1 From Case Western Reserve University, School of Medicine, Cleveland, Ohio
At least 8.2 million children younger than the age of 4 years have working mothers.1 More than half of these infants and children receive out-of-home care: approximately 23% attend day-care centers, 37% are in "family day care," 8% are cared for by the mother herself at work, and the remainder are cared for at home by a relative or sitter.1 Illness is a significant and frequent problem for children of parents working out of the home. We know that respiratory illnesses are the most common acute illness among children in the United States,2 and a recent study found that for children younger than the age of 3, the prevalence of medicated respiratory tract infections is lowest in children cared for in their own homes, higher in those receiving "family day care," and highest in those attending child-care centers.3 Children in day-care centers are additionally at greater risk of several other infectious diseases.4-6 The Bureau of National Affairs concluded that on any given day more than 359 000 children younger than the age of 14 with both parents working are too ill to attend school or day care.7 Who is caring for these sick children? Several recent reviews have examined this question in detail.8,9
A variety of patterns of care for sick children of parents working outside the home have evolved. These can be grouped by type of provider and by location of care. Possible care givers include (1) a parent, (2) a familiar care giver who is not the parent, or (3) a trained but unfamiliar health worker.
Submitted on February 22, 1990