Upper respiratory morbidity in preschool children - A cross-sectional study

Objectives: To estimate the occurrence of and associations between upper re spiratory tract infections in preschool children, and to assess constitutio nal and environmental factors as determinants of these infections. Design: Population-based cross-sectional study. Setting: Oslo, Norway. Participants: Preschool children, aged 4 to 5 years (3853 completed questio nnaires). Main Outcome Measures: Acute and recurrent acute otitis media, tonsillophar yngitis, common cold, and rhinitis; Results: Upper respiratory tract infections were common at age 4 years. Dur ing the last month, 7.1% of the children had acute otitis media and 7.5% ex perienced tonsillopharyngitis. Corresponding figures for common cold and rh initis were 58.3% and 16.4%, respectively. During the last 12 months, 9.5% of the children experienced more than 1 bout of acute otitis media, 6.9% ha d more than 1 tonsillopharyngitis episode, 47.7% contracted more than 2 com mon colds, and 3.2% had rhinitis weekly or monthly. The lifetime prevalence of recurrent acute otitis media (greater than or equal to 4 episodes in an y 12-month period) was 12.7% (n=473). Bivariate correlations showed small-t o-moderate relationships between the infections. Common cold was only weakl y related to otitis media, tonsillopharyngitis, and chronic rhinitis. The p robability for developing acute otitis media was almost 4-fold increased in children who had tonsillopharyngitis in the last year (adjusted odds ratio =4.19; 95% confidence interval, 3.09-5.66). In logistic regression analysis , atopic disease was a strong determinant of all upper respiratory tract in fections. Low birth weight increased the risk of acute otitis media. Day ca re attendance and the presence of siblings, which were considered to be ind icators of exposure to respiratory pathogens, increased the risk of upper r espiratory tract infections. Conclusions: In preschool children, acute otitis media, tonsillopharyngitis , and common cold were quite.. common, while chronic rhinitis was less prev alent and strongly associated with atopic disease. Attendance at day care c enters increased the risk of upper respiratory tract infections in this age group, although the effect was weaker than that in younger children.