Attending Child Care Centers Research Articles

Obesity Determinants in Mexican Preschool Children: Parental Perceptions and Practices Related to Feeding and Physical Activity

Obesity represents a major public health problem worldwide. In Mexico, overweight and obesity have increased dramatically, affecting 26% of school-aged children. The aim of this study was to explore perceptions and practices of key obesity determinants among parents of preschool children attending child care centers. We conducted five focus groups with 38 parents from six Mexico City child care centers. Inquiry topics were 1) childhood obesity causes and consequences; 2) child feeding practices at the child care center and home; 3) healthful and unhealthful foods for young children; 4) significance of physical activity in childhood; and 5) physical activity-promoting factors and barriers. We analyzed these data using content analysis. We identified a number of barriers to healthful eating, including parental time constraints, permissive feeding styles, unhealthful food preparation practices, lack of knowledge about nutrition, food advertisement, and high availability of unhealthful foods in public places. Facilitators to healthful eating included recognition of childhood overweight prevention and consequences, and healthy food choices. Main barriers to childhood physical activity included influence of young family members to play video games, parental time constraints, street safety, low access to sports facilities, and insufficient communication with child care centers. Understanding parental views and perceptions of the main factors influencing preschoolers' weight-related behavior can inform home-based or environmental interventions that support healthful eating and regular physical activity.

Community resilience, quality childcare, and preschoolers’ mental health: A three-city comparison

Many studies suggest that quality childcare can positively influence children’s outcomes in a wide range of domains, including mental health. While an extensive literature on the effects of childcare on individual children exists, how quality childcare programs contribute to trends at the population-level is yet to be established. In this study, we examine community differences in the quality of childcare and the mental health of children attending childcare centres in three communities in British Columbia, Canada. Previous research on Kindergarten children conducted in these communities indicated that two exhibited expected outcomes (based on socioeconomic criteria, these communities were classified as “better off” and “worse off”), and one exhibited better than expected outcomes and was therefore labeled “resilient.” We hypothesized that the better than expected child outcomes in the resilient community were due to better quality childcare in this community. To test this hypothesis, we assessed 621 children and their 24 respective childcare centres, and conducted extensive observations of the three study communities. As expected, teachers (but not parents) from the resilient community reported fewer children’s mental health problems and childcare quality was found to be higher in the resilient community than in the comparison communities. However, city differences were lost in the hierarchical linear regressions suggesting that the community effects were mediated through childcare quality. To interpret these findings we turned to our observations that indicated that the resilient community was markedly different from the other two in terms of the social capital and developmental assets that it possessed.

Prevalence and Risk Factor Analysis for Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Children Attending Child Care Centers

Children attending child care centers (CCCs) are at increased risk for infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA). Nasal colonization often precedes infection, and MRSA colonization has been associated with increased infection risk. Community-associated MRSA (CA-MRSA) has caused increased MRSA infections in the general population, including children. Little is known about the frequency of MRSA nasal colonization in young children, particularly in those attending CCCs where disease transmission is common. We sampled the nares of 1,163 children in 200 classrooms from 24 CCCs in North Carolina and Virginia to assess S. aureus colonization. MRSA strains were molecularly analyzed for staphylococcal cassette chromosome mec (SCCmec) type, Panton-Valentine leukocidin status, and multilocus sequence type. A case-control study was performed to identify risk factors for MRSA colonization. We found that 18.1% children were colonized with S. aureus and 1.3% with MRSA. Molecular analysis of the MRSA strains identified 47% as CA-MRSA and 53% as health care-associated MRSA (HA-MRSA). Although two centers had multiple children colonized with MRSA, genotyping indicated that no transmission had occurred within classrooms. The case-control study did not detect statistically significant risk factors for MRSA colonization. However, MRSA-colonized children were more likely to be nonwhite and to have increased exposure to antibiotics and skin infections in the home. Both CA-MRSA and HA-MRSA strains were found colonizing the nares of children attending CCCs. The low frequency of colonization observed highlights the need for a large multicenter study to determine risk factors for MRSA colonization and subsequent infection in this highly susceptible population.

Haemophilus influenzae type b carriage in Indigenous children and children attending childcare centers in the Northern Territory, Australia, spanning pre- and post-vaccine eras

This paper investigates Haemophilus influenzae type b (Hib) carriage in Indigenous children and children attending childcare centres in the Northern Territory of Australia, 1992–2005. More than 10 years after the introduction of the Hib conjugate vaccine, Hib carriage persists in Indigenous children (3.4%, 2003–2005) and children attending childcare centres (0.2%, 2004). This is the first Australian study to examine Hib carriage spanning the pre- and post-vaccination eras. Increasing carriage rates contribute to Hib disease resurgence especially in those with higher disease burdens, such as remote Indigenous Australians, ongoing carriage surveillance provides a sentinel warning system for invasive disease. Background Following the introduction of H. influenzae type b (Hib) conjugate vaccine to Australia in 1993 as a three dose (2, 4, 12 month) schedule, the incidence of Hib disease decreased dramatically in children, especially in those aged under 5 years. We investigate Hib carriage in Indigenous children and children attending childcare centres from the Northern Territory (NT) of Australia between 1992 and 2005. We report Hib carriage rates in this well vaccinated population, with previously documented high rates of invasive disease. Methods Hib carriage was reviewed in nasopharyngeal or nasal swabs collected between 1992 and 2005; from over 2000 children (61% Indigenous) aged 0–6 years enrolled in 7 otitis media or carriage surveillance studies in the NT. Results More than 10 years after the introduction of the Hib conjugate vaccine, Hib carriage persists at low levels, but at a higher rate in Indigenous children (3.4%, 2003–2005) than children attending childcare centres (0.2%, 2004), in the NT of Australia. Conclusions This is the first Australian study to examine Hib carriage spanning the pre- and post-vaccination eras. Ongoing carriage surveillance provides a sentinel warning system for invasive disease. This notifies public health professionals of potential invasive disease, creating early warning systems for intervention if Australian Indigenous children or children attending childcare centres are to follow current international trends associated with high rates of carriage preceding invasive disease—despite high vaccination rates. Internationally there is growing concern that increasing carriage rates are the driving force behind Hib disease resurgence especially in those with higher disease burdens, such as remote Indigenous Australians. Changes to the vaccination schedule from PRP-OMPC (PedvaxHIB ®), to PRP-T (2, 4, 6, 12 months) from January 2010—may affect carriage and in time, invasive disease rates. This work is important for national and International comparisons as well as feeding back information to vaccine policy makers of the Hib carriage environment throughout this period.

Influences of the Family and Childcare Food Environments on Preschoolers' Healthy Eating

THE STUDY EXTENDS CAMPBELL, Crawford and Ball's (2006) findings that the family food environment influences eating in children by examining whether young children's food intake at home is also influenced by the childcare food environment. Participants were 103 parents of children aged three to five years who attended childcare centres in South Australia. Centres had either obtained the ‘Start Right Eat Right’ (SRER) nutrition certification; an award associated with compliance with the government's healthy eating guidelines, or had not attained certification with SRER. Participating parents completed a questionnaire measuring the family food environment as well as a food frequency questionnaire that recorded children's intake of ‘healthy’ and ‘unhealthy’ foods. Parents of children at SRER centres reported that their children ate more healthy food choices at home, as measured using the food frequency questionnaire, than parents of children attending non-SRER accredited centres. Pressure to eat, parental modelling, monitoring and perceptions of adequacy of a child's diet were all associated with children's eating. The results suggest that childcare centres, in addition to the family environment, can have an important role to play in developing healthy dietary choices in preschool children.

Risk factors for severe hand foot and mouth disease

Hand foot and mouth disease (HFMD) and herpangina are enteroviral infectious diseases caused mainly by Coxsackie virus A (CA) or enterovirus 71 (EV71). From 2000 to 2002, many complicated cases were reported in Japan, therefore a nationwide questionnaire survey was carried out to assess the situation. The subjects were patients with HFMD or herpangina, or other enterovirus infection from 2000 to 2002, who were either hospitalized over 24 h or who died. The response rates were 41.3% in 2000 and 2001 and 31.6% in 2002. The survey period included the year 2000, when HFMD epidemics due to EV71 occurred. To examine risk factors causing complications of enterovirus infection, severe cases of HFMD were focused on. HFMD cases in 2000 were divided into two groups according to severity: 'more severe' and 'less severe'. 'More severe' was defined as 'fatal, involving sequelae, or involving hospitalization for 7 days or longer'. Statistical analyses were conducted with Epi info version 3.3 and the association between risk factors and severity was estimated. The number of patients with more severe and less severe cases was 96 and 103, respectively. There was no difference in sex, age, having siblings and family history between the two groups. There was a significant association between attending child care center and severe HFMD. It is not clear why attending child care centers was associated with HFMD severity. Further study is needed.

Relationship-Focused Child Care Practices: Quality of Care and Child Outcomes for Children in Poverty

Research Findings: Child care delivery practices promoting continuous, primary caregiver–child relationships (relationship-focused child care) were evaluated for 223 preschool-age children (45% African American, 55% Latino) attending child care centers serving low-income children. Both relationship-focused and non-relationship-focused centers were accredited by the National Association for the Education of Young Children. Children in relationship-focused programs received more sensitive, involved, and affectionate caregiving and were more engaged with their caregivers than children in comparison centers, but some differences were greater for African American children. Outcomes associated with relationship-focused care included greater parent-reported child compliance and closer parent–caregiver relations, but no consistent benefits for cognitive school readiness, receptive language, or child behavior problems were found. Follow-up assessments were completed 1 year later for 119 children who remained in their programs. Social and cognitive outcomes improved over time, but some changes were moderated by child race/ethnicity and center type. Over time, parents reported greater child compliance and caregivers reported better parent–caregiver relationships in relationship-focused programs. Practice or Policy: Some social benefits of continuous, primary caregivers were found, but children's cognitive competencies improved with sustained attendance at these accredited programs regardless of the relationship-focused practices.

The CUPDAY Study: prebiotic‐probiotic milk product in 1–3‐year‐old children attending childcare centres

The aim of the study was to evaluate the efficacy of a milk product containing probiotics and prebiotics (CUPDAY Milk) on the incidence of diarrhoea in children attending daycare centres. The study was undertaken in a randomized controlled trial with 496 children aged 1-3 years attending 29 childcare centres in Perth, Australia. The endpoint for the study was the number of days in which children were recorded as having four or more stools. The diarrhoeal rates were analyzed by Poisson regression using 'intention to treat' (all children) and 'reduced' (children enrolled for more than 10 days) data sets. There was no difference in demographic characteristics between the case and control groups. In the 'intention to treat' analysis, a total of 41 745 child-days were included in the study. The adjusted risk ratio for those consuming the 'Cupday' milk drink was 0.82 (95% CI 0.73-0.94) for the intention to treat sample (n = 496) and 0.80 (95% CI 0.70-0.91) for the reduced sample (n = 315). The children consuming the 'Cupday' drink had a 20% reduction in the number of days experiencing four or more stools per day. A milk containing probiotics and prebiotics reduced the number of days children attending child care who had four or more stools by 20%.

Association Between PM2.5 Exposure in Child Care Centers and Wheeze Among Young Children in Singapore

ISEE-440 Objective: Numerous epidemiologic studies have reported adverse effects of air PM2.5 on children's health. The objective of this study was to determine the associations between current wheeze symptom among children attending child care centers (CCCs) in Singapore and exposures to PM2.5. Material and Methods: From a large survey using the International Study on Asthma and Allergies in Childhood (ISAAC) questionnaire on 4759 children attending 104 CCCs, 15 high- and 15 low-current wheeze prevalence CCCs were selected. A total of 1551 children participated in this study. PM2.5 exposure measurements were performed indoors as well as outdoors of the CCCs. The concentrations were computed into quartiles. Prevalence ratios (PR) and 95% confidence interval (95% CI) were evaluated using Cox proportional hazard regression assuming a constant risk period controlled for the influence of confounders such as age, gender, race, familial atopy, socioeconomic status, preterm births, breast-feeding, respiratory infections, ETS, home dampness, and CCC status. Results: We found higher indoor concentrations of PM2.5 in high-prevalence CCCs than in low-prevalence CCCs (mean: 79.3 vs. 77.3 mg/m3). We found that current wheeze was associated with outdoor PM2.5 levels, as well as indoor PM2.5 levels. Comparing the categories of fourth, third, and second quartiles of indoor PM2.5, respectively, with first quartile, the adjusted PRs (95% CIs) for wheeze were 1.52 (1.00–2.31), 1.28 (0.79–2.06), and 1.13 (0.70–1.84). The corresponding adjusted PRs (95% CIs) for outdoor PM2.5 were 1.57 (1.03–2.39), 1.21 (0.80–1.84), and 1.15 (0.75–1.77). Conclusions: The slightly stronger association found for outdoor PM2.5 with wheeze symptoms suggests outdoor source of causal agent and reduction of toxicity as it is transported indoors. Given that fine particulate matter exposures of children have been considered a health risk from ambient data, the results from this study of Singapore children revealed that indoor exposures within CCC needs to be equally addressed. Therefore, CCCs should consider mitigation strategies to reduce indoor PM2.5 exposures of outdoor origin via ventilation and/or filtration.

An evaluation of a nutrition intervention at childcare centres in South Australia

Research has shown that childcare menus in South Australia, Australia and overseas lack key nutrients recommended for children. This paper describes an incentive initiative that aimed to improve the nutrition provided to children attending childcare centres in the southern metropolitan area of South Australia between 2001 and 2003. To attain the 'Start Right Eat Right' award, aimed at childcare centres, directors and cooks from 50 centres were required to attend training, analyse a current menu for quality and quantity against various tools, review their food policy for essential criteria, have two site visits and have all staff trained in a recognised food safety and hygiene program. Forty-four (88%) of the centres completed training. Qualitative feedback from 10 awarded centres reported substantial changes and their food policy analysis showed an increase of essential points from an average score of 8.4 to 17.1 (max. score 18). More than 300 staff completed food hygiene training. Fifty per cent of the eligible centres had completed the award at program evaluation. This multi-strategic intervention was effective in improving the food provided and nutrition practices in childcare settings. Strategies attributed to its success were an inter-sectoral approach and the creation of supportive environments.

Planning for Health Promotion in Low-Income Preschool Child Care Settings: Focus Groups of Parents and Child Care Providers

To identify potentially successful strategies, barriers, and facilitators for health promotion in preschool child care settings. We conducted 6 focus groups including each of the following: parents of children attending child care centers and home-based family child care (2 in English, 1 in Spanish) and directors of child care centers and family child care providers (2 in English, 1 in Spanish). Systematic thematic analysis was conducted to generate themes to address study questions. A total of 24 parents and 45 child care providers, serving predominantly urban, low-income children in Boston, participated. Parents and child care providers agreed that in-person group discussions would be the most effective strategy for providing health education information to parents. Several barriers that could affect implementation emerged. First, some providers expressed frustration toward parents' attitudes about child safety and health. Second, there was diversity of opinion among providers on whether conducting health promotion activities was consistent with their training and role. In addition, literacy, language, and cultural barriers were identified as potential barriers to health promotion in child care. In order to be successful, health promotion strategies in child care settings will need to overcome tensions between providers and parents, allow professional growth of child care providers to serve in a health promotion role, and better integrate external health resources and personnel. Group sessions and peer learning opportunities that are culturally and linguistically sensitive are potentially successful strategies for implementation of health promotion interventions for many parents.

The Meanings Embedded within Childcare Regulations: A Historical Analysis

In response to current discussions about a universal Canadian childcare system (affordable childcare for all families), this article deconstructs the position that childcare occupies in the province of Ontario through the examination, from a historical perspective, of a document that outlines regulations for childcare programs: the Day Nurseries Act. Three discourses are analyzed by tracing them to social and demographic conditions during the early twentieth century: discourses related to the need for medical supervision of children attending childcare centres; discourses that emphasize the relationship between childcare centres and ‘families in need’; and discourses that refer to the need to follow strict programming and behavioural guidelines.

Effect of a Probiotic Infant Formula on Infections in Child Care Centers: Comparison of Two Probiotic Agents

To investigate the effect of 2 different species of probiotics in preventing infections in infants attending child care centers. A double-blind, placebo-controlled, randomized trial was conducted from December 1, 2000, to September 30, 2002, at 14 child care centers in the Beer-Sheva area of Israel in healthy term infants 4 to 10 months old. Infants were assigned randomly to formula supplemented with Bifidobacterium lactis (BB-12), Lactobacillus reuteri (American Type Culture Collection 55730), or no probiotics. Duration of feeding, including follow-up, for each participant was 12 weeks. All infants were fed only the assigned formula and were not breastfed due to parental decision before recruitment to the study. Probiotic or prebiotic food products or supplements were not allowed. Main outcome measures were number of days and number of episodes with fever (>38 degrees C) and number of days and number of episodes with diarrhea or respiratory illness. Participants (n = 201) were similar regarding gestational age, birth weight, gender, and previous breastfeeding. The controls (n = 60), compared with those fed B lactis (n = 73) or L reuteri (n = 68), had significantly more febrile episodes (mean [95% confidence interval]: 0.41 [0.28-0.54] vs 0.27 [0.17-0.37] vs 0.11 [0.04-0.18], respectively). The controls also had more diarrhea episodes (0.31 [0.22-0.40] vs 0.13 [0.05-0.21] vs 0.02 [0.01-0.05], respectively) and episodes of longer duration (0.59 [0.34-0.84] vs 0.37 [0.08-0.66] vs 0.15 [0.12-0.18] days, respectively). The L reuteri group, compared with BB-12 or controls, had a significant decrease of number of days with fever, clinic visits, child care absences, and antibiotic prescriptions. Rate and duration of respiratory illnesses did not differ significantly between groups. Child care infants fed a formula supplemented with L reuteri or B lactis had fewer and shorter episodes of diarrhea, with no effect on respiratory illnesses. These effects were more prominent with L reuteri, which was also the only supplement to improve additional morbidity parameters.

Probiotics: Not Just for Treatment Anymore

Probiotics, microorganisms that can have positive health effects when ingested, are increasingly studied and used in humans. Thus far, they have shown particular promise in the treatment of acute infectious diarrhea and the prevention of antibiotic-associated diarrhea, associations that have been investigated widely and have been subject to systematic review.1–4 Other conditions potentially treatable by probiotics include chronic diarrhea,5 inflammatory bowel disease,6 irritable bowel syndrome,7 and food allergy8; potentially preventable conditions range from travelers’ diarrhea9 and necrotizing enterocolitis10 to urogenital infections,11 atopic diseases,12 and dental caries.13 Vanderhoof14 and other leaders in the field propose future applications in cystic fibrosis, rheumatoid arthritis, and cancers. The study reported by Weizman et al15 in this issue of Pediatrics is one of a handful of randomized, controlled trials that have examined probiotics as a prevention for acute infectious illnesses in otherwise healthy infants and children.16–20 This study aims to investigate whether a so-called functional food, infant formula containing either Bifidobacterium lactis or Lactobacillus reuteri , can decrease the risk of diarrhea, respiratory symptoms, fever, and other “morbidity parameters” when compared with a placebo formula. This represents a plausible future real-world scenario: infants attending child care centers, who may be at increased risk of these illnesses, could receive regular prophylaxis in the form of probiotic formula. The authors report a decrease in the numbers of episodes and numbers of days of both diarrhea and fever in the probiotic groups when compared with the placebo group. For example, the subjects in the placebo, B lactis , and L reuteri groups averaged 0.59, 0.37, and 0.15 days with diarrhea (presumably per child during the 12-week study period), respectively. This finding is interesting, although … Address correspondence to Cornelius W. Van Niel, MD, Sea Mar Community Health Centers, 8720 14th Ave S, Seattle, WA 98108. E-mail: cvanniel{at}u.washington.edu

Update on sudden infant death syndrome.

With the introduction of the Back to Sleep campaign by the American Academy of Pediatrics in 1992, the incidence of Sudden infant death syndrome has decreased by almost 50%. Despite this success, SIDS continues to be the most common cause of unexplained infant death in Western countries. This article will briefly review the definition, etiology, and risk factors of SIDS. Attention will then focus on ways to target specific associated risk factors and at risk populations to promote a continued downward trend in the number of SIDS deaths. Recent literature in SIDS research has focused on identifying infants at continued risk for SIDS. Children attending child care centers have an increased risk for SIDS, which is of particular concern as the number of infants in child care continues to rise. The reasons for this, along with strategies to decrease this risk, will be reviewed. In addition, the SIDS rate among black infants continues to be more than twice that of white infants. A review of the reasons for this disparity and ways to intervene through targeted campaigns will be discussed. Recent data has also suggested that the prevention of SIDS should not be an indication for use of home cardiorespiratory monitoring. The use of home monitoring may be warranted for some infants and will be reviewed. Our jobs as pediatricians should be to ensure that the incidence of SIDS continues to decline. This can be done through parent education at each and every well child visit, lobbying to enforce state law to implement SIDS education campaigns for child care centers and within African-American communities, and continued review of the most current literature in SIDS research to keep ourselves current and well informed.

The frequency of common skin conditions in preschool-aged children in Australia: seborrheic dermatitis and pityriasis capitis (cradle cap).

To determine the prevalence and severity of seborrheic dermatitis and pityriasis capitis in Australian preschool-aged children. A stratified cross-sectional skin survey using cluster sampling of centers throughout Victoria, Australia. The study population included children attending child care centers, preschools, and Maternal and Child Health Centers, with the reference population being Australian children 5 years and younger. Of the 1,634 children in the original sample, 1.116 children aged 11 days to 5 years 11 months were included in the study. Parents completed a questionnaire recording demographic information and personal and family history of skin problems and related diseases. A dermatologist performed a total skin examination, including the diaper area for children younger than 12 months. The age- and sex-specific prevalence rates and site and severity of seborrheic dermatitis and pityriasis capitis were measured. The overall age- and sex-adjusted prevalence of seborrheic dermatitis was 10.0% (95% confidence interval [CI], 8.2%-11.7%): 10.4% (95% CI, 7.8%-12.9%) in boys and 9.5% (95% CI, 7.0%-12.0%) in girls. This was highest in the first 3 months of life, decreasing rapidly by the age of 1 year, after which it slowly decreased over the next 4 years. Most (71.9%) had disease classified as minimal to mild. Pityriasis capitis occurred in 41.7% (95% CI, 38.8%-44.6%) of the 1,116 children examined, with 85.8% categorized as minimal to mild only. Seborrheic dermatitis and pityriasis capitis are common in early childhood. Most children have minimal to mild disease that would require little if any treatment. Education programs directed at those caring for preschool-aged children are needed to provide information on simple preventative measures and treatment, if necessary, that could easily reduce the morbidity associated with these very common conditions.

Human cytomegalovirus a sequence and UL144 variability in strains from infected children

Human cytomegalovirus (HCMV) displays genetic polymorphisms. This variability may contribute to strain-specific tissue tropism and disease expression in HCMV-infected humans. To determine strain variability in a sequence and UL144 gene regions, 51 low-passage isolates from 44 HCMV-infected children were studied. Isolates were obtained from 28 healthy children attending child care centers in Iowa and from 16 congenitally infected infants born in Texas. Isolates demonstrated substantial nucleotide variation in each gene region. Phylogenetic analysis of a sequence variability allowed 39 isolates to be grouped into six clades. The largest clade contained 16 isolates with > or = 95% nucleotide homology. Forty-eight of the 49 HCMV isolates yielding UL144 amplicons was grouped according to the clades described a few years ago [Lurain et al. (1999) Journal of Virology 73:10040-10050]. No linkage was observed among a sequence, UL144, and glycoprotein B (gB; UL55) polymorphisms. Four Texas and 11 Iowa isolates displayed > or = 95% sequence homology for a sequence and UL144 regions and possessed identical gB genotypes. No relationship between UL144 polymorphisms and outcome of congenital HCMV infection was observed. These data indicate that HCMV strains circulating among young children have UL144 polymorphisms similar to those of HCMV strains excreted by immunocompromised adults. Identification of conserved nucleotide sequences among Iowa and Texas children suggests genetic stability and biologic importance of these gene regions.

Infectious diseases in schools and child care facilities.

1. Joan Robinson, MD* 1. 2. *Clinical Associate Professor, Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. Objectives After completing this article, readers should be able to: 1. Compare the incidence of infections between preschool children who attend child care centers and those who are cared for in their own homes. 2. Delineate illness exclusion criteria for children attending a child care facility. 3. Describe the potential relationship between cytomegalovirus infection among children cared for in a child care facility and congenital cytomegalovirus infection. 4. Determine when transmission of human immunodeficiency virus or hepatitis C may be a problem in child care facilities or schools. Management of infectious diseases in schools and child care centers is becoming increasingly complex. The emergence of penicillin-resistant pneumococci (PRP) means that oral antibiotic treatment of common bacterial infections acquired in schools or child care facilities may be less successful in the future. The etiology of many rashes, fevers, and respiratory tract diseases now can be determined with relatively noninvasive procedures. If other children attending the same school or child care center have the same diagnosis, it is evident that a child probably acquired an infection such as parvovirus, influenza, or respiratory syncytial virus (RSV) in these facilities. Accordingly, issues related to infection control in these settings are of greater interest to parents and staff than in the past. Furthermore, because of immunization programs, serious infections are now less common in children, which has made parents less tolerant of their children acquiring these infections outside the home. Until the 1960s, the vast majority of preschool children were cared for in their own homes, initially entering a group setting at age 5 or 6 years, when they started school. Now, most preschoolers are exposed to large numbers of other children in a closed setting several days per week when they enter a child care facility. Child care facilities for preschoolers can be:

Molecular epidemiology of childhood astrovirus infection in child care centers.

This study assessed the role of human astrovirus (HAstV) in outbreaks and sporadic cases of diarrhea among children attending child care centers (CCCs) and determined the infecting astrovirus antigenic types by reverse transcriptase-polymerase chain reaction (RT-PCR) and sequence analysis. Eight astrovirus outbreaks occurred in 6 CCCs. Of 179 children with diarrhea, 36 (20%) had astrovirus-associated diarrhea. Diarrhea stools obtained during diarrhea outbreaks were more likely to contain astrovirus (40/476) than were samples not associated with a diarrhea outbreak (14/452) (P<.001). Type-specific RT-PCR and DNA sequencing identified 5 outbreaks associated with HAstV-1 and 3 outbreaks with HAstV-2. Sequential outbreaks in 2 CCCs occurred with a different type in the same year. Phylogenetic analysis identified 6 clades of HAstV-1 and 2 clades of HAstV-2 during this 1-year surveillance. Astrovirus was a significant cause of diarrhea outbreaks, and 2 antigenic types were present in the community during 1 diarrhea season.

Streptococcus pneumoniae carriage in children attending 59 Canadian child care centers. Toronto Child Care Centre Study Group.

To determine the prevalence of Streptococcus pneumoniae nasopharyngeal carriage, antibiotic resistance patterns, and serotypes; to examine the variability of microbiological findings between child care centers; and to determine risk factors for antibiotic resistance. Point prevalence survey. Licensed child care centers in Toronto, Ontario. Healthy children attending the centers. Prevalence (simple and adjusted for clustering) of carriage, antibiotic resistance, and serotypes; multivariate analysis of risk factors for resistance. Of 1322 children from 59 centers, 586 (44.3%) carried 599 S. pneumoniae isolates. On the day of study, 129 (10.7%) of 1203 children for whom a questionnaire was completed were taking antibiotics and 336 (227.9%) had taken them in the previous month. Decreased susceptibility to penicillin was found in 102 isolates (17.0%) and 82 (13.7%) were resistant to multiple antibiotics. The most common serotypes, in order, were 6B, 23F, 6A, 19F, 14, 11A, and 19A, composing 78% of all isolates. Microbiological results from individual centers were variable, but the overall prevalence of carriage, antibiotic resistance, and serotypes was not significantly different when adjusted for effects of clustering within centers. Multiple logistic regression determined that age younger than 24 months and antibiotic use within the previous month were significant risk factors for carriage of S. pneumoniae resistant to penicillin, sulfamethoxazole-trimethoprim, and erythromycin. Efforts to reduce antibiotic use in children should be particularly directed toward young children attending child care centers. Studies of infectious diseases in child care centers should consider clustering of pathogens or factors promoting transmission within centers that may result in variability between centers.