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Ralph L. Cordell, PhD; Stephen H. Waterman, MD; Albert Chang, MD, MPH; Mitchell Saruwatari, MPH; Monica Brown, MPH; Stephen L. Solomon, MD

Arch Pediatr Adolesc Med. 1999;153:275-280.

Purpose  To compare the incidence of provider-reported illness and absence due to illness among children attending small child-care homes, large child-care homes, and child care centers in a large metropolitan area.

Methods  From July 6, 1992, through January 28, 1994, we collected information from child-care providers on illness and absence due to illness at 64 small and 58 large child-care homes and 41 child-care centers. This included 113,446 child-weeks of information on 5360 children.

Results  Providers reported 14,474 illness episodes (6.6 episodes per child-year) and 8593 days of absence due to illness (3.9 days per child-year). The incidence of illness episodes was greatest in children who were younger than 1 year, white, or enrolled in small child-care homes. The incidence of absence due to illness was greatest in children who were 1 year of age, Hispanic, or enrolled in child-care centers. Respiratory symptoms were most commonly associated with illness episodes and absence due to illness.

Conclusions  Children in child-care homes had a greater incidence of provider-reported illness than did those in centers. This risk varied by the type of facility and was greatest in small child-care homes. The increased risk for absence due to illness among children in child-care centers reflects exclusion and attendance patterns. It may be possible to reduce the incidence of absence due to illness and subsequent economic impact of child-care–associated illness by educating providers on exclusion guidelines.

From the Special Studies Activity, Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Cordell and Solomon); and the San Diego County Department of Health Services (Dr Waterman, Mr Saruwatari, and Ms Brown) and the Graduate School of Public Health, San Diego State University (Dr Chang), San Diego, Calif. Dr Waterman is now affiliated with the California Department of Health, Berkeley; Mr Saruwatari, the Los Angeles County Emergency Management Services, Commerce, Calif; and Ms Brown, the Center for Healthier Communities for Children, San Diego.

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