How do child care center personnel define fever?

Background. Children with 'fever' are routinely excluded from child care centers, resulting in disruption of parental work schedules. Little is known about how child care centers define fever in states that do not provide guidelines. Objective To determine the frequency of temperature thresholds for the definition of fever used by child care centers that are either lower or higher than thresholds commonly used and to identify factors associated with their use. Methods. We interviewed a random sample of 1632 child care program directors in Connecticut. Child care centers were classified into three groups based on their temperature threshold for definitions of fever by oral temperature: (1) group with lower fever threshold (<99.5°F); (2) group with mid-range fever threshold (99.5-100°F); or (3) group with higher fever threshold (>100°F). Results. Of the 115 directors randomly selected and then contacted, 100 (87%) agreed to be interviewed. Of the 100, one center did not have a numerical definition of fever. Eight centers used a lower temperature threshold, 60 centers used a standard or mid-range temperature threshold, and 31 centers used a higher temperature threshold. The multinomial logistic regression model indicated that directors without a college degree were more likely to use higher or lower temperature threshold for the definition of fever compared to those with a degree (p < 0.05). Conclusions. There is substantial variation in the definition of fever used by child care centers. Directors without a college degree may be target groups for continuing education of what constitutes fever in child care settings. In addition, implementation of state-wide standards for definition of fever in child care programs should be advocated.