Gaps and excesses in the regulation of child day care: report of a panel.

A panel representing the perspectives of providers, regulators, policy makers, and lawyers discussed day care regulation. The participants identified areas of overregulation caused primarily by the number of separate, uncoordinated regulators. In addition, they identified gaps where improved requirements are needed: smaller group size; emphasis on handwashing procedures; mandatory, ongoing training of providers; and more-defined policy on inclusion or exclusion of mildly ill and asymptomatic children. The number of routine standard-by-standard inspections can be reduced when states identify a few significant standards, compliance with which correlates with compliance with all standards. Education by the state health agency is needed. Pediatricians should know when their patients use day care and be conscious of public health implications when diagnosing infectious disease. More frequent interaction between pediatricians and the day care programs of their patients is needed.