Child care center directors' opinions, overuse of antibiotics, and social policy.

The Concise Communication by M'ikanatha et al in this issue of Infection Control and Hospital Epidemiology, "Child Care Center Exclusion Policies and Directors' Opinions on the Use of Antibiotics," is a useful window into child care policies and child care directors' opinions about the use of antibiotics in child care. Given our knowledge that infectious disease is more common among children in child care than among children reared at home, it not surprising that directors, not to mention parents, are concerned. For parents, a child's illness often means medical expenses, a day (or more) of lost wages, or the extra expense of hiring an in-home caregiver or placing their child in a facility specializing in the care of children with acute, self-limited illness or injury. For directors, although they generally do not refund tuition for a child's sick days, a reputation for unusually high illness rates or even strict infection control policies could mean the loss of potential customers. These are powerful incentives for both directors and parents to try to reduce the impact of infectious disease on the individual child and on the child care center.