Andrew N. Hashikawa

Emergency Department and Urgent Care for Children Excluded From Child Care

BACKGROUND: Children in child care are frequently unnecessarily excluded for illness. We investigated parental use of urgent medical evaluation for sick children unable to attend child care. METHODS: In May 2012, authors conducted a nationally representative survey of parents, who completed online questions regarding child illness causing absence from child care and their medical care-seeking behavior. Main outcome was parents’ use of emergency department or urgent care (ED/UC). RESULTS: Overall survey participation rate was 62%. Of participating parent cohort with children 0 to 5 years old, 57% (n = 357) required child care, of which 84% (n = 303) required out-of-home child care. Over 88% of parents sought acute medical care for their sick children unable to attend child care. Approximately one-third of parents needed a doctor’s note for employers and/or child care. Parents sought medical evaluation (>1 option possible) from primary care (81%), UC (26%), or ED (25%). ED/UC use was most common for rash (21%) and fever (15%). Logistic regression indicated ED/UC use was significantly higher among single/divorced parents (odds ratio [OR] = 4.3; 95% confidence interval [CI]: 2.5–13.5); African American parents (OR = 4.2; 95% CI: 1.2–14.6); parents needing a doctor’s note (OR = 4.2; 95% CI: 1.5–11.7); and those with job concerns (OR = 3.4; 95% CI: 1.2–9.7). CONCLUSIONS: A substantial proportion of parents whose sick children cannot attend child care seek care in ED/UC. Training child care professionals regarding appropriate illness exclusions may decrease ED/UC visits by lowering child care exclusions.

Heterotypic Infection and Spread of Rhinovirus A, B, and C among Childcare Attendees

This longitudinal study of HRV detection in childcare attendees demonstrates sequence-confirmed clusters of rhinovirus within the context of continuous heterotypic circulation of multiple strains in both symptomatic and asymptomatic children.

Assessing Disaster Preparedness Among Select Children’s Summer Camps in the United States and Canada

Objective Children’s summer camps are at risk for multiple pediatric casualties during a disaster. The degree to which summer camps have instituted disaster preparedness is unknown. We assessed disaster preparedness among selected camps nationally for a range of disasters. Methods We partnered with a national, web-based electronic health records system to send camp leadership of 315 camp organizations a 14-question online survey of disaster preparedness. One response from each camp was selected in the following order of importance: owner, director, physician, nurse, medical technician, office staff, and other. The results were analyzed using descriptive statistics. Results A total of 181 camps responses were received, 169 of which were complete. Camp types were overnight (60%), day (21%), special/medical needs (14%), and other (5%). Survey respondents were directors (52%), nurses (14%), office staff (10%), physicians (5%), owners (5%), emergency medical technicians (2%), and other (12%). Almost 18% of camps were located >20 mi from a major medical center, and 36% were >5 mi from police/fire departments. Many camps were missing emergency supplies: car/booster seats for evacuation (68%), shelter (35%), vehicles for evacuation (26%), quarantine isolation areas (21%), or emergency supplies of extra water (20%) or food (17%). Plans were unavailable for the following: power outages (23%); lockdowns (15%); illness outbreaks (15%); tornadoes (11%); evacuation for fire, flood, or chemical spill (9%); and other severe weather (8%). Many camps did not have online emergency plans (53%), plans for children with special/medical needs (38%), methods to rapidly communicate information to parents (25%), or methods to identify children for evacuation/reunification with parents (40%). Respondents reported that staff participation in disaster drills varied for weather (58%), evacuations (46%), and lockdowns (36%). The majority (75%) of respondents had not collaborated with medical organizations for planning. Conclusions A substantial proportion of camps were missing critical components of disaster planning. Future interventions must focus on developing summer camp-specific disaster plans, increasing partnerships, and reassessing national disaster plans to include summer camp settings.

Unintentional injuries in child care centers in the United States A systematic review

The study systematically reviewed all types of unintentional injury and injury prevention research studies occurring within child care centers in the United States. A total of 2 reviewers searched 11 electronic databases to identify 53 articles meeting inclusion criteria. No studies used trauma registries or randomized control trials. Data were not pooled for further analysis because studies lacked standardized definitions for injury, rates, severity, exposure, and demographics. The following child care center injury rates were reported: (0.25–5.31 injuries per 100,000 child-hours); (11.3–18 injuries per 100 children per year); (6–49 injuries per 1000 child-years); (2.5–8.29 injuries per child-year); (2.6–3.3 injuries per child); (3.3–6.3 injuries per 100 observations); (635–835 medically attended injuries per year per 100,000 children and 271–364 child care center playground injuries per year per 100,000 children); and (3.8 injuries per child per 2000 exposure hours). Child care center injury rates were comparable to injury rates published for schools, playground, and summer camp. Most injuries were minor, while most severe injuries (fractures and concussions) were falls from playground structures. Future studies need to use standardized injury definitions and injury severity scales, focus efforts on preventing severe playground injuries in child care centers, and report child care parameters for inclusion in national injury databases.

Enlarged Vestibular Aqueduct Syndrome: Sudden Hearing Loss in a Child with a Cerebral Shunt

Abstract Enlarged vestibular aqueduct syndrome (EVAS) is the most common congenital ear anomaly that causes sensorineural hearing loss in children and may predispose a child to sudden hearing loss from sudden pressure changes or minor head trauma. We report a case of a 4-year-old boy with a history of a ventriculoperitoneal shunt and migraines who presented to the emergency department with parental and child care provider reports of acute hearing loss, without a history of trauma, infection, or hardware malfunction, who was diagnosed with bilateral EVAS. Diagnosis of EVAS occurs with specific temporal bone imaging with either high-resolution, thin-cut computed tomography or magnetic resonance imaging scans. Enlarged vestibular aqueduct syndrome is typically refractory to medical treatment and often results in hearing loss that is too severe to benefit from amplification, requiring cochlear implantation.

Web-Based Surveillance of Illness in Childcare Centers

School absenteeism is an inefficient and unspecific metric for measuring community illness and does not provide surveillance during summertime. Web-based biosurveillance of childcare centers may represent a novel way to efficiently monitor illness outbreaks year-round. A web-based biosurveillance program ( sickchildcare.org ) was created and implemented in 4 childcare centers in a single Michigan county. Childcare providers were trained to report sick children who required exclusion or had parent-reported absences due to illness. Deidentified data on age range, number of illnesses, and illness categories were collected. Weekly electronic reports were sent to the county public health department. Data for reports were gathered beginning in December 2013 and were summarized using descriptive statistics. A total of 385 individual episodes of illness occurred during the study period. Children with reported illness were infants (16%, n = 61), toddlers (38%, n = 148), and preschoolers (46%, n = 176). Illness categories included: fever (30%, n = 116), gastroenteritis (30%, n = 115), influenzalike illness (8%, n = 32), cold without fever (13%, n = 51), rash (7%, n = 26), conjunctivitis (1%, n = 3), ear infection (1%, n = 5), and other (10%, n = 37). The majority of reports were center exclusions (55%, n = 214); others were absences (45%, n = 171). The detection of a gastroenteritis outbreak by web-based surveillance during winter 2013-14 preceded county health reports by 3 weeks; an additional outbreak of hand-foot-mouth disease was detected during June 2014 when standard school-based surveillance was not available. Web-based biosurveillance of illness in childcare centers represents a novel and feasible method to detect disease trends earlier and year-round compared to standard school-based disease surveillance.