PEDIATRICS Vol. 104 No. 3 September 1999, pp. 495-500

Day Care Attendance in the First Year of Life and Illnesses of the Upper and Lower Respiratory Tract in Children With a Familial History of Atopy

Received Sep 16, 1998; accepted Apr 1, 1999.

Juan C. Celedon^{*, §}, Augusto A. Litonjua^{*, , §}, Scott T. Weiss^{*, , §}, and Diane R. Gold^{*, , §}

From the ^* Channing Laboratory and Department of Medicine, Brigham and Women's Hospital;  Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Hospital; and ^§ Harvard Medical School, Boston, Massachusetts.

Objective.  To examine the relationship between day care attendance and illnesses of the upper and lower respiratory tract in the first year of life.

Study Design.  Prospective birth cohort study.

Methods.  Children (N = 498) who had at least 1 parent with a history of allergy or asthma were enrolled at birth and followed prospectively for the first year of life. A home visit at 2 to 3 months of age and bimonthly telephone questionnaires were used to obtain information on day care arrangements, home characteristics, respiratory symptoms, and physician-diagnosed illnesses of the upper and lower respiratory tract.

Results.  Day care attendance in the first year of life was associated with two or more doctor-diagnosed ear infections (OR: 2.4; 95% CI: 1.7-3.6), three or more parental reports of runny or stuffed nose (OR: 3.2; 95% CI: 1.9-5.5), a doctor's diagnosis of sinusitis (OR: 2.2; 95% CI: 1.1-4.2), and doctor-diagnosed lower respiratory illnesses (croup, bronchitis, bronchiolitis, and pneumonia; OR: 1.6; 95% CI: 1.0-2.4). For children attending day care, exposure to pets in day care, the presence of a rug or carpet in the area where the child slept in day care, and a nonresidential setting for day care all were independent predictors of two or more doctor-diagnosed ear infections.

Conclusions.  The results suggest that day care increases the risk of illnesses of the upper and lower respiratory tract in the first year of life for children with a familial history of atopy. Specific environmental exposures within day care, such as the presence of pets or having a rug or carpet in the area where children sleep, may increase the risk of recurrent ear infections in the first year of life among children with familial history of atopy who attend day care.  Key words:  day care, children, respiratory illness, atopy, ear infections.

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