Day care attendance during the first 12 months of life and occurrence of infectious morbidities and symptoms

ObjectiveTo investigate the occurrence of infectious morbidities according to day care attendance during the first year of life.MethodsThis was a cross-sectional analysis of data from the 12-month follow-up of a medium-sized city birth cohort from children born in 2015, in the Southern Brazil. Main exposure variables were day care attendance from 0 to 11 months of age, type of day care center (public or private), and age at entering day care. Health outcomes were classified as follows: “non-specific respiratory symptoms,” “upper respiratory tract infection,” “lower respiratory tract infection,” “flu/cold,” “diarrhea,” or “no health problem,” considering the two weeks prior to the interview administered at 12 months of life. Associations were assessed using Poisson regression adjusted by demographic, behavioral, and socioeconomic variables.ResultsThe sample included 4018 children. Day care attendance was associated with all classifications of health outcomes mentioned above, except for flu/cold. These were stronger among children who entered day care at an age closer to the outcome time-point. An example are the results for lower respiratory tract infection and diarrhea, with adjusted prevalence ratios of 2.79 (95% CI: 1.67–4.64) and 2.04 (95% CI: 1.48–2.82), respectively, for those who entered day care after 8 months of age when compared with those who never attended day care.ConclusionsThe present study consistently demonstrated the association between day care attendance and higher occurrence of infectious morbidities and symptoms at 12 months of life. Hence, measures to prevent infectious diseases should give special attention to children attending day care centers.     

Daycare attendance and risk of first infectious disease

The health hazards of daycare attendance for the development of upper and lower respiratory tract infections have been well documented; however the importance and the mechanism of this association have not been well defined. In order to ascertain the risk associated with the beginning of daycare (DC) attendance we conducted a survey on 1263 children aged from 3 months to 3 years; the analysis focused on the risk of developing an initial episode of common cold with fever, a first otitis and a first wheezy bronchitis (WB) within the 2 month period following adminission to DC. For each 2 month period, the risk of a first infectious event was much higher in children who had just begun attending DC than in children who remained at home: the risk ratio varied from 1.7 to 2.4 for common cold, from 1.5 to 1.9 for otitis and from 1.8 to 3.2 for WB. Because age at onset of the first infectious event may be related to a higher risk of repeated events we consider that admission to DC under 12 months of age should be quesioned.     

Burden of otitis media and pneumonia in children up to 6 years of age: results of the LISA birth cohort

Infections play an important role in childhood. For Germany, few data are available on the epidemiology of infectious diseases such as otitis media and pneumonia in children. We therefore described the prevalence, first episode proportions and recurrence of these childhood infection diseases in selected regions of Germany in children up to 6 years of age. The analysis was based on data from the LISA Study, a prospective population-based birth cohort study including 3,097 full-term infants. Information was collected by parent questionnaire. The first episode proportions for the first 6 years of life were high for otitis media (66.7%; 95%CI 0.65–0.69) and pneumonia (13.5%; 95%CI 0.12–0.15). The annual first episode proportions for otitis media ranged from 7.3% to 25.6% and for pneumonia from 1.4% to 3.4%; both peaked during the second year. The average number of otitis media episodes was 2.2 (SD 2.0) episodes per child within the first 2 years. During the first 2 years of life, hospitalisations due to otitis and pneumonia occurred in up to 7.8‰ and 3.0‰ of the children, respectively. On average, 50.6% of the children with otitis media were treated with antibiotics during the first year of life. In conclusion, this analysis shows that infectious diseases, especially otitis media, are very frequent childhood diseases in Germany. Thus, parents and physicians should not per se worry about a high frequency of otitis media during early childhood.     

Value of pneumococcal vaccination in infants and young children]

Streptococcus pneumoniae is a common cause of meningitis, sepsis, pneumonia, acute otitis media, and sinusitis in children. Children younger than 24 months have the highest rates of invasive pneumococcal infections (Germany 1997-1999: 19.5/100,000/year). Pneumococcal infections cause in Germany 220-250 cases of meningitis, about 50,000 of pneumonia (children younger than 5 years) and more than 1 million cases of otitis media (children) annually. The case-fatality rate for invasive pneumococcal diseases is high (1997-1999 5.5%, meningitis 8.3%). 20-30% of survivors from meningitis suffer from CNS-related sequelea. In children up to 2 years vaccination with the heptavalent pneumococcal conjugate vaccine can reduce invasive pneumococcal diseases by about 80% and otitis media and recurrent otitis media by 6% and 9-16%, respectively. Due to the increased risk of pneumococcal infections in the first two years of live all children of this age group should be vaccinated. The high rate of resistance of pneumococci against macrolides in Germany, the high rate of non-licensed antibiotics in infants and the inefficacy of the 23-valent vaccine in children younger than 2 years makes the new vaccine to a necessary alternative.     

Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age

Infants and young children are prone to developing upper respiratory tract infections, which often result in bacterial complications such as acute otitis media and sinusitis. We evaluated 623 upper respiratory tract infection episodes in 112 children (6-35 months of age) to determine the proportion of upper respiratory tract infection episodes that result in acute otitis media or sinusitis. Of all upper respiratory tract infections, 30% were complicated by acute otitis media and 8% were complicated by sinusitis. The rate of acute otitis media after upper respiratory tract infection declined with increasing age, whereas the rate of sinusitis after upper respiratory tract infection peaked in the second year of life. Risk for acute otitis media may be reduced substantially by avoiding frequent exposure to respiratory viruses (eg, avoidance of day care attendance) in the first year of life.     

Day care attendance, respiratory tract illnesses, wheezing, asthma, and total serum IgE level in early childhood

BACKGROUND: It has been hypothesized that day care--related infections may explain the inverse relation between day care attendance in early life and asthma in childhood. OBJECTIVE: To examine the relation between day care attendance or respiratory tract illnesses in the first year of life and wheezing and asthma in the first 4 years of life among children with a parental history of atopy who were followed up from birth. RESULTS: Day care attendance in the first year of life was inversely associated with geometric mean total serum IgE level (12.9 [+/-1 SD = 3.3, 51.4] IU/mL for day care vs 18.5 [[+/-1 SD = 5.3, 64.7] IU/mL for no day care; P =.03) at 2 years of age but not significantly associated with wheezing at or after 2 years of age. Having at least 1 physician-diagnosed lower respiratory tract illness in the first year of life was significantly associated with recurrent wheezing (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.0-4.1) and asthma (OR, 2.5; 95% CI, 1.1-5.5) at 4 years of age, but not with any wheezing (infrequent and frequent) at 3 years or older. Illnesses of the upper respiratory tract (> or = 1 physician-diagnosed upper respiratory tract illness or > or = 3 episodes of nasal catarrh) in the first year of life were associated with any wheezing (frequent and infrequent) between the ages of 1 and 4 years, but not with recurrent wheezing or asthma at 4 years of age. CONCLUSIONS: Our results suggest that among children with a parental history of atopy the protective effect of day care attendance in early life against the development of atopy has begun by 2 years of age, and that a protective effect of day care attendance in early life against wheezing may not be observed until after 4 years of age.     

Day care and asthma morbidity

An association between attendance at day care centres and lower respiratory symptoms among pre-school asthmatic children who were attending follow-up appointments at a specialist respiratory outpatient clinic was studied. Parents of 69 children completed a questionnaire. Because of the variation in the age distribution of the two groups, analysis was restricted to children aged 2-4 years old; results from 49 children were analysed. Cough, wheeze at night and wheeze on waking occurred significantly more frequently in the two weeks prior to clinic visits among asthmatics attending day care. Among asthmatic children requiring specialist outpatient follow up, those attending day care are more likely to be troubled by lower respiratory symptoms than those looked after at home.     

Causes of fever in febrile seizures

The causes of pyrexia in 100 cases of febrile seizures were studied. The fever was due to a viral infection in 71 percent, primary complex in 15 percent, due to bronchopneumonia and lobar pneumonia in 8 per cent and 1 per cent cases were due to otitis media. No case of urinary tract infection, enteric fever or infective diarrhea was seen.     

Breastfeeding initiation or duration and longitudinal patterns of infections up to 2 years and skin rash and respiratory symptoms up to 8 years in the EDEN mother–child cohort

This paper aimed to examine the effect of breastfeeding on longitudinal patterns of common infections up to 2 years and respiratory symptoms up to 8 years. To assess the incidence and reoccurrence of infections and allergic symptoms in the first years of life among 1,603 children from the EDEN mother–child cohort, distinct longitudinal patterns of infectious diseases as well as skin rash and respiratory symptoms were identified by group‐based trajectory modelling. To characterize infections, we considered the parent‐reported number of cold/nasopharyngitis and diarrhoea from birth to 12 months and otitis and bronchitis/bronchiolitis from birth to 2 years. To characterize allergy‐related symptoms, we considered the parent‐reported occurrence of wheezing and skin rash from 8 months to 8 years and asthma from 2 to 8 years. Then associations between breastfeeding and these longitudinal patterns were assessed through adjusted multinomial logistic regression. Compared with never‐breastfed infants, ever‐breastfed infants were at a lower risk of diarrhoea events in early infancy as well as infrequent events of bronchitis/bronchiolitis throughout infancy. Only predominant breastfeeding duration was related to frequent events of bronchitis/bronchiolitis and infrequent events of otitis. We found no significant protective effect of breastfeeding on longitudinal patterns of cold/nasopharyngitis, skin rash, or respiratory symptoms. For an infant population with a short breastfeeding duration, on average, our study confirmed a protective effect of breastfeeding on diarrhoea events in early infancy, infrequent bronchitis/bronchiolitis and, to a lesser extent, infrequent otitis events up to 2 years but not on other infections, skin rash, or respiratory symptoms4.     

Middle ear effusion among children diagnosed and treated actively for acute otitis media

We assessed the point prevalence of middle ear effusion among day care children in an area where acute otitis media is diagnosed, treated and followed actively. Minitympanometry was used to screen 850 day care centre attendants aged 0.6 to 6.9 years (mean 3.7 years). Tympanometry was performed by two trained nurses at the day care centres and pneumatic otoscopy was done by a paediatrician when effusion was suspected. We found 60 (7.1%) children to have middle ear effusion, which was bilateral in 23 (2.7%) cases. Of the children with bilateral effusion 13 had respiratory symptoms fulfilling the criteria of acute otitis media, 8 of them had experienced acute otitis media during the past 3 weeks and were diagnosed to have otitis media with effusion, and only 2 (0.2%) were asymptomatic children not identified earlier. Of the 37 (4.4%) children with unilateral effusion, 14 had acute otitis media and 23 otitis media with effusion, of whom 12 children (1.4%) had not been identified earlier. The point prevalence of acute otitis media was 3.2% and that of otitis media with effusion 3.9%. Conclusion We conclude that active diagnosis and treatment of acute otitis media practically eliminates such middle ear effusion that could cause significant hearing impairment. Received: 10 November 1997 / Accepted: 31 January 1998     

Upper respiratory tract infections in young children: duration of and frequency of complications

This study was performed to determine the usual duration of community-acquired viral upper respiratory tract infections and the incidence of complications (otitis media/sinusitis) of these respiratory tract infections in infancy and early childhood. Children in various forms of child-care arrangements (home care, group care, and day care) were enrolled at birth and observed for 3 years. Families were telephoned every 2 weeks to record on a standardized form the type and severity of illnesses experienced during the previous interval. Only children remaining in their original child-care group for the entire study period were compared. The mean duration of an upper respiratory tract infection varied between 6.6 days (for 1- to 2-year-old children in home care) and 8.9 days (for children younger than 1 year in day care). The percentage of apparently simple upper respiratory tract infections that lasted more than 15 days ranged from 6.5% (for 1- to 3-year-old children in home care) to 13.1% (for 2- to 3-year-old children in day care). Children in day care were more likely than children in home care to have protracted respiratory symptoms. Of 2741 respiratory tract infections recorded for the 3-year period, 801 (29.2%) were complicated by otitis media. During the first 2 years of life, children in any type of day care were more likely than children in home care to have otitis media as a complication of upper respiratory tract infection. In year 3, the risk of otitis media was similar in all types of child care.     

Do we need to treat otitis media?

Otitis media is a common pediatric problem. It is well established that over half of infants and children with acute otitis media may have spontaneous recovery. Since it is difficult to predict the course (self-limited versus serious disease) all the children with acute suppurative otitis media need to be treated with antibiotics. Amoxicillin is still the initial antibiotic of choice. There are several alternate antibiotics available with activity against beta-lactamase positive bacteria. These agents have no advantage over amoxicillin in infections due to penicillin resistant pneumococci. Recent use of beta-lactam antibiotics and/or attendance in a day care where there is frequent use of antibiotics are predisposing factors for penicillin resistant pneumococcal infection. In such cases after tympanocentesis, higher dose of amoxicillin, clindamycin or intramuscular ceftriaxone should be considered. Secretory otitis media does not need to be treated with antibiotics unless the patient is in high risk group. Prophylactic use of antibiotics should be actively discouraged. Influenza and pneumococcal vaccination (2 years or older) should be encouraged in children with recurrent episodes of acute otitis media. Breast feeding should be encouraged.     

Upper respiratory tract infections

Acute respiratory infections accounts for 20–40% of outpatient and 12–35% of inpatient attendance in a general hospital. Upper respiratory tract infections including nasopharyngitis, pharyngitis, tonsillitis and otitis media constitute 87.5% of the total episodes of respiratory infections. The vast majority of acute upper respiratory tract infections are caused by viruses. Common cold is caused by viruses in most circumstances and does not require antimicrobial agent unless it is complicated by acute otitis media with effusion, tonsillitis, sinusitis, and lower respiratory tract infection. Sinusitis is commonly associated with common cold. Most instances of rhinosinusitis are viral and therefore, resolve spontaneously without antimicrobial therapy. The most common bacterial agents causing sinusitis areS. pneumoniae, H. influenzae, M. catarrhalis,S. aureus andS. pyogenes. Amoxycillin is antibacterial of choice. The alternative drugs are cefaclor or cephalexin. The latter becomes first line if sinusitis is recurrent or chronic. Acute pharyngitis is commonly caused by viruses and does not need antibiotics. About 15% of the episodes may be due to Group A beta hemolytic streptococcus (GABS). Early initiation of antibiotics in pharyngitis due to GABS can prevent complications such as acute rheumatic fever. The drug of choice is penicillin for 10–14 days. The alternative medications include oral cephalosporins (cefaclor, cephalexin), amoxicillin or macrolides.     

Swimming pool attendance, respiratory symptoms and infections in the first year of life

We evaluated the relationship between indoor and outdoor swimming pool attendance and respiratory symptoms and infections during the first year of life. A population-based mother–child cohort study was conducted in four Spanish areas (INMA project). Study subjects were recruited at pregnancy, followed to delivery and 14 months after birth. Information on swimming pool attendance and health manifestations during the first year of life was collected at 14 months: low respiratory tract infection (LRTI), persistent cough, wheezing, atopic eczema and otitis. Odds ratios and 95 % confidence interval (OR 95 %CI) were calculated by logistic regression adjusting for confounders. Among the 2,205 babies included, 37 % reported having LRTI, 37 % wheezing, 16 % persistent cough, 22 % atopic eczema, 33 % otitis and 50 % attended swimming pools during the first year of life. Around 40 % went to outdoor pools in summer with a median cumulative duration of 7.5 h/year, and 20 % attended indoor pools with a median cumulative duration of 18 h/year. Pool attendance differed by area, season of birth and sociodemographic characteristics, and was not associated with LRTI, wheezing, persistent cough, atopic eczema or otitis. Adjusted OR of wheezing and LRTI were, respectively, 1.06 (95 %CI, 0.88–1.28) and 1.09 (0.90–1.31) for babies attending vs. babies not attending pools. Stratification by type of swimming pool, cumulative duration or parental atopy did not modify the results. Conclusion: No association was detected between pool attendance and LRTI, wheezing, persistent cough, atopic eczema or otitis during the first year of life in Spain.     

Factors affecting the occurrence of acute otitis media during the first year of life

A regional birth cohort of 5,356 infants was enrolled into a follow-up study in order to investigate the determinants of the development of infectious diseases in children. The infants were examined at three months, six months and twelve months of age by the physicians at the well-baby clinics. At these occasions the number of episodes of acute otitis media in the infants, the duration of breast-feeding, the number of siblings, the type of day care, parental smoking, the presence of animal pets at home and the number and type of other illnesses than otitis were registered. Two thirds of the infants had no episodes of acute otitis media. The median age for the first episode of acute otitis media was eight months. About 10% of the infants had experienced recurrent otitis media (three episodes or more) during their first year of life. Significant associations were found between the occurrence of acute otitis media and the number of siblings, the type of day care, the sex of the infant, the duration of breast feeding, maternal socioeconomic status and prematurity.     

Factors Affecting the Occurrence of Acute Otitis Media during the First Year of Life

ABSTRACT. A regional birth cohort of 5356 infants was enrolled into a follow-up study in order to investigate the determinants of the development of infectious diseases in children. The infants were examined at three months, six months and twelve months of age by the physicians at the well-baby clinics. At these occasions the number of episodes of acute otitis media in the infants, the duration of breast-feeding, the number of siblings, the type of day care, parental smoking, the presence of animal pets at home and the number and type of other illnesses than otitis were registered. Two thirds of the infants had no episodes of acute otitis media. The median age for the first episode of acute otitis media was eight months. About 10% of the infants had experienced recurrent otitis media (three episodes or more) during their first year of life. Significant associations were found between the occurrence of acute otitis media and the number of siblings, the type of day care, the sex of the infant, the duration of breast feeding, maternal socioeconomic status and prematurity.     

Infantile diarrhoea: breast and bottle feeding compared with special reference to their clinical role

This study compared the clinical features of diarrhea in breastfed and bottle-fed infants in Indonesia. Study subjects included 375 infants (221 breastfed, 88 bottle-fed, and 66 fed by a combined method) under 2 years of age admitted to Gunung Wenang Hospital with diarrhea. Both the duration of diarrhea and the prevalence of prolonged diarrhea were significantly greater in bottle-fed than breastfed infants. Diarrhea persisted for 8-14 days among 17% of breastfed infants, 28% of bottle-fed infants, and 35% of infants fed by a combined method. The mean duration of diarrhea was 5.5 days among breastfed infants compared with 7.2 days among bottle-fed infants. Also noted was a significantly greater incidence of acute otitis media and rhinopharyngitis among bottle-fed infants. The prevalence rates of pneumonia, bronchitis, encephalitis, and pyelonephritis were not associated with type of infant feeding. It is suggested that acute infantile diarrhea may damage intestinal mucosa, causing an increase of foreign protein of cow's milk absorption and leading to the development of further intestinal mucosal damage and prolonged diarrhea. During episodes of diarrhea in bottle-fed infants, it is advisable to substitute low allergic milk or chicken meat porridge to avoid cow's milk intolerance.     

Clinical and laboratory findings in children with adenovirus infections

The hospital records of 49 children with adenovirus infection were reviewed. Diagnosis was made by virus isolation from the airways in 73%, the stools in 44%, the conjunctiva in 2% and by serology in 14% of the patients. Most children were less than 3 years of age. The peak indidence of virus isolation occurred during the month of April. Pharyngotonsillitis was the most frequent main diagnosis (49%), followed by pneumonia (14%), gastroenteritis (10%) and bronchitis (8%). Fever was the most frequent main symptom (43%), and 96% of the patients had fever at some time during the illness. The average fever temperature was 39.6°C with a mean duration of 5.9 days. An obvious bacterial superinfection could be demonstrated in three patients: two had otitis media and one had pneumonia with pleural effusion. All three had more than 3 band forms per 100 peripheral white blood cells, whereas only 1 out of 46 children without demonstrable superinfection had an elevated band count. Other laboratory tests were not useful in detecting bacterial superinfection. That 71% of all children received antibiotics at some time during their illness, reflects the difficulty of excluding bacterial disease.     

Impact of recurrent otitis media on middle ear function, hearing, and language

Whether recurrent otitis media in infants and young children is followed by delayed language development was addressed by following 210 normal subjects longitudinally through the first 2 years of life with pneumatic otoscopy and tympanometry performed at every physician encounter. Otitis accounted for 26% of the medical visits. One hundred fifty-six of these children had speech and hearing evaluation at 2 years of age. Thirty percent of the children with recurrent otitis media had a mild or moderate hearing loss. However, after multiple speech and language tests, we could not identify a delay in language acquisition in the otitis-prone children. At 3 to 4 years old, 36 children, including nine with a hearing loss at 2 years of age, were retested; all nine had normal hearing. Recurrent otitis media induced a temporary decrease in hearing sensitivity demonstrable at 2 years of age, which appeared to resolve as the children matured and which was not associated with delay in language acquisition.