Care of the Ill Child in Day-Care Settings

Abstract

Children experience many minor illnesses during the toddler and preschool years, and illness frequency is compounded by attendance in out-of-home child care programs. Although most of these illnesses are uncomplicated, some lead to complications that require medical evaluation and treatment. A majority of working parents of childbearing age have children in day care, and these illnesses have an impact on both the child's health and the parents' attendance at work. As a result, in-home and out-of-home sick-child care programs have emerged. The common infectious diseases of children in child day care are also common among children not in out-of-home care. They can be identified as those primarily affecting the respiratory system, gastrointestinal system, and skin and those that may affect multiple organs. Respiratory infections predominate, followed by vomiting and diarrheal illnesses. Wald et al1 followed a cohort of children through the first 3 years of life; 97 received exclusive care at home, 23 received care in a group setting out of the home, and 33 attended day-care centers. During the first year of care, children in center care experienced significantly more infections than children in home care. Children in group care and center care were significantly more likely than children in home care to experience six or more infections and four or more severe illnesses. The majority (76% to 89%) of infections were respiratory, and otitis media complicated 28% to 44% of these respiratory infections.2 Children in nonparental home care experienced an average of 41 days of illness during the year; the average increased to 78 days in group care, and 96 days in center care.