Early daycare attendance linked with greater childhood healthcare use

By Joanna Lyford, Senior medwireNews Reporter

Daycare attendance in the first year of life is a risk factor for earlier respiratory infections and is associated with greater use of healthcare services in childhood, study findings show.

The findings “emphasize the need for improved prevention strategies in daycare facilities to lower infection rates at the early ages”, say Marieke de Hoog (University Medical Center Utrecht, the Netherlands) and study co-authors writing in BMC Medicine.

The researchers used information on 1728 children who were participating in the Wheezing-Illnesses-STudy-LEidsche-Rijn (WHISTLER) birth cohort, a prospective study of perinatal and infant risk factors for wheezing illness.

In all, 1378 children attended daycare during their first year of life; these children tended to have more highly educated parents, were less likely to have an older sibling and were more likely to have been breastfed, compared with other children.

Overall, the incidences of upper respiratory tract infections (URTI) and acute otitis media (AOM) were highest in the first 2 years of life and declined thereafter.

Children who attended daycare before the age of 1 year had a significantly higher incidence rate of URTI and AOM at age 0 to 1 years compared with children who were cared for at home (100.4 vs 59.1 per 100 child–years), but a significantly lower incidence between the ages of 4 and 6 years (25.0 vs 41.7 per 100 child–years at age 4–5; 20.4 vs 41.6 per 100 child–years at age 5–6).

Thus, after adjusting for confounders, the average incidence of these infections over the first 6 years of life was similar irrespective of daycare attendance.

Over their first 6 years, however, children who attended daycare in their first year had 15% higher rates of general practitioner consultation and 43% higher rates of specialist referrals, relative to those cared for at home. Furthermore, antibiotic use was 32% higher in the subgroup of children who entered daycare aged between 6 and 12 months.

Indeed, the subgroup of children who started daycare aged 6 to 12 months had the highest overall rate of URTI, AOM, primary care consultations and specialist referrals.

Taken together, the study suggests that first-year daycare attendance influences the timing of infections rather than the overall number of infections a child experiences during childhood, say the researchers.

The findings also demonstrate that the increased use of healthcare resources for URTI and AOM in children attending daycare during early infancy is “persistent and not fully compensated by a lower use of healthcare resources during school age”, write de Hoog and colleagues.

They conclude: “Future studies are needed to determine which prevention strategies may be most effective, for example, reduction of daycare group size or determination of an optimal age of day care entry.”

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