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An 8-Year Population-Based Study

Sylvana M. Côté, PhD; Amélie Petitclerc, PhD; Marie-France Raynault, MD; Qian Xu, MSc; Bruno Falissard, PhD; Michel Boivin, PhD; Richard E. Tremblay, PhD

Arch Pediatr Adolesc Med. 2010;164(12):1132-1137. doi:10.1001/archpediatrics.2010.216

Objective  To determine whether the frequency of infections during the first 8 years of life varies according to age at initiation and type of group child care (GCC).

Design  Eight-year (1998-2006) prospective cohort study.

Setting  Families with a newborn living in Quebec in 1998.

Participants  A representative sample of families (n = 1238) selected through birth registries.

Main Exposure  Home care compared with small or large GCC during the early (ie, before 2 years old) or late (3-4 years old) preschool period.

Main Outcome Measures  Maternal reports of children's respiratory tract, ear, and gastrointestinal tract infections during the early preschool, late preschool, and early elementary school (5-8 years old) periods.

Results  Compared with children cared for at home, those who started large GCC in the early preschool period had higher rates of respiratory tract infections (incidence rate ratio [IRR], 1.61; 95% confidence interval [CI], 1.27-2.03) and ear infections (IRR, 1.62; 95% CI, 1.19-2.20) during that period but lower rates of respiratory tract infections (IRR, 0.79; 95% CI, 0.66-0.96) and ear infections (IRR, 0.57; 95% CI, 0.37-0.88) during the elementary school years.

Conclusions  Children contract infections around the time they initiate large structured group activities. Participation in large GCC before 2 years old, although associated with increased infections at that time, seems to protect against infections during the elementary school years. Physicians may reassure parents that infections during the first child care years do not lead to a higher overall burden of infections.

Author Affiliations: Department of Social and Preventive Medicine (Drs Côté and Raynault), Ste-Justine Hospital (Drs Côté and Tremblay and Ms Xu), and Department of Psychology (Dr Tremblay), University of Montreal, Montreal, Quebec, Canada; International Laboratory for Child and Adolescent Mental Health, University of Montreal and INSERM U669 (Drs Côté and Tremblay); Geary Institute (Dr Petitclerc) and School of Public Health and Population Sciences (Dr Tremblay), University College Dublin, Dublin, Ireland; INSERM U669, University Paris-Sud and Descartes, UMR SO669, Paris, France (Dr Falissard); and School of Psychology, Laval University, Quebec City, Quebec (Dr Boivin).

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