[Influence of out-of-home day care on the incidence of infectious processes in 0-3-year-olds].

Introduction: A number of studies have shown that out-of-home day care in very young children increases the incidence of infectious processes in comparison with that in children cared for in a family environment. The aim of this study was to assess the influence of the type of childcare (family environment vs. collective care) and the age at which schooling begins on morbidity due to infectious processes and to determine the repercussions on the health system (frequency of visits and antibiotic consumption).
Patients and Methods: The study population was composed of a cohort of children born between 1st January 2001 and 31st December 2003, drawn from five pediatric clinics. Infectious processes and health service use were recorded prospectively by the pediatrician over the 10 months of the study. The mean number and incidence of infectious processes in children attending day care and those cared for at home were compared.
Results: A total of 764 children were studied, of which 47% attended day care centers. Compared with children cared for at home, children attending day care had a significantly higher mean number of infectious episodes (6.7 vs. 4.1), antibiotic use (1.3 vs. 0.4), visits to the pediatrician (10.3 vs. 6.3) and hospital emergency visits (0.6 vs. 0.4) (p<0.0001). For each age group, the greatest difference between children in day care and those kept at home was found in the first year of schooling. This difference was largest in the youngest age group (RR=2.3).
Conclusions: If parents request advice, pediatricians should inform them of the increase in infectious morbidity that children can be predicted to experience during the first year of schooling.