Preschool Child Care Not Linked to More Infections in Elementary School

Emma Hitt, PhD

December 07, 2010

December 7, 2010 — Entering a child into child care during the preschool years is associated with increased infections in the short term, but then may protect against infections during the elementary school years, according to the findings of a long-term prospective study.

Sylvana M. Côté, from the Ste-Justine Hospital, in Montreal, Quebec, Canada, and colleagues reported their findings in the December issue of the Archives of Pediatric and Adolescent Medicine.

According to the researchers, preschool children in group child care are known to have a higher rate of infections than children cared for at home, but "few studies have examined the impact of group childcare on infections beyond the preschool years." They add that "there is evidence for the common cold that longer [group childcare] attendance provides greater long-term immunity."

To examine the short- and long-term risks for infections associated with group child care attendance, Dr. Côté and colleagues conducted an 8-year prospective study from 1998 to 2006 in 1238 families residing in Quebec that had a newborn in 1998. Participants were followed-up for entry of the newborn into small- or large-group childcare before the age of 2.5 years, considered "early," or between the ages of 3.5 and 4.5 years, considered "late."

Maternal reports of infections, including gastrointestinal, ear, and respiratory tract, were documented until the child reached the age of 8 years.

Compared with children who did not attend child care, those starting large-group child care in the early preschool period had about a 60% higher rate of respiratory tract infections (incidence rate ratio [IRR], 1.61; 95% confidence interval [CI], 1.27 - 2.03) and ear infections (IRR, 1.62; 95% CI, 1.19 - 2.20).

In contrast, during the elementary school years of ages 5 to 8 years, these children had a lower rate of respiratory tract infections (IRR, 0.79; 95% CI, 0.66 - 0.96) and ear infections (IRR, 0.57; 95% CI, 0.37 - 0.88) compared with those who had been cared for at home.

Group child care was not associated with an increased risk for gastrointestinal infections at any time.

"To our knowledge, this is the first prospective population-based study to examine the associations between different [group childcare] experiences and 3 different types of serious infections, throughout preschool and up to mid-elementary school," the authors note.

"This study provides reassuring evidence for parents that their choices regarding child care...should not have a major effect on the health of their children from a long-term perspective," the authors conclude.

"Physicians may reassure parents whose children initiate large [group childcare] early that their child's experiencing infections is temporary and is likely to provide them with greater immunity during the elementary school years," they add.

The study was supported by the Government of Quebec, The Fondation Chagnon, the Fond Québécois de la Recherche sur la Société et la Culture, the Fonds pour la Recherche en Santé du Quebec, the Social Science and Humanities Research Council of Canada, the Canadian Institutes for Health Research, Ste-Justine Hospital’s Research Center, and the University of Montreal. The authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2010;164:1132-1137.

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