RISK OF INFECTIOUS-DISEASES IN CHILDREN ATTENDING DIFFERENT TYPES OF DAY-CARE SETTING

This population-based prospective cohort study compared the risk of re current infections in children attending family day care (less than or equal to 3 children per family), small (10-20 children) day-care cent ers (DCCs), and large (greater than or equal to 40 children) DCCs. The parents of a total of 1,242 children participated in the study (97% o f the families initially contacted). An infectious episode was defined as the acute occurrence of a new symptom lasting for at least 48 h an d resulting in specific treatment. Two episodes were counted as such o nly if they were separated by a symptom-free week. Surveillance was un der the responsibility of a nursing director and was similar for all t hree types of DCCs. During the 8.5-month follow-up period, 3,639 infec tious episodes were recorded. Compared to those in family day-care, ch ildren attending small DCCs presented a higher risk for greater than o r equal to 6 total infectious episodes [odds ratio (OR) = 2.4; 95% con fidence interval (CI) = 1.6-3.7]; greater than or equal to 5 upper res piratory tract infections (OR = 2.2; 95% CI = 1.4-3.4); greater than o r equal to 2 episodes of otitis media (OR = 2.6; 95% CI = 1.0-2.6); gr eater than or equal to 2 episodes of conjunctivitis (OR = 4.1; 95% CI = 2.1-8.2); and greater than or equal to 2 episodes of croup (OR = 4.1 ; 95% CI = 1.6-10.9). The risk for children attending large DCCs was i ntermediate between those in family day care and those in small DCCs. Apart from sampling variation, one explanation for this result could b e that children in large DCCs are divided into groups according to the ir age (i.e. <12, 12-24, and >24 months). It is possible that the homo geneity of age within each group and the absence of direct contact bet ween groups confers some protection against the spread of infections. Children who had been in day care for at least 6 months at the beginni ng of the study were at a lower risk for recurrent infections than tho se who had entered day care earlier. This result might be explained by the acquisition of specific immunity as well as by nonspecific immuni ty that protects against microorganisms not previously encountered by the body. These results suggest that, for children with repeated infec tions in DCCs, a move to the family day-care setting, when feasible, s hould be contemplated. It also suggests that the development of family daycare settings should be encouraged. However, the decision of promo ting one type of day-care setting rather than another requires further studies focusing on different outcomes such as the long-term health c onsequences, the psychological development, and also the total economi c consequences related to attendance of each type of structure.