Public health surveillance in child-care settings.

To investigate the potential contribution of public health surveillance systems to the health of children and workers in out-of-home child-care settings, we review existing public health surveillance practice in the United States. We identify issues that are of particular concern for surveillance in child-care settings. We propose a framework for developing public health surveillance systems that uses sentinel child-care sites, notifiable disease surveillance, modification of existing surveillance systems, and population surveys. Successful surveillance in these settings depends on the active participation of child-care providers, public health practitioners, and clinicians in (a) the selection of high priority diseases and injuries for surveillance; (b) the development of practical case definitions; (c) the augmentation of current surveillance systems to include disease and injury related to child care; and (d) the implementation, assessment, dissemination, and evaluation of new approaches for surveillance in child-care settings.