[Are day care children often absent because of illness?]

Over an 18-month period, we observed 759 children attending eight day care centres in the Quebec City area to determine the rate of absenteeism due to illness in day care centres. 481 children were absent for a mean duration of 4.1 days. The absenteeism rate was 5.6 days out of a possible 1 000 days of attendance and did not vary with day care centre or age.

Smoking policies of licensed child day-care centers in the United States

The authors analyzed data from a national survey of 2003 directors of licensed child day-care centers to determine employee smoking policies, measure compliance with state and local employee smoking regulations for child day-care centers and state clean indoor air laws, and to estimate the extent of exposure to environmental tobacco smoke in these settings. Forty states regulated employee smoking in child day-care centers, but only three states required day-care centers to be smoke-free indoors. More than 99% of licensed child day-care centers had employee smoking policies that complied with the appropriate state or local smoking regulations. Nearly 55% of centers were smoke-free indoors and outdoors, and 26% were smoke-free indoors only. The best predictors of more stringent employee smoking policies were location in the West or South, smaller size, independent ownership, or having written smoking policies. Despite the presence of strong smoking policies at the majority of licensed child day-care centers, more than 752,000 children in the United States are at risk for environmental tobacco smoke exposure in these settings. Health care professionals and parents should insist that child day-care centers be smoke-free indoors and, preferably, smoke-free indoors and outdoors.

Which child will have a febrile seizure?

OBJECTIVE

To identify risk factors predictive of a first febrile seizure.

DESIGN

Case-control study.

SETTING

Regional referral pediatric hospital emergency department.

PATIENTS

Seventy-five patients aged 6 months to 4 years presenting with a first febrile seizure were age-matched to two febrile and two afebrile noninfectious controls who had never had a seizure.

METHODS

Telephone interview of parents.

MAIN OUTCOME MEASURES

Risk factors assessed included family history of febrile or afebrile seizures, neurodevelopmental abnormality, and child-care arrangement. Analysis was done by matched case-control and logistic regression.

RESULTS

Factors associated with a significant increase in risk of a first febrile seizure were febrile seizures in first-degree relative (odds ratio [OR], 4.5) or second-degree relative (OR, 3.5); neonatal discharge at 28 days or later (OR, 5.6); parental report of "slow" development (OR, 4.9); and day-care attendance (OR, 3.1). For children with two risk factors (an estimated 3% of the population), the risk of developing febrile seizures is approximately 28% (assuming a population incidence of febrile seizures of 4%).

[Criteria for the hygienic evaluation of the state of preschool institutions and their classification]

Significant factors of enterobiasis spreading in preschool institutions in Rostov-on-Don were: water supply conditions, staff number, number of children in groups (above 25 per group). Classification of those institutions was given.

Parents' evaluations of pre-school services for children with Down syndrome in two Scottish regions

Parental evaluations of current pre-school provision for children with Down's syndrome were surveyed in two Scottish regions. Two methods were used: postal questionnaires and telephone interviews. Services covered were those provided by general practitioners, hospital specialists, health visitors, speech therapists, occupational therapists, physiotherapists, educational psychologists, home teachers, social workers and voluntary organizations. Regional differences were found in provision and in parental satisfaction with currently available services, with some of these differences being dependent on child age. Overall, parents felt they were being given insufficient professional support, with contradictory advice not uncommon. Findings indicate that if limited resources are to be used to the maximum benefit of family and child, both subjective and objective measures of the relative values of different kinds of support at different ages are urgently needed.

Absences for sickness among children in day care

The number of days of absence because of sickness, recorded for all children in one city in Finland, cared for in municipal day care over a period of 2.5 years, was collected from the monthly figures kept by the city council office for accounting purposes. The average number of days of absence per child was 24 per year at child-care centers and 9 in family care (p < 0.01) at age less than 3 years, 13 and 7, respectively (p < 0.05) at age 3-5 years, and 10 and 5, respectively (p < 0.05) among those aged 6 years. The average duration of absence in all age groups was 3.6 days in child-care centers and 2.5 days in family-care centers. The number of days absent at each child-care center in 1986 correlated significantly with that for 1987 (r = 0.58, p < 0.001), indicating consistency in the absence figures. A bivariate analysis showed the number of children in the child-care centers (r = 0.32, p < 0.05) to explain the number of absences for sickness, and after this factor had been controlled in a multivariate analysis, the number of nurses serving out food while looking after the children (r = 0.27, p < 0.01) and the number of families to whom the children belonged (r = 0.27, p < 0.01).

Infectious diseases and injuries in child day care. Opportunities for healthier children

OBJECTIVE

To provide pertinent background information on infectious diseases and injury in child day care and outline measures to address these health care needs.

DESIGN

We reviewed published English-language literature identified through a MEDLINE bibliographic search, major literature summaries, and bibliographies from identified articles.

SETTING

Child day-care settings reviewed included family child care homes, centers, special facilities for ill children, and facilities for children with special needs.

PATIENTS OR OTHER PARTICIPANTS

Primarily children in a variety of day-care settings, often compared with children cared for at home.

MAIN OUTCOMES

The occurrence of outbreaks and illness related to infectious disease and injury.

RESULTS

Compared with preschool-aged children reared at home, among children in day care the risk of some infectious diseases was two to four times greater. Rates of both intentional and unintentional injuries in day-care settings were somewhat lower than those for children cared for at home.

CONCLUSIONS

Because preschool-aged children spend increasing time in structured day-care settings, the risk for some infectious diseases has increased. At the same time, child day-care settings present opportunities for ensuring healthier children through enhanced development, safer environments, better nutrition, increased vaccination coverage, and health promotion.

[The prevalence of enteropathogens in urban day nurseries]

BACKGROUND

Survey on the intestinal pathogens prevalence in a population of preschool children attending to the urban day-nurseries.

METHODS

Samples of faeces of 408 children and 31 adults, in their charge, were collected. The children were classified per sex, age and kind of day-nursery they were to; data on their physical condition and the faeces characteristics were obtained.

RESULTS

Parasites were the enteropathogens, found with the greatest frequency (21% of children and 19% of adults), next were rotavirus (3% of the children's samples and only one case in adults). The cases of a double parasitization only were 0.74% of the total number of the children surveyed (3 children per each case).

CONCLUSIONS

The highest prevalence of enteropathogens in children attending to the urban day-nurseries in our community belongs to the group of parasites; rotavirus are a much smaller group and bacterium are only isolated cases.

How can local health agencies improve health knowledge and skills of child care centre operators?

As the number of child care centres increases across Canada, local health agencies are increasingly involved in health issues within these facilities. 90% of operators of the 98 child care centres in an Ontario community responded to a mail survey distributed by the local health unit to determine health needs in these facilities. Infectious disease was reported to be the major health problem of the children. 76% of operators requested information about infectious diseases, in particular through use of written materials made available to their centre. The level of education of operators was high with 79% having completed community college courses. Over 70% of operators had attended continuing education sessions or workshops on child abuse, growth and development and nutrition; fewer operators reported attending sessions on infectious diseases, child safety, parent-child relationships and dental health. As a result of the needs assessment, a health unit multidisciplinary team has met and initiated a number of activities including meeting with child care centre operators, publication of newsletter for operators, and development of educational materials.

Evaluation of an intervention to reduce playground hazards in Atlanta child-care centers

In 1988, we identified playground hazards at 58 child-care centers (CCCs) and intervened by showing the director the hazards and distributing safety information. In 1990, we evaluated the 58 intervention CCCs as well as 71 randomly selected control CCCs. Intervention centers had 9.4 hazards per playground; control centers had 8.0. We conclude that the intervention was ineffective.

Meeting employees' needs through on-site child care

Reports on the Canadian public service sector, which has led the way in providing employer‐sponsored on‐site child care for employees. Suggests that such child care may be one way to recruit and retain staff, reduce staff turnover and absenteeism and increase staff morale in hospitals particularly, where irregular hours make the problem of child care especially acute.

Infections and other illnesses of children in day-care centers in Helsinki. II: The economic losses

The economic consequences of illnesses among children in day-care centers (DCCs) were estimated in Helsinki during a one-year period, 1985-1986. The municipal DCCs took care of altogether 14,882 children at the end of 1985. In terms of money value in 1990, the total loss due to illnesses among all DCC children was $22,485,000 (1 US dollar = 3.80 FIM). Nearly half (46%) of this loss was caused by illnesses among children under three years of age, although these represent only 20% of the children in day care. The losses were $3,535 per child place in use among children under three years of age and $1,012 among older children. Economic losses due to the guardian's absence from work totalled $1,623, deficient utilization of DCCs $1,254, visits to a physician $169, hospitalization $221, paid care of children at home $219 and antibiotic courses $12 per child place in use for those under the age of three years. The corresponding figures for older children were 541, 248, 95, 51, 73 and 4 dollars per child. More than 90% of illnesses and costs were caused by infectious diseases. Because the costs due to illnesses among children under three years of age were more than three times as high as those for older children, preference should be given to home care and family day care for younger children and efforts should be made to find out how to build healthy DCCs for them.

Biting in day care centers: incidence, prevention, and intervention

Analysis of accident logs in child day care centers indicates that biting is common, especially among toddlers 13 to 30 months of age. Children of this age often lack appropriate verbal skills and resort to aggressive means to achieve their goals. Still awkward in gross-motor skills, toddlers can also suffer self-bites following accidental falls. According to medical reports, human bites sometimes are more virulent than animal bites and can cause severe trauma. Although the AIDS virus has been cultured from saliva, transmission from saliva alone has not been documented. Bite injuries in day care, however, usually are minor and can be treated by washing, applying cold compresses, and comforting the child. Suggested methods to diminish the frequency of biting in day care include physical changes within the room, behavior modification, and other classroom management techniques.

Infections and other illnesses of children in day-care centers in Helsinki. I: Incidences and effects of home and day-care center variables

Illnesses among children attending municipal day-care centers (DCCs) were followed in a prospective study in Helsinki during 1985-1986. The study comprised 1,905 follow-up years among children in 29 DCCs. The mean number of illness periods was 4.9 per follow-up year, 7.9 for those under the age of three years and 3.8 for older children. The corresponding average numbers of days of illness were 23, 39 and 17. The most common diagnoses were upper respiratory tract infections (46.0%), diarrhea (17.2%), otitis media (12.9%), eye infections (4.0%), acute tonsillitis (3.2%), and bronchitis (3.0%). The six most common diagnoses, all infections, caused 86% of periods and 79% of days of illness. The ten most common infectious diseases caused 90.9% of absence periods, surgical operations 1.8%, and injuries 0.8%. In children under three years of age, a small area and volume of a DCC, lack of fully mechanized ventilation, and lack of separate facilities were associated with a higher incidence of one or all of the six most common infections. A large number of children at a DCC and small homes were associated with a high incidence of one or all of the most common infections among both younger and older children. The effects of passive smoking, number of siblings, number of household members, and incomes of families were not statistically significant.

Injuries and poisonings in out-of-home child care and home care

As part of a national telephone survey regarding health events associated with out-of-home child care, data regarding poisonings and injuries were collected. Of 171 reported poisonings, none occurred during out-of-home child care. The rate of injury during out-of-home child care was 1.69 per 100,000 child-hours compared with 2.66 for home care. Overall injury rates were slightly higher for children who attended out-of-home child care than for those who do not. This occurred because children who attended out-of-home child care had a higher injury rate during home care than did the children who did not attend out-of-home child care at all. Although out-of-home child care may carry an increased risk of infectious disease relative to home care, it does not appear to carry an increased risk of injury and, in fact, may confer a lower risk.

Acute respiratory illness in Adelaide children--the influence of child care

OBJECTIVE

To test the hypothesis that children attending child care centres are more likely to be prone to acute respiratory illness.

DESIGN

A case-control study.

SETTING

A community-based study in the Adelaide metropolitan area.

PARTICIPANTS

A randomly selected sample of Adelaide children whose births were registered in 1983.

MAIN OUTCOME MEASURE

A respiratory illness score was calculated for each child, based on parents' reports of acute respiratory illness in the previous 12 months.

RESULTS

Information was obtained by postal survey for 2618 children (mean age at time of study, 26 months). Eight hundred and nineteen of these children (31%) were reported to be regular or occasional attenders of child care centres or crèches. Home interviews were carried out with parents of children whose respiratory illness scores fell in the top 20% of the range and those whose score was in the bottom 20%. Children prone to respiratory illness were more likely to be users of child care centres or crèches than the children who were not prone (odds ratio = 2.28; 95% confidence interval, 1.53-3.40). The risk of being prone to respiratory illness increased with the frequency of use of child care, and tended to be greater the younger children were when they first attended child care centres. Adjustment in multivariate analysis for confounding factors made little difference to the strength of the association of proneness to respiratory illness with the use of child care (adjusted odds ratio = 2.23; 95% confidence interval 1.38-3.61).

CONCLUSION

Use of child care centres is an important cause of acute respiratory illness among Australian children.

The effect of diaper type and overclothing on fecal contamination in day-care centers

Fecal coliform contamination of environmental surfaces and hands in the day-care center is common. This study evaluated the effect of two diaper types on fecal contamination. Ten rooms in four day-care centers containing 141 children were studied in a prospective, randomized, crossover study. A total of 2946 samples were cultured during the 9-week study. Fecal coliforms were isolated from 307 inanimate objects (15%), 73 toy balls (46%), and 131 hands (17%). The number of contaminated inanimate objects was significantly less in rooms where paper diapers were worn when compared with that in rooms where double cloth diapers with plastic overpants were worn and in rooms where clothes were worn over diapers. Inanimate object cultures had more contamination in rooms in which diarrhea had occurred. Containment of feces by overclothes and diaper type may be important in decreasing transmission of enteric pathogens in day-care environments.

Diarrhea in children newly enrolled in day-care centers in Houston

Diarrhea is a common illness among children in day-care centers (DCC). We hypothesized that the incidence of diarrhea was greater among children in their first 1 or 2 months after enrollment in a DCC than in any subsequent period in day care. We followed 442 children younger than 2 years of age enrolled in 13 randomly selected DCCs for the occurrence of diarrhea during a 14 1/2-month period. Parents completed standardized baseline questionnaires and research nurses visited the DCC twice weekly to record the occurrence of diarrhea and to collect stool specimens. Incidence rates, rate ratios, chi square statistics and 95% confidence intervals were calculated for crude and stratified analyses. The diarrheal incidence rate of 4.4 cases/child-year in the first 4 weeks in the centers was significantly (rate ratio, 1.6; confidence interval, 1.3 to 2.1; P less than 0.01) higher than the 2.7 cases/child-year incidence rate of diarrhea in subsequent weeks. The effects of gender, ethnicity, age, DCC size, previous DCC attendance and season were examined and did not account for the association observed between recent enrollement and risk of diarrheal illness. Rotavirus was identified in 18% of cases of diarrhea, but no association was seen with recent enrollment in DCC. A significantly higher incidence of diarrhea occurred in males compared with females (P less than 0.002) and in younger children (P less than 0.001) compared with older children. Diarrhea is common in children in DCCs and occurs significantly more frequently in children during their first 4 weeks in a DCC.

[The level of enterobiasis infectivity in children in relation to the sanitary status of preschool institutions]

Nursery schools and kindergartens have been examined in Rostov-on-Don. Five most essential factors based on the determination of signs informativeness and prognostic coefficients and responsible for possible enterobiasis determination have been identified: the state of water supply, staffing with personnel, presence (absence) of the round-the-clock groups, overcrowded groups, location of bedrooms. An attempt is made to classify kindergartens according to these indexes.

Statistical methods for determining risk factors of chronic otitis media with effusion

We use logistic regression with paired Bernouilli outcomes to analyse data on subjects who have either one or two organs (e.g. ears) each of which may develop disease. In this model, subject-specific covariates are related to the probability of developing disease. The proposed method is applied to determine risk factors for chronic otitis media with effusion.

A program evaluation of a sick child day-care facility

This survey examined the characteristics of families who used a sick child day-care center and the variables that determined their use in comparison with families who did not use such a facility. Families who used sick child day-care had more favorable attitudes toward the facility and a greater need for these services.

[An analysis of the seasonal rise in hepatitis A morbidity at a children's center and ways to improve the sanitary epidemiologic surveillance for this infection among organized preschoolers]

The spread of hepatitis A in children's institution occurred through everyday contacts, the boundaries of the focus of infection embraced the whole institution, and the active detection of the prevailing subclinical forms of the disease proved to be possible by means of virological and biomedical tests. The enhancement of the effectiveness of clinical and epidemiological surveillance by its orientation to the control of the spread of this infection through water and everyday contacts, the rational organization of sanitary, microbiological and serological studies, the development of criteria of epidemiological safety of children's institutions is proposed.

[Haemophilus influenzae carriers among child care personnel: its prevalence and the efficacy of enoxacin in its elimination]

In a previous study we observed that 6% of adult and 18% of children contacts of H. influenzae infected patients became carriers of the bacillus. We studied 1296 adults involved in children care, 398 from day care centers and 898 from hospitals in Santiago. A pharyngeal sample was cultured in chocolate agar plus bacitracin (300 mg/ml) and incubated at 37 degrees C in a 5-10% CO2 atmosphere for 18-24 h. Isolates of H influenzae were biotypified and serogrouped according to international recommendations. We observed that 2.4% of subjects were H influenzae carriers. Thirty carriers were treated with 2 doses of enoxacin, 440 mg. All became free of H influenzae at a 30-day follow-up.

Infant feeding patterns during the first year of life in Denmark: factors associated with the discontinuation of breast-feeding

We prospectively studied 500 infants born consecutively in a university-affiliated community hospital in Copenhagen, Denmark, over the first 12 months of life using a detailed monthly mailed questionnaire (overall response rate = 73%) which focused on feeding practices and illnesses. Seventy-seven percent of respondents breast-fed their infants at 1 month of life compared to 19% at 12 months of life. Analysis of breast-feeding behavior using survival analysis showed that 50% of the mothers who breast-fed since the first month of their infant's life were still breast-feeding at 7 months of life. Also, there was a greater than two-fold increase in the rate of discontinuation of breast-feeding for infants in daycare compared to infants not attending daycare (RR = 2.08, 95% CI = 1.43, 3.01). Discontinuation of breast-feeding was not significantly associated with the number of children in the family or with social class. These results give insight into infant feeding patterns in a developed country and suggest that: (1) breast-feeding is the dominant method of feeding during the infant's first year of life, and (2) the rate of discontinuation of breast-feeding is increased by the entry of these infants into daycare.

Dual-earner families' stress levels and personal and life-style-related variables

This study investigated personal and life-style-related variables and stress levels in dual-earner families in the preschool stage of family development. The sample was composed of 92 families receiving child day care through a major day care provider in the Upper Midwest. The Family Inventory of Life Events and Changes was used to measure the family stress level. The majority of dual-earner families in this sample were experiencing a moderate level of family stress based on national stress level norms calculated for families in the preschool stage of development. Parental age and age of children were statistically related to the family stress level. Life-style-related variables statistically significant in this study were amount of income and satisfaction with income level, satisfaction with child care, and flexibility in vacation scheduling. Parents who could easily schedule vacations during the same time period had significantly lower family stress levels than parents who had difficulty scheduling vacations together, p less than .003. Additionally, parents who reported being forced to take separate vacations because of their work schedules had statistically higher scores on family stress than parents who had never had to take separate vacations because of work schedules, p less than .002.

Honeylands' role in the pre-school years: II. Patterns of use; and III. Factors inhibiting use

This is the second paper arising from an independent evaluation of Honeylands' role in the pre-school years. The study was based on interviews with parents of young handicapped children in the Exeter area, both 'users' and 'non-users' of Honeylands' services. In the first section of the paper we examine the ways in which parents made use of Honeylands' facilities. Residential care, both regular and 'on demand' is considered in particular detail. We then go on to examine the reasons for non-use and the factors inhibiting the use made by 'user' families. After considering some objective factors which may effect take-up, we discuss more generally the dilemma of accepting help.

Intervention with high-risk infants and toddlers

This early intervention program serves children and parents. It includes a therapeutic infant day care center and a mother-child interaction group. Counseling is also provided for families with children in the center and for families with children under three years of age in the community.

A study of some environmental influences in language development

A study of the language development of a group of three year old children living on a housing estate is described. Various factors in their environment are examined in relation to their development. The only significant finding was that children possessing toys which encouraged creative play were more advanced in both verbal comprehension and expressive language. The role of language in intellectual development and possible implications for pre-school facilities are discussed.