75 - Children Caught in the Middle: A Qualitative Study on How Decisions Are Made to Exclude Children from Childcare

Poster Number: 75
Publication Number: 75.210

Nicole M. Poole, University of Colorado, Denver, CO, United States; Chloe Glaros, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, United States; Leisha M. Andersen, American Academy of Pediatrics- Colorado Chapter, Greenwood Village, CO, United States; Sean T. O'Leary, University of Colorado School of Medicine, Denver, CO, United States; Brooke Dorsey Holliman, University of Colorado Anschutz Medical School, Aurora, CO, United States

Background: Attendance policies for common pediatric illnesses vary widely across childcare centers despite nationally published guidelines from the American Academy of Pediatrics. The COVID-19 pandemic has exacerbated this problem, leading to economic loss from parental work absenteeism and excess medicalization of children with common illnesses.

Objective: To understand barriers to and recommendations for adopting best practices on attendance policies at Early Head Start and Head Start (EHS/HS) childcare centers.

Design/Methods: We conducted semi-structured qualitative interviews (n=19) with childcare leadership (n=9) and parents (n=10) from EHS/HS childcare centers across Colorado. Interviews took place between April and December 2021. Interviews were audio-recorded, transcribed, and coded in ATLAS.ti using a priori and emergent coding strategies. Descriptive content analysis was used to identify central themes which were iteratively revised by two authors.

Results: Seven convergent and 4 divergent themes from leadership and parents addressing attendance decisions were identified (Table 1). Overlapping themes on barriers to adopting best practices included difficulty assessing symptom severity, limited medical provider understanding of childcare requirements, parent employment pressures, and impact of the COVID-19 pandemic on exclusion durations. Leadership and parent perspectives differed on resources utilized, understanding of exclusionary symptoms, and role of medical providers in making attendance decisions (Table 2). Overlapping themes on recommendations for best practices included access to registered nursing, concrete guidance on symptoms, and partnering with health departments. Both leadership and parents recommended consistency in exclusion practices, but leadership and parents identified medical providers and childcare leadership, respectively, as current sources of inconsistency. Salient findings showed variability in defining a fever by both leadership and parents. Conclusion(s): Coordination is needed between childcare centers, medical facilities, and health departments to improve attendance decisions for common pediatric illnesses. Future work should (1) develop concrete symptom guidance for parents with specific exclusion criteria (e.g., via a decision aid), (2) assess the feasibility of regular classroom access to registered nursing, and (3) advocate for employee protections to care for sick children at home.
Table 1: Overlapping themes between childcare leadership and parents on the barriers to and recommendations for adopting best practices on attendance policies at Early Head Start/Head Start childcare centers.
Table 2: Divergent themes between childcare leadership and parents on the barriers to and recommendations for adopting best practices on attendance policies at Early Head Start/Head Start childcare centers.