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PEDIATRICS Vol. 106 No. 5 November 2000, pp. 1013-1016
From the * Center for Statistical Consultation and Research,
University of Michigan, Ann Arbor, Michigan; and Department of
Epidemiology, University of Michigan School of Public Health, Ann
Arbor, Michigan.
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ABSTRACT |
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Abstract
Methods
Results
Discussion
Conclusion
References
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Objectives. Children receiving child care outside the home are at greater risk of upper respiratory infection, but whether parents of those children are also at increased risk is undocumented. We describe the incidence of 2 or more respiratory symptoms in the previous 2 weeks among 185 mothers of children 3 years of age or younger by child care use.
Methods. Mothers in Michigan and Nebraska were interviewed by phone regarding respiratory symptoms, use of outside child care (for an index child), sleeping habits, and demographic information.
Results. Nearly one half (46.5%) reported 2 or more symptoms during the past 2 weeks; 15.1% had contacted a health care provider and 13.0% spent 1 or more days in bed because of their symptoms, which lasted an average of 5.5 days. Prevalence of symptoms was invariant to sociodemographic characteristics. Mothers using outside child care (74.6%) were twice as likely as those without outside care to have been ill in the past 2 weeks (odds ratio: 2.26; 95% confidence interval [CI]: 1.12,4.54). Most mothers (69.2%) reported having their sleep interrupted by their children at least once in the last 2 weeks or sharing a bed with a child part or all of the night (61.1%); 25.4% slept 6 hours or less nightly. Women reporting that they rarely or never felt rested (26.5%) were 2.65 times more likely to be ill (95% CI: 1.26,5.55), compared with those reporting that they frequently or always felt rested (46.5%), after adjusting for any outside child care.
Conclusions. Future studies should focus on risk factors that can be modified to reduce illness among both children and their parents. Key words: respiratory symptoms, mothers, toddlers, day care, sleeping habits, survey.
More than one half of mothers of children 5 years of age or
younger (60%) work part- or full-time.1 They work a
second shift at home and often have their sleep interrupted to care for
their children. Parents miss an average of 4.2 work days annually to
care for sick children.2 Children attending day care,
compared with those cared for at home, are more likely to develop
otitis media and other respiratory infections.3-5 In
addition, child care has been identified as the source of several
outbreaks of diseases spread by fecal-oral or respiratory transmission, including meningitis. In one experiment, Jiang et al6 demonstrated pathogen transmission from a child care
center to the child's home using DNA markers. With increasing numbers
of mothers in the workforce,7 children are more likely to
attend day care or preschool, which may adversely affect the entire
family's health.
To the best of our knowledge, whether parents of children in day care
in fact have more upper respiratory infections has not been documented.
We describe the frequency of upper respiratory symptoms and sleep
habits among 185 mothers of young children. As anticipated, mothers
often experience upper respiratory symptoms and are frequently sleep
deprived.
Study Protocol and Questionnaire
As part of data validation of a larger study on breastfeeding
practices and lactation mastitis, 222 mothers of children younger than
3 years of age were selected for a follow-up telephone interview. To
the best of our knowledge, selection was independent of risk factors
for upper respiratory illness, number of children in the household, and
other variables under study. Of those selected, 34 women could not be
relocated. Before being contacted by telephone, mothers received a
notification letter and a small incentive. Three women refused, for a
response rate of 98%. All 185 participating women completed the
computer-assisted telephone interview. Interviews took place primarily
from January 16, 1998 through March 16, 1998, although 5 interviews
took place on December 19 and 20, 1997. Questionnaire items asked about
respiratory symptoms, sleeping habits, and day care use during the
previous 2 weeks in addition to sociodemographic information. Questions
regarding the use of day care related only to the index child involved
in the larger study; this information was not obtained for other
children in the home.
Statistical Analyses
We describe the frequency of respiratory symptoms and potential
risk factors using simple descriptive statistics. To assess relationships with 2 or more respiratory symptoms, we calculated odds
ratios (ORs) and 95% confidence intervals (CIs) using logistic regression. SPSS, Version 8.0 (SPSS, Cary, NC)
was used for all analyses.8
Study Population
Eighty-three women from Omaha, Nebraska, and 102 women from the
greater Detroit area in Michigan participated in the study. Participating mothers were primarily white (95.1%), typically married
(95.6%), and usually had some college education (76.6%; Table
1). Most (72.8%) had other children in
the household. The median household income was ~$50 000 per year.
TABLE 1
METHODS
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Abstract
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Results
Discussion
Conclusion
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RESULTS
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Methods
Results
Discussion
Conclusion
References
Demographic Characteristics of 185 Mothers of Children 3 Years of Age
or Younger, and Prevalence of 2 or More Respiratory Symptoms During the
Previous 2 Weeks by
Characteristic
Mothers were asked about the presence or absence of 8 respiratory symptoms (described below) during the previous 2 weeks. Most women (61.6%) had at least 1 respiratory symptom, while nearly one half (46.5%) had 2 or more. Symptoms lasted an average of 5.5 days (standard deviation: 4.1). The most common symptom was a runny nose (38.9%), followed by a stuffy head (37.3%), cough (33.0%), and sinus pain (31.9%). Other symptoms included itchy eyes (17.8%), wheezing (10.8%), fever (10.8%), and earache (8.6%). Women were asked: "Were your symptoms caused by allergies or hay fever?" Symptoms were attributed to hay fever approximately one fourth (28.4%) of the time. Among the 114 mothers with at least 1 symptom, 21.1% spent at least 1 day in bed, 41.2% purchased some medication, and 24.6% contacted a health care provider. Of those contacting a provider, 75.0% were prescribed medication; 57.1% were prescribed an antibiotic.
Incidence of 2 or more recent respiratory symptoms was unrelated to study site, education, household income, number of children in the household, and age of the youngest child (Table 1). When we considered symptoms attributed to or other than hay fever separately, there was still no association. We had too few unmarried and nonwhite women to assess differences in prevalence by marital status or ethnicity.
One quarter (25.4%) of mothers had slept 6 hours or less on a typical night in the previous 2 weeks (Table 2). A similar proportion (26.5%) reported that they never or rarely felt rested when awakening. Most (69.2%) reported that their sleep had been interrupted to tend to a child at least once in the previous 2 weeks. More than one third of mothers (37.3%) reported sharing their bed on 4 or more days; 16.2% reported sharing their bed with a child every night in the last 14 days.
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Three quarters of mothers (74.6%) used some form of day care in the previous 2 weeks (Table 2), with close to one third (31.9%) using multiple facilities for such care. When outside care was used, in nearly all cases (92.1%), there were other children present; approximately one fifth of the time (19.7%), more than 10 other children were present. The majority of children cared for outside the home (61.3%) were in day care an average of 8 hours or longer per day.
Mothers with children in outside child care, compared with those caring for children at home, were 2.26 (95% CI: 1.12,4.54) times more likely to have suffered 2 or more respiratory symptoms in the past 2 weeks (Table 2). The estimated increase in the odds of 2 or more respiratory symptoms was fairly consistent across type of child care facility and number of other children present. There was only a slight increase in mothers' respiratory symptoms with increasing hours of outside child care. The association between outside care and mothers' respiratory symptoms existed regardless of whether respondents attributed their symptoms to hay fever (symptoms attributed to hay fever, OR: 2.68; 95% CI: .76,9.42; symptoms not attributed to hay fever, OR: 1.59; 95% CI: .76,3.35).
Lack of adequate sleep, measured subjectively by asking mothers how often they felt rested on awakening, seemed to increase the likelihood of 2 or more respiratory symptoms. Those reporting that they sometimes felt rested were 2.22 times more likely (OR: 2.22; 95% CI: 1.07,4.58) to have been ill in the previous 2 weeks, compared with those reporting they frequently or always felt rested. Mothers who never or rarely felt rested were 2.65 times more likely to report 2 or more respiratory symptoms (OR: 2.65; 95% CI: 1.26,5.55).
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DISCUSSION |
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In 1997, there were 19.3 million households with work-related child care needs in the United States.1 Our study suggests that, regardless of sociodemographic characteristics, mothers of young children frequently have respiratory symptoms, and that those with children in day care are even more likely to have symptoms. Furthermore, the illness is often severe enough to warrant consulting a health care provider, purchasing medication, and staying in bed. One quarter of those with symptoms consulted a health care provider, nearly twice as many as reported in a study of the general population of adults with respiratory symptoms in Ontario (14%).9 Children attending larger, compared with smaller, child care facilities are reported to have more illnesses,10 but we found little difference in the prevalence of mothers' symptoms by day care type or size.
The incidence of respiratory symptoms in the previous 2 weeks in our sample suggests that mothers of young children have an increased incidence of colds and acute ear infections, compared with all American women of childbearing age. Based on the 1995 National Health Interview Survey (NHIS),11 the incidence of respiratory conditions among women 18 to 44 years of age was 90.9 episodes per 100 women per year. Assuming a 6-month cold season, we estimate a national incidence of as many as 7.0 episodes per 100 women every 2 weeks. In our sample a similar rate was 4 times as high: 32.4% of mothers reported 2 or more respiratory symptoms in the past 2 weeks that they did not attribute to hay fever. Using the same NHIS data and assuming ear infections occur in only 6 months of the year, we estimate at most .3 acute ear infections per 100 women every 2 weeks. Among our respondents, 8 times as many (2.4%) had earache, fever, and contacted a health care provider within the previous 2 weeks.
Sleep deprivation increases reaction time and impairs psychomotor performance.12,13 Immune function may also be suppressed by lack of sleep.14,15 Mothers of young children seem particularly at risk: the majority of our participants believed that they never, rarely, or only sometimes felt rested when awakening during the previous 2 weeks, and most had their sleep interrupted during the previous 2 weeks by their children.
Respiratory symptoms were measured subjectively by self-report. Over one quarter of mothers (28.4%) attributed their symptoms to hay fever, although the vast majority of interviews took place during December, January, and February, when airborne pollen levels would be expected to be low. Furthermore, the observed associations with day care use and sleeping habits were similar for symptoms attributed to hay fever and symptoms not attributed to hay fever. It seems unlikely that hay fever would be associated with day care use.
Some misclassification of the effects of child's day care on mothers' health might have occurred because we do not have information on the child care arrangements of all children in the household. When we limited the analysis to the 50 women with only 1 child in the household, the OR for 2 or more respiratory symptoms associated with outside child care increased to 3.47 (95% CI: .75,15.92), compared with the 2.26 (95% CI: 1.12,4.54) observed overall. We still observe an association among mothers with multiple children in the household, but the increase is smaller: OR = 2.05 (95% CI: .91,4.60). Women with multiple children may have a lower risk of recent symptoms because past exposures may have increased their immunity to antigenic variants in circulation. Although our sample of breastfeeding mothers is not representative of the general population, the relationships observed here are biologically plausible and probably more broadly generalizable.
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CONCLUSION |
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Our findings highlight the physical toll on mothers that
comes with raising young children, both through reduced sleep and increased incidence of respiratory symptoms. In addition to child care
use, factors we did not measure
including hygiene practices of
parents, children, and day care providersare probably important predictors of mothers' respiratory symptoms. Future studies should focus on risk factors that can be modified to reduce illness among both
children and their parents.
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ACKNOWLEDGMENTS |
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This work was supported by Grant HD30866 (to B.F.) from the National Institutes of Health.
Telephone surveys were conducted by the Institute for Social Research, University of Michigan.
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FOOTNOTES |
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Received for publication Dec 21, 1999; accepted Mar 20, 2000.
Reprint requests to (B.F.) Department of Epidemiology, 109 Observatory St, Ann Arbor, MI 48109-2029. E-mail: bfoxman{at}umich.edu
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ABBREVIATIONS |
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OR, odds ratio; CI, confidence interval; NHIS, National Health Interview Survey.
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This article has been cited by other articles:
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  B. Foxman, H. D'Arcy, B. Gillespie, J. K. Bobo, and K. Schwartz Lactation Mastitis: Occurrence and Medical Management among 946 Breastfeeding Women in the United States Am. J. Epidemiol., January 15, 2002; 155(2): 103 - 114. [Abstract] [Full Text] [PDF]
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