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Day-care center attendance and hospitalization for lower respiratory tract illness
L J Anderson1, R A Parker, R A Strikas
1Division of Viral Diseases, Centers for Disease Control, Atlanta, GA 30333.
Insights
For children under 2, attending large day-care centers increases the risk of lower respiratory tract illness. Smaller day-care homes may offer a safer alternative, reducing exposure to infectious diseases.
Area of Science:
- Pediatrics
- Epidemiology
- Infectious Diseases
Background:
- Acute lower respiratory tract illness (LRTI) is a common cause of hospitalization in young children.
- Identifying risk factors is crucial for prevention and management strategies.
Purpose of the Study:
- To identify risk factors associated with hospitalization for acute lower respiratory tract illness in children under 2 years of age.
- To compare risk factors between day-care centers and day-care homes.
Main Methods:
- A case-control study involving 102 hospitalized children with LRTI and 199 matched controls.
- Telephone interviews collected data on demographics, childcare, medical history, and household factors.
- Univariate and multiple logistic regression analyses were used to identify significant risk factors.
Main Results:
- Five factors were significantly associated with LRTI hospitalization: overcrowding in sleeping quarters, lack of immunization, prematurity, allergy history, and attendance at large day-care centers (more than six children).
- Attendance at smaller day-care homes (less than or equal to six children) was not associated with increased LRTI risk.
- Respiratory syncytial virus was the most common causative agent, followed by other viruses, Haemophilus influenzae, and Streptococcus pneumoniae.
Conclusions:
- Care outside the home, particularly in large day-care centers, is a significant risk factor for LRTI and other infectious diseases in children under 2.
- Utilizing smaller day-care homes may reduce the risk of infectious illness compared to larger day-care centers.
Abstract:
To identify risk factors associated with hospitalization for acute lower respiratory tract illness, 102 children less than 2 years of age admitted to four Atlanta metropolitan area hospitals between December 1984 and June 1985 with the diagnosis of lower respiratory tract illness were studied. The most common causative agent associated with illness was respiratory syncytial virus, followed by other respiratory viruses, Haemophilus influenzae, and Streptococcus pneumoniae. The 102 case-patients were compared with 199 age- and sex-matched controls. A parent or guardian for each patient and control was interviewed by telephone regarding demographic data, care outside the home, breast-feeding, previous medical history, allergies, and smoking and illness in household members. Five factors were associated with lower respiratory tract illness in both a univariate analysis and a multiple logistic regression model (P less than .05). These factors were the number of people sleeping in the same room with the child, a lack of immunization the month before the patient was hospitalized, prematurity, a history of allergy, and regular attendance in a day-care center (more than six children in attendance). Care received outside of the home in a day-care home (less than or equal to six children in attendance) was not associated with lower respiratory tract illness. The suggestion made by our study and other studies was that for children less than 2 years of age, care outside of the home is an important risk factor for acquiring lower respiratory tract illness, as well as other infectious diseases, and that this risk can be reduced by using a day-care home instead of a day-care center.