medication as directed by the parents and/or pediatricians
  • The emotional needs will be less simple to meet - there is widespread agreement that mildly ill children are best served in a familiar place, and with a familiar person
    

The adults who carry out this work of caring for mildly ill children need:

• Knowledge of illnesses and knowledge of child growth and development
• Skills in contagion prevention, and communication with parents about illness
  

Resource:

A copy of Wisconsin's Communicable Disease Chart may be obtained by contacting the Child Care Information Center (CCIC)
Phone: 800-362-7353 
Email: ccic@dpi.state.wi.us

References:

• Aaronson, Susan S. - regular articles in the Child Care Information Exchange.
• Haskins, Ron and Kotch, Jonathon, MD: "Day Care and Illness: Evidence, Costs, and Public Policy," Pediatrics. Volume 77, June 1986.
• Fredericks, Beth; Harman, Robin; Morgan, Gwen; Rodgers, Fran. A Little Bit Under The Weather: A Look at Care for Mildly Ill Children. Work/Family Directions, Boston, MA. 1986.
• Healthy Child Care America Newsletter 
  Healthy Child Care, P.O. Box 624, 
  Harbor Springs, MI 49740

WCCIP • 2109 S. Stoughton Road, Madison WI 53716 • Ph 800.366.3556 • Fx 608.224.6178
These tip sheets developed by WCCIP, March 1998 with funding from the WI Dept. of WFD, Office of Child Care, and DHFS