EDIToR’s NOTE: This paper indicates points of disagreement in an area of
growing importance to pediatrics and public health. Letters to the editor will
be welcomed.
(Submitted November 16; accepted for publication December 30, 1965.)
This study was done under the sponsorship of the combined committee of the North Carolina
Chapter of the American Academy of Pediatrics and the North Carolina Pediatric Society.
T.D.S. is Chief, Maternal and Child Health Section, North Carolina State Board of Health. ADDRESS: Raleigh, North Carolina 27602.
PEDIATRICS, Vol. 38, No. 1, July 1966
44
ATTITUDES
OF
PEDIATRICIANS
TOWARD
DAY
CARE
T. D. Scurletis, M.D., F.A.A.P., Ann DeHuff Peters, M.D., and
W. A. Robie, M.D., F.A.A.P.
From the Maternal and Child Health Section, North Carolina State Board of Health and the School of Public Health, University of North Carolina
P
ROBLEMS associated with day careplague many communities. All over
the United States children are being cared
for in inadequate or harmful environments
with many health hazards. There is
dis-pute between groups as to the real needs
of children in day care and how
profes-sional help can best be utilized. Good day
care can provide services and facilities
which some homes cannot supply, hut this
does not assume that day care will ever
be a complete replacement for proper
home environment. Many children in day
care, especially those in commercial
cen-ters, are under the care of physicians in
private practice. The need for medical
supervision of children in day care has
been recognized and yet very little is
known about the attitude of the practicing
physician toward the day care of children.
In order to get a picture of the problems
and potentials in day care, as seen by
prac-ticing physicians, a survey was conducted
in the summer of 1965 among the
pedia-tricians of North Carolina. Pediatricians
were selected because of their obvious
in-terest in the problems of children and also
because they were easily accessible through
the North Carolina Pediatric Society. A
further hope was that this survey would
stimulate critical review of current
prac-tices and arouse interest in the
develop-ment of better health guidelines for the
broad needs of day care.
METHOD
With the assistance of the North
Caro-lina Pediatric Society and the North
Caro-lina Chapter of the Academy of Pediatrics,
a questionnaire was distributed to all
prac-ticing pediatricians in North Carolina.
They were asked to reply to the following
questions:
1. Ilave you had any experience with day care
centers or day nurseries in your comlnunity?
2. As a physician interested in children what do
you think are the areas that need study or
atten-tion in the field of clay care?
3. What are your feelings about day care for
(a) the normal child, (b) the mentally retarded
child, (c) the child with other handicaps, and
(d) the child under 2?
4. Have you been asked for advice about day
care centers or day nurseries?
5. Do you feel that day care centers in your
community have adequate regulation and
super-vision?
6. Do you have enough interest in day care to
be willing to help develop more adequate day care
centers and/or programs?
7. Please add any comments or suggestions you
wish to make that are not covered in the previous
questions.
Open-ended questions were deliberately
limi-Classification CommeNo
I
UnqnahfiedNoNo
Quahfied UnqualifiedYes QualifiedYes
58
Normal child 8 3 12 22
Mentally retarded child I 1 1 2 33 56
handicapped child 16 1 2 15 69
Under 2 years of age 9 ‘II ‘26 7 47
ARTICLES 45
TABLE I
SUITABILITY OF DAY CARE FOR DIFFERENT GROUPS OF CHILDREN
tations of this approach were recognized.
No attempt was made to follow up
non-responders, since it was felt that those who
answered the first questionnaire would
give the evidence of spontaneous interest
that was sought.
RESULTS
Two hundred questionnaires were sent
out and 103, or just over 50%, returned.
The material was coded and tabulated and
the results are reported as follows.
Table I represents the respondents’
feel-ings toward day care for the four
classifi-cations of children.
According to these figures, 80 to 95% of
the respondents reacted favorably to the
idea of day care for the normal child, the
mentally retarded, and the handicapped
child, whereas approximately 50% of the
respondents were not in favor of day care
for the child under 2. Only 47% were in
favor of day care for the child under 2,
and this only under specific conditions or
qualifications.
TABLE H
QUALIFIED YES
, . Condthonsfor Day Care
Normal
Child
Mentally Retarded
Ilandi-capped
( nder
Economic 16 11
“Neceuary evil” 11 . 9
Social or educational
development 1 18 21 1
Maternal relief 1 14 3 1
Non.specific
qualification 9 8 9 8
Under “supervised”
conditions :i 11 9 8
Individual
consider-ation 7 1 18 4
Misecllaneous I 7 9
Total 8 56 69 47
Table II reflects a breakdown of the
“qualified yes” responses to the four groups
of children.
A large percentage of physicians who
responded positively to the use of day care
show genuine concern about positive
values in day care for the retarded and
the handicapped child, especially in
rela-tion to social and educational development
of the child and the factor of maternal
relief. In addition, their comments
empha-sized the need for specifically supervised
programs for the mentally retarded and
the handicapped child; with the normal
child the major qualifying comments were
economic in nature or that day care is a
“necessary evil” resulting from factors in
our society.
Only 39 respondents said they had ever
been asked for advice about day care by
parents or centers. Table III classifies
these responses by type of advice
re-quested.
With the small number indicating
re-quest for advice by centers, one wonders
TABLE III
TYPE OF ADVICE REQUESTED
Advise Requested by ParenLs AdriceRequested by Centers
Selecting facility 6 General medical 6
Should a specific child be Communicable disease 2
in day care 10
Maid at home vs nursery Entrance physical
care 3 examinations I
Essential effect on child I Care ofsick children 3
Screening physical exam- Help with recruitment
ination and immuniza- and/or training of
zations 4 personnel 3
Illness 5
TABLE IV
PERSONNEL
TABLE V
CHILD’S NEEDS MET
TABLE VI
DAY CARE
Response Number Ability Training
No comment Adequate Inadequate 83 1 17 70 2 26 72 0 27
where advice about health matters is
ob-tamed, if at all. The responses indicated
that more parents than operators had
asked for advice, chiefly around the
ques-tions of the advisability of day care for a
particular child.
An attempt was made to classify the
free comments given by physicians in
re-sponse to question 2, “. . . what do you
think are the areas needing attention .
.
. ,“and question 7 asking for additional
com-merits. These were broadly grouped into
the following categories :
personnel-num-her, qualffications, and training; special
needs of children; broad community needs
in day care organization and service; and
health aspects of day care. Further
break-down is shown in Tables IV through VII.
Tables IV, V, and VI indicated that few
of the respondents stated a concern about
the number, ability, or training of
person-nel involved in day care of children or
Responae Economic . Cultural Educa-.
Special . hand,-capped No comment Adequate Inadequate 81 1 14 85 1 16 96 1 6 90 .. 13
whether the children’s needs and/or the
broad community needs are being met.
The large number of “no comments” may
indicate failure to recognize the
impor-tance of these aspects of day care, or it
may mean that the respondents did not
feel that such problems were within their
province of concern. Those who did
com-ment, however, showed a striking
predom-inance of negative responses, indicating
dissatisfaction with presently organized
services.
In contrast, Table VII indicates a higher
concentration of the respondent’s interest
in control of communicable diseases and
health supervision of children in day care.
The nature of spontaneous comments in
the areas represented in Tables IV through
VII seemed to indicate primary concern
of the respondents for the individual child
as a patient rather than a broad focus on
BROAD NEEDS IN DAY CARE ORGANIZATION
Response Plans for Further Study Community Interest ana Responsibility Financiniv of Services Quality and Type of Service Number of (‘enters No Comment Adequate Inadequate 78 1 24 85 1 16 92 0 11 91 0 11 90 0 11 TABLE VII
PERSONAL HEALTH FAC’rORS
Response
Screening Exam
Before Entry Immunization
ARTICLES 47
the community needs of children. For
example:
I feel that they [day care organizations] are an
important factor in the epidemiology of contagious
disease of children under school age.
Most children seem to benefit from the social
contact in the nursery. However, in my experience,
this is outweighed by the occurrence of illness,
primarily respiratory infections.
No direct experience with nurseries per se but
much experience with the effects of young children
in nurseries, i.e., repeated infections.
No matter how good the facilities are and no
matter how good the supervision is, the children
cared for in these centers will continue to be sick
constantly because of repeated exposure to other
children who are ill.
They provide much nuisance to the pediatrician
who gets called “after hours” when mother retrieves
child from nursery who has been sick + /-
ex-posed to all the bugs in the community.
In contrast, of the 103 physicians who
returned the questionnaire 65 responded
that they were strongly interested and
willing to participate in any program to
improve the day care of children. An
ad-ditional 22 (making a total of 87 out of
103) indicated interest in cooperating in
the development of day care programs.
One of the respondents, at least, was
stimulated to action by the questionnaire:
“I have not been aware of the problem in
day care units in my community.
.
. . Iwill certainly look into the situation now
that it has been brought to my attention.”
SUMMARY
This is a report of the attitudes
ex-pressed by 103 pediatricians in North
Carolina toward the day care of children.
They indicate a concentration of interest
in the individual child and his health
rather than on the broad community needs
and problems in day care. There is more
recognition of the needs and value of day
care to the handicapped child in contrast
to the normal child. However, the variety
and spontaneity of many responses, and
the willingness of the great majority of
respondents to help in better development
of day care seems to indicate interest of
physicians in this growing field of child
