Juggling Sick Children and Child Care

If you’re a parent with a young child in child care, chances are you’ve had a call to pick up your child due to some type of illness.  Nearly 11 million children under age 6 are in some type of child care every week.  As every parent knows, colds happen.  Other illnesses happen too, but recognizing when a child should be excluded from child care and when it’s okay for them to stay in group care, varies by state and by program.

A study published in Pediatrics Magazine in May, “Unnecessary Child Care Exclusions in a State That Endorses National Exclusion Guidelines”  found that child care center directors would exclude nearly 60 percent of children with mild illnesses – although guidelines by the American Academy of Pediatrics (AAP) and the American Public Health Association (APHA) would not warrant their exclusion.  Directors with greater child care experience made fewer unnecessary exclusion decisions.  The authors of the study recommended that child care center directors have initial and ongoing training regarding the AAP/APHA guidelines to reduce the high rates of unnecessary exclusion.  For the AAP/APHA cheat sheet on exclusion symptoms and signs, click here.

What’s the big deal? When children are excluded from child care due to illness, working parents have to scramble to figure out how to take care of their children and still meet their work obligations so that they can support their families.  Many child care programs exclude sick children until they have a doctor’s note, are taking antibiotics, or their illness has improved or resolved.  In some situations, that’s warranted.  But, for many mild illnesses, it’s not.  A new national poll of parents with children under age 6 in child care by the University of Michigan C.S. Mott Children’s Hospital found:

  • Nearly two-thirds (62 percent) of parents say their children could not attend because of an illness in the past year.
  • Nearly 40 percent (38 percent) of parents say their child was unable to attend child care three or more times during the past year.
  • One-third (33 percent) of parents are concerned about losing their jobs or losing pay when taking off work to care for their sick children.
  • Nearly 10 percent of parents say that taking their sick child to the emergency room is more convenient than seeing a primary care doctor.

Work Impact:

  • 42 percent of parents said they had missed work in the last year due to their child’s illness.
  • 26 percent of parents said they missed work 3 or more times over the last year due to their child’s illness.
  • 50 percent of parents said that finding alternative or back-up child care for their sick children was difficult.
  • 33 percent of parents said taking time off from work with a sick child is difficult because they may lose pay or their job.

Clearly, there are illnesses that warrant exclusion. And, no doubt, child care program directors are trying to balance a healthy setting for all children against the working needs of parents.  At the same time, the authors of the May Pediatrics article found that many directors were not aware of the AAP/APHA guidelines.  Appropriate handling of sick children, including exclusion policies, is yet another reason why training for child care providers (and directors) can make a difference. Training can also help child care providers use healthy practices to reduce the spread of germs.  The Child Care and Development Block Grant (CCDBG), the law that allocates funds to states for child care and sets the framework for state child care laws, does not require any training for child care providers – not even basic health and safety practices (let alone sick child exclusion policies).  Send an email to your Members of Congress today to urge that CCDBG require minimum training for child care providers.  Children do get sick.  Child care providers need to know when to exclude children and how to reduce the likelihood that germs will be spread. Training can address both, yet state policies vary greatly.  It’s time for Congress to require training.

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Child Care Training Matters!

In a survey by the National Center for Early Development and Learning, nearly half (46 percent) of kindergarten teachers in a nationwide sample said that over half of the children in their class weren’t ready to succeed in school. Why?  Before we get out the magic wand and with Harry Potter-like precision create pre-kindergarten programs in every state focused on pre-literacy and early math strategies, education experts ought to review the relationship between “executive function” and a child’s future school success – particularly for low income children.

What’s executive function? And, what does that have to do with children younger than age five? There are three functions that make up the core of executive functioning:

  • working memory  (the capacity to remember information and tap it when you need it – like following directions, planning, taking turns, and rejoining a game after taking a break)
  • inhibitory control  (the capacity to filter thoughts and control impulses, resist distractions, stay on task, and focus)
  • cognitive or mental flexibility (the capacity to switch gears and adjust to changing demands, priorities, solve problems, apply different rules to different settings)

Children are born with the potential to develop these capacities, but the foundation for executive function skills are shaped by their early experiences.  This is important because it means that the foundation for school success, the capacity and strategies a child draws upon and uses in kindergarten, are not first learned in kindergarten. The building blocks for school readiness and school success are stacked long before a child enters the public school system. A strong working memory, self-control, and focusing skills provide the basis for which children learn to read, write, do math, and engage in other critical thinking skills.

A child with weak executive functioning skills will have a much harder time succeeding in school.  A child with weak executive functioning skills is at risk of expulsion from a preschool or child care setting or potentially is at-risk of the inappropriate use of medication. The child might be labeled as having “bad behavior” or may disappear in a child care program rather than engage with friends and the teacher.

Here’s what the science tells us.  Executive function capacity can be taught and improved. In three randomized trials, children in settings that emphasized executive function skills showed improved performance in a range of developmental areas.  Children who experienced a combined approach integrating both executive function focus and literacy had significantly greater achievement once in public school.

Yes, well-designed pre-k programs are part of the solution to school success. But, children aren’t born at age 4 and given the hours that children spend in child care, it can no longer be ignored as an early learning setting (in addition to being a work support).

The science tells us that 80 percent of a child’s brain develops by the age of 3 and nearly 90 percent by the age of 5. Assessments of child care programs have found that low income children have the most to gain from a quality child care program.  A long-term study by the National Institute of Child Health and Human Development (NICHD) found that even a decade after children had been in a quality child care program, the effects were still evident at age 15 when those children scored higher on measures of academic and cognitive achievement and were less likely to misbehave than those enrolled in low quality care.

Nearly 11 million children under the age of 5 are in some type of child care setting every week. Yet, the training required by child care staff varies greatly by state. And, most states have very weak training and education requirements.  Why ignore the science? Doesn’t it make sense to require minimum training to ensure that children have all the skills they need to succeed in school (including executive function skills that will equip a child to learn)?

Take action today! The Child Care and Development Block Grant (CCDBG), the federal law that sets the framework for state child care laws, does not require any minimum training for child care staff or those who want to get a license to operate a child care program out of their home.  That’s just wrong. Particularly when you know the science, it makes no sense.  CCDBG has not been updated in 16 years. It’s time to update the law to be in sync with the science. Urge your Members of Congress today to require child care providers to have minimum training.