Child care and children's illness

Transient and sustained effects of child-care attendance on hospital admission for gastroenteritis

BACKGROUND

There is evidence that children experience a transient increase in mild episodes of gastroenteritis when they start attending out-of-home child care. We assessed the transient and sustained effects of cumulative day-care attendance, age at first enrolment and type of child care facility attended on hospitalization rates for gastroenteritis.

METHODS

Cox proportional hazard models were used to estimate the risk of being hospitalized for gastroenteritis in two large cohorts of preschool (<6 years old) and elementary school-going (6-10 years old) children in Denmark. Day-by-day child-level registry data were used. Together, the two cohorts comprised 443,872 children, 21,038 hospitalizations and 1742,284 child-years (1994-2011).

RESULTS

From first day-care attendance until 12 months of cumulated attendance, preschool children attending day-care centres, but not those attending day-care homes, had an increased risk of hospitalization for gastroenteritis compared with children never attending registered day-care. Such increased risk was highest shortly after starting day-care attendance and then gradually declined. After 12 months of attendance, attending either day-care centres or day-care homes was associated with a lower risk for hospitalization. Such decreased risk was confined to children starting day-care attendance before the age of one year and extended throughout, but not beyond, their preschool years.

CONCLUSIONS

Attending day-care centres is associated with a higher risk for gastroenteritis hospitalization until completing 1 year of attendance. However, if children start attending day-care before the age of 1 year, they experience a lower risk of being hospitalized during their preschool years. This apparent protective effect does not last into the elementary school years.

Gastrointestinal and respiratory illness in children that do and do not attend child day care centers: a cost-of-illness study

Background

Gastrointestinal and respiratory diseases are major causes of morbidity for young children, particularly for those children attending child day care centers (DCCs). Although both diseases are presumed to cause considerable societal costs for care and treatment of illness, the extent of these costs, and the difference of these costs between children that do and do not attend such centers, is largely unknown.

Objective

Estimate the societal costs for care and treatment of episodes of gastroenteritis (GE) and influenza-like illness (ILI) experienced by Dutch children that attend a DCC, compared to children that do not attend a DCC.

Methods

A web-based monthly survey was conducted among households with children aged 0–48 months from October 2012 to October 2013. Households filled-in a questionnaire on the incidence of GE and ILI episodes experienced by their child during the past 4 weeks, on the costs related to care and treatment of these episodes, and on DCC arrangements. Costs and incidence were adjusted for socioeconomic characteristics including education level, nationality and monthly income of parents, number of children in the household, gender and age of the child and month of survey conduct.

Results

Children attending a DCC experienced higher rates of GE (aIRR 1.4 [95%CI: 1.2–1.9]) and ILI (aIRR: 1.4 [95%CI: 1.2–1.6]) compared to children not attending a DCC. The societal costs for care and treatment of an episode of GE and ILI experienced by a DCC-attending child were estimated at €215.45 [€115.69–€315.02] and €196.32 [€161.58–€232.74] respectively, twice as high as for a non-DCC-attending child. The DCC-attributable economic burden of GE and ILI for the Netherlands was estimated at €25 million and €72 million per year.

Conclusions

Although children attending a DCC experience only slightly higher rates of GE and ILI compared to children not attending a DCC, the costs involved per episode are substantially higher.

Multiple child care arrangements and common communicable illnesses in children aged 3 to 54 months

The study examined the relationship between the number of concurrent child care arrangements and children's incidence of communicable illnesses throughout the first 4½ years of life, and whether this association is mediated by the total number of children across care settings. Within-child fixed effects regression models were used to relate changes in the numbers of concurrent nonparental arrangements to changes in children's illnesses using longitudinal data from the NICHD's Study of Early Child Care and Youth Development (N = 1,265). 52 % of children attended multiple child care arrangements at least once from 3 to 54 months. Increases in the number of arrangements were associated with a 15 % increase in respiratory problems among children 3-54 months of age, and a 25 % increase in otitis media among children 36-54 months. Associations were smaller among African American children compared to European American and other-race children. Findings suggest that the number of peers with which a child comes into contact at child care mediates the association between increases in number of arrangements and increases in reported respiratory problems. Children attending multiple child care arrangements prior to kindergarten entry experience slightly more contemporaneous communicable diseases, relative to attending single nonparental arrangements, through exposure to more peers.

Multiple childcare arrangements and health outcomes in early childhood

This study examined the associations between multiple childcare arrangements and young children's health problems. This study used three waves of the Early Childhood Longitudinal Study-Birth Cohort, collected from a nationally representative sample of children when they were 9 months old, 2 years old, and 4 years old (N = 7,150). 'Multiple childcare arrangements' was defined and measured by the number of non-parental childcare arrangements that occurred on a regular basis. During each wave of the data collection, the mother reported the number of regular childcare arrangements by three types: relative care, non-relative care, and center-based care. These numbers were summed to calculate the total number of arrangements. The mother also reported the incidence of ear infections, gastrointestinal illnesses, asthma diagnosis, and unintentional injuries of the child. Random effects and fixed effects regression models were used to estimate the association between the number of childcare arrangements and measures of early childhood health problems. Increases in the total number of childcare arrangements were associated with an elevated risk of ear infections, gastrointestinal illnesses, and diagnosed asthma in children. Further analysis indicates that increases in both the number of center-based care and non-relative care (but not relative care) arrangements can lead to a greater chance of health problems in young children. Multiple childcare arrangements are associated with communicable illness and diagnosed asthma in early childhood and appear to be a risk factor for health problems in early childhood.

Early child care and illness among preschoolers

The majority of young American children regularly spend time in nonparental care settings. Such arrangements are associated with their experiences of common childhood illnesses. Why this linkage exists, how it varies across the socioeconomic spectrum, and whether it has implications for how parents arrange care are all important theoretical and policy issues. In this study, therefore, we applied a fixed-effects design within structural equation modeling to data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (n = 1,364). Results revealed that children were sick more often when cared for in a center and had more peer exposure in their primary care settings, although this latter association was observed only among children of the least educated mothers. Net of such factors, children in multiple arrangements did not experience more illness, but illnesses tended to decrease subsequent peer exposure as parents changed children's care arrangements.

Maternal employment and the health of low-income young children

This study examines whether maternal employment affects the health status of low-income, elementary-school-aged children using instrumental variables estimation and experimental data from a welfare-to-work program implemented in the early 1990s. Maternal report of child health status is predicted as a function of exogenous variation in maternal employment associated with random assignment to the experimental group. IV estimates show a modest adverse effect of maternal employment on children's health. Making use of data from another welfare-to-work program we propose that any adverse effect on child health may be tempered by increased family income and access to public health insurance coverage, findings with direct relevance to a number of current policy discussions. In a secondary analysis using fixed effects techniques on longitudinal survey data collected in 1998 and 2001, we find a comparable adverse effect of maternal employment on child health that supports the external validity of our primary result.

The public health problem of acute respiratory illness in childcare

Acute respiratory illness continues to be a significant problem for children attending childcare. The problems for the child are in terms of prevalence, incidence, and quality of life. Additional costs relate to parental absence from work and loss of earnings. This paper reports on the literature, and notes that little research has been undertaken to determine whether there are long-term risks or benefits to experiencing acute respiratory illness in early childhood. Research to date is presented, and the role of public health nurses is discussed in relation to how they might assist in reducing the incidence/prevalence of acute respiratory illness in children attending childcare.

The relationship between otitis media with effusion and contact with other children in a british cohort studied from 8 months to 3 1/2 years. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

OBJECTIVE

It is generally acknowledged that otitis media with effusion is more prevalent among children attending grouped day care. This study aimed to refine this by determining the relationships with the numbers of children at the place of day care, the age of the child and the number of siblings he/she had.

METHODS

ALSPAC (the Avon Longitudinal Study of Pregnancy and Childhood) is a population based longitudinal study starting early in pregnancy and following the children throughout their lives. Nested within this study, a randomly selected group of 1590 children, the Children in Focus, were invited to attend a clinic for hands on examinations. Tympanometry was carried out at ages 8, 12, 18, 25, 31, 37 and 43 months of age. Bilateral otitis media with effusion (OME) was identified if both ears showed a flat trace. Multi-level modelling with logistic regression adjusted for a number of social and environmental influences.

RESULTS

Of the 1590 children invited to the 8-month clinic, 300 (19%) were excluded from the analysis because of failure to attend or because of missing data. The analyses were based on 1290 children. The prevalence of bilateral OME decreased with age, from 24.6% at 8 months to 11.9% at 43 months. Children with older siblings and those attending day care with four or more other children were at an increased risk of OME. The adjusted odds ratios (AOR) were 1.52 (95% confidence interval [CI] = 1.23, 1.88) and 1.36 (95% CI = 1.02, 1.82), respectively. The risk associated with older siblings declined with age and by 3 years these children were no longer more likely to have OME than children with no older siblings. No such interaction with age was found for children in group day care and these children continued to be at an increased risk over the entire age period of the study. There was no increased risk associated with day care when no other children attended (AOR = 1.18, 95% CI = 0.88, 1.58) or when one to three others were present (AOR = 1.10, 95% CI = 0.85, 1.42). Although there was no relationship with the number of hours spent in day care, children who had started attending group care with four or more other children before 9 months of age did have an increased risk compared with children starting later AOR = 1.88, 95% CI = 1.12, 3.14.

CONCLUSIONS

These results provide evidence that early contact with other children increases the risk of OME and that children attending day care with four or more other children remain at an increased risk of OME at least until 31/2 years.

Dietary intake and health outcomes among young children attending 2 urban day-care centers

OBJECTIVE

To assess the impact of the Child and Adult Care Food Program (CACFP) on diet and 3 health outcomes--weight-for-height status, dental caries (tooth decay) score, and number of days of illness--among preschool children attending 2 urban day care centers.

DESIGN

Dietary intake and health outcome measures were assessed and compared for children attending 2 day-care centers in an urban community. Data were obtained for 14 days of dietary intake, which were analyzed for energy and 15 nutrients and 6 food groups; anthropometric measures, including weight-for-height; dental caries; and days of illness.

SUBJECTS/SETTING

Forty 3- to 5-year-old black children from 2 day-care centers participated. One center participates in the CACFP. At the other center, children bring all meals and snacks from home.

STATISTICAL ANALYSES PERFORMED

Data from the 2 groups of children were compared using parameteric and nonparametric t tests.

RESULTS

Children receiving CACFP meals at day care had significantly higher mean daily intakes of vitamin A (804 +/- 191 vs 595 +/- 268 retinol equivalents), riboflavin (1.45 +/- 0.32 vs 1.21 +/- 0.22 mg), and calcium (714 +/- 180 vs 503 +/- 143 mg) than the children who brought all of their meals and snacks from home. Children who received CACFP meals also consumed significantly more servings of milk (2.9 +/- 0.9 servings vs 1.5 +/- 0.7) and vegetables (1.8 +/- 0.5 vs 1.2 +/- 0.5 servings) and significantly fewer servings of fats/sweets (4.6 +/- 1.3 vs 5.4 +/- 1.1 servings) than children who brought their meals. Weight-for-height status and dental caries scores did not differ between the 2 groups. Children from the center participating in the CACFP have significantly fewer days of illness (median 6.5 vs 10.5 days) than children from the nonparticipating center.

APPLICATIONS

Nutritious meals provided by the CACFP can improve diets and may promote health among young, urban children. Registered dietitians can contribute to food assistance programs by intervening to enhance the quality of meals served and by examining the impact of participation on measures of diet quality and diet-related health outcomes.

Illnesses and absence due to illness among children attending child care facilities in Seattle-King County, Washington

OBJECTIVES

Although much of the economic impact of child care-associated illness in the United States is due to parents' time lost from work, there are no data on the incidence of absence due to illness among children in various types of out-of-home child care settings in the United States. The goals of this study were to compare the incidence of illness and absence due to illness among children attending child care homes (CCHs) and child care centers (CCCs).

METHODS

From July 1992 through June 1993, child care providers from 91 CCHs and 41 CCCs in Seattle-King County, Washington, provided information on absenteeism and illness for 96 792 child-weeks of observation.

RESULTS

The age-adjusted incidence of provider-reported illness episodes among children in CCHs (10.4 episodes per 100 child-weeks) was greater than that among children in CCCs (6.7 episodes per 100 child-weeks). The incidence density ratio of illness among children <1 year of age in comparison to those >/=5 years of age in CCCs (4.5) was greater than that among similar groups in CCHs (2.3). The age-adjusted incidence of absence due to illness among children in CCHs (5.1 days per 100 child-weeks) was less than that among children in CCCs (8.9 days per 100 child-weeks).

CONCLUSIONS

Results comparing the incidence of illness between children in various types of child care settings may be influenced by information sources. The incidence of illness among children in CCHs may be greater than that among children in CCCs. The increased incidence of absence due to illness among children in CCCs compared with that among children in CCHs probably reflects differences in exclusion and attendance policies and practices between these two types of settings.

Communicable disease outbreaks in long day care centres in western Sydney: occurrence and risk factors

We surveyed the directors of all 92 long day care centres in western Sydney to document the occurrence of communicable disease outbreaks during 1992 and to identify risk factors for the occurrence of these outbreaks. A total of 6092 children were enrolled at the centres, of whom 530 (8.7%) were less than 3 years old. Most centres (80.4%) reported at least one outbreak of communicable disease. Diarrhoea was the most commonly reported outbreak type (60 outbreaks), followed by conjunctivitis, head louse infestation and chicken pox (46, 44 and 24 outbreaks, respectively). Chicken pox outbreaks had the largest mean number of cases per outbreak (9.6) and the longest mean outbreak duration (4.4 weeks). Centres with a large total enrollment (50 or more children), those that were open for 12 or more hours each day and those which had commenced operating in 1990 or more recently were generally more likely to report outbreaks, particularly of diarrhoea. The vast majority of communicable disease outbreaks (92.1%) were handled by day-care staff without seeking outside assistance. Day-care centre directors may be unaware of the health services that could help them. We need to work more closely with long day care centres, and to focus preventative efforts on large centres, those open for long hours, and newly opened centres.

Air quality during the winter in Québec day-care centers

Over 90% of 91 day care centers in greater Montréal, Québec exceeded 1000 ppm of CO2 during January through April 1989. Four variables were independent positive predictors of CO2 levels: the density of children in the center; presence of electric heating; absence of a ventilation system; and building age. High levels of CO2 are associated with respiratory tract and other symptoms. Clear standards and inspection policies should be established for day care center air quality.

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.

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.

Occurrence of infectious symptoms in children in day care homes

Transmission of enteric pathogens is facilitated in child day care centers, including family day care homes, by frequent and intimate exposure among susceptible hosts, with diaper changing as the highest-risk procedure for such transmission. The objective of this study was to evaluate the effectiveness of an intervention program in decreasing the incidence of infectious disease symptoms in children attending family day care homes during a 12-month period. Each of 24 family day care homes was randomly assigned to an intervention or control group. The intervention included four components: (1) a handwashing educational program and (2) use of vinyl gloves, (3) use of disposable diaper changing pads, and (4) use of an alcohol-based hand rinse by the day care provider. Symptoms of enteric disease (diarrhea and vomiting) were significantly reduced in intervention family day care homes (p less than or equal to 0.05), whereas respiratory symptoms were not significantly different between intervention and control family day care homes (p = 0.35). Diarrhea was reported in 1 of every 100 child care days, representing one diarrhea episode per month in a typical family day care home.

Day care characteristics associated with Haemophilus influenzae disease. Haemophilus influenzae Study Group

To identify characteristics of day care facilities associated with H. influenzae disease, we compared 92 licensed facilities in which a case of H. influenzae disease had occurred with randomly selected facilities at which no cases occurred. Matched univariate analysis showed that personnel at facilities where H. influenzae disease occurred were more likely than those at control facilities to use towels or handkerchiefs to wipe children's noses, admit children who were not toilet trained or had diarrhea ("liberal fecal policy"), had a narrower age range, were more likely than control facilities to be for-profit and less likely to use volunteers. In a multivariate model that adjusted for age range, profit status and liberal fecal policy, towel or handkerchief use (OR 5.5, 95% CI: 1.1, 30) was the only variable independently associated with case facilities. This is the first association of a specific day care practice with H. influenzae disease.

Family resources and children's use of primary health care services in Finland in 1979

The purpose of the study was to determine how children's use of primary health care services was related to family resources (socio-economic status, marital and residential stability of the family, and core/periphery dichotomy). The population consisted of a random sample of 3201 children from 15 municipalities in the province of Uudenmaan lääni in Southern Finland in 1979. Among two-parent families in the core regions total utilization of primary health care services was significantly higher among the children of workers and upper white-collar employees. Children of farmers and lower white-collar employees in the periphery exhibited low primary health care utilization. Children in upper white-collar employees' families (both two- and one-parent) in core regions frequently used private services. Among children of one-parent families, exceptionally high users of private services were children of upper white-collar mothers in core regions, and of municipal health services the children of working-class mothers in the periphery. Non-migrated children had a slight tendency to use health services more than migrated children. Differences in family resources thus cannot be ignored when children's utilization of primary health care services is studied.

Health services in child day-care centers: a survey

This descriptive study examined the types of health services provided by 49 child day-care centers. A questionnaire was used to collect data from the day-care center directors. The study explored the existing health services and education and training for children, parents, and staff. The study also explored services that the centers would like to offer. Fewer than 50% of the day-care centers offered more than three primary care health services for children. The provision of health education and training for children, parents, and staff varied widely, but these services were offered more frequently than primary care health services. Directors were very interested in offering more comprehensive primary care services, options for sick-child care, and education and training in the areas of safety, disease prevention and management, child development, and availability of community resources. Directors cited infectious disease prevention and management, sick-child care options, and staff training as their most pressing health issues. Recommendations are made for improving the delivery of health services to day-care centers.

Illness associated with child day care: a study of incidence and cost

We studied 843 children under 36 months of age enrolled in a prepaid health plan from September 1985 through March 1986, to identify characteristics of day care which might be risk factors for infection and to describe the resulting economic costs. Children cared for in their own home had a mean of 2.03 infections diagnosed during the study period. Adjusted rates of excess infection (95 per cent CI) for children cared for in other settings were: -.09 (-.73, .54) in relatives' homes; .10 (-.51, .71) in day care homes; .79 (.13, 1.45) in day care centers; .60 (-.24, 1.46) in mother's day out programs; and .66 (-.01, 1.34) in multiple settings. Children in day care centers were 4.5 times more likely to be hospitalized than those in other settings (95 per cent CI = 1.55, 13.00), primarily due to an increased rate of tympanostomy tube placement (relative risk 3.79, 95 per cent CI = 1.04, 13.36). The strongest predictor of illness risk was the number of other children in the room. The mean monthly cost of medical care was $32.94 for children in the highest risk settings compared with $19.78 for those in other settings. Illness in a child in our study accounted for 40 per cent of parental absenteeism from work; the mean number of days lost per month was 0.52 for parents of children in day care centers compared with 0.37 for those of children in other forms of full time care outside the home.

Child care for preschoolers: differences by child's age

Because of the high rates of employment of mothers, a large and increasing number of preschool children receive regular care from someone else. This article develops and tests hypotheses about the choice of child care arrangements for younger and older preschool children, using data from the National Longitudinal Survey of Young Women. We argue that appropriate care depends on the age of the child. It includes care by the mother or a paid provider in the child's home for children aged 0-2 and mother care and nursery school or center care for those 3-5. We estimate models of the mother's employment and choice of child care separately for younger and older preschoolers. Our results show that need for care, presence of substitutes for the mother, financial resources, and preferences all affect both full-time care by the mother and the type of child care chosen by working women, although they affect these two decisions in different ways.