Attending Child Care Research Articles

Short-Term Effects of an Outdoor Activities Intervention on Children’s Stress, Socio emotional, Behavioral, and Cognitive Regulation Skills

ABSTRACT Research Findings: In recent years, interest has grown in the potential benefits of outdoor activities (OA) for children’s development, particularly in promoting socioemotional, behavioral, and cognitive regulation skills and reducing stress. However, empirical evidence on the effects of OA programs for children in the first three years of life on these outcomes still needs to be provided. To address this gap, our study involved 95 infants and toddlers (girls = 48, M age = 23.3 months) attending child care centers in north and south Italy and their teachers. Participants were divided into two groups: the Outdoor group (n = 55), actively involved in the OA program for four months, and the Control group (n = 40), who followed the standard curriculum. We assessed the children’s cortisol levels and emotional, behavioral, and cognitive regulation skills before (T1) and after (T2) the implementation of the OA intervention. After the 4-month intervention, improvements in the children’s adaptive behavior (particularly in social interaction) and cognitive-behavioral regulation skills were observed only in the Outdoor group. Children’s stress levels remained stable. Practice or Policy: Our findings show the benefits of daily OA on young children’s self-regulation, suggesting to schools and families that increasing OA from the first years of life may support cognitive and social growth.

Child care for young children with disabilities.

More than half (56%) of Canadian children aged 0 to 5 years are in non-parental child care, but data on child care attendance among children with disabilities is limited. This study examines child care participation among young children with disabilities in Canada, with a focus on different disability types. Analyses were conducted on 1,189 children aged 0 to 5 years identified with disabilities from Statistics Canada's 2023 Survey on Early Learning and Child Care Arrangements - Children with Long-term Conditions and Disabilities. Rates of child care participation, difficulties finding child care, difficulties within child care, and whether parents reported that their child had ever been denied a child care space because of their condition were examined. Logistic regression models tested for differences in the main child care arrangement and difficulty finding child care based on the child's disability while controlling for sociodemographic variables. Among children aged 0 to 5 years with disabilities, 45% attended a daycare centre, preschool, centre de la petite enfance, or before or after school care as their main child care arrangement; 17% attended another type of child care, such as a family child care home or care by a relative; and 38% did not regularly attend non-parental child care. The parents of nearly half of children with disabilities reported difficulty finding a child care arrangement, particularly for children with emotional conditions. Close to 1 in 10 parents of children with disabilities who were using child care reported that their child had been denied a child care space because of their condition. These findings highlight the need for information to support inclusive policies, practices, and resources for children with disabilities within the Canada-wide early learning and child care system.

Early childcare and developmental delay risk at 3.5 years: Insights from the French ELFE cohort.

We tested the association between early childcare attendance in the first three years of life and child development at age 3.5years in the French context, where early childcare is subsidized. In the ELFE (Étude Longitudinale Français depuis l'Enfance) birth cohort study set in metropolitan France, children's development was reported by parents at age 3.5years (n = 11,033) via the Child Development Inventory (CDI) questionnaire. CDI scores were transformed into a development quotient (DQ), with a DQ < 90 corresponding to possible and a DQ < 85 corresponding to a probable developmental delay. Inverse probability weighted multivariable regression models were used to analyse whether early childcare in the first three years of life (centre-based, childminder, informal or parental care) was associated to development delay. Compared to children in exclusive parental care, those in centre-based childcare (CBC) or with a childminder prior to school entry were significantly less likely to experience possible (OR = 0.56, [95% CI = 0.51-0.61] for CBC and OR = 0.77, [95% CI = 0.72-0.83] for childminder attendance) and probable developmental delay (OR = 0.62, [0.58-0.67] for CBC and OR = 0.80 [0.76-0.83] for childminder). Informal childcare attendance was not significantly associated with children's possible nor probable developmental delay ((OR = 0.97, [0.84-1.12]) and (OR = 0.97, [0.82-1.15]), respectively). Conclusions: Overall, our findings add to the existing scientific literature, showing that in the French context, where childcare can start as early as 3months of age, early childcare attendance can contribute to child's development. What's Known on This Subject: • Studies on early childcare attendance and child development have shown mixed results, associations with better psychomotor development mainly being observed in Nordic countries, while some studies in other countries such as the USA showed no or negative associations. What This Study Adds: • In a country with broad and subsidized access to childcare such as France, access to early childhood education can positively contribute to children's psychomotor development. However, we found that access to childcare does not appear to reduce social inequalities in children's psychomotor development.

Early childcare arrangements and children's internalizing and externalizing symptoms: an individual participant data meta-analysis of six prospective birth cohorts in Europe

Early childcare attendance may be related to children's internalizing and externalizing symptoms throughout childhood and young adolescence, however evidence from Europe is limited. We aimed to assess this association across multiple population-based birth cohorts of children recruited in different European countries. Data come from six parent-offspring prospective birth cohort studies across five European countries within the EU Child Cohort Network. A total of 87,208 parent-child dyads were included in the study. To test associations between childcare attendance (centre-based or informal) anytime between ages 0 and 4 years and children's internalizing and externalizing symptoms in middle childhood and young adolescence (measured at: 5-6 years, 7-9 years, and 10-13 years) a two-stage individual participant data meta-analysis was implemented. Linear regression models were performed in each cohort separately; combined random-effects meta-analysis was then used to obtain overall association estimates. In secondary analyses, we tested interactions between childcare attendance and mother's post-partum depression, low education status, and the child's sex. Compared to children who were exclusively cared for by their parents prior to school entry, those who attended centre-based childcare had lower levels of internalizing symptoms in all age groups [5-6 years: β:-1.78 (95% CI:-3.39,-0.16); 7-9 years: β:-0.55 (95% CI:-0.88,-0.73); 10-13 years: β:-0.76 (95% CI:-1.15,-0.37)]. Children who attended informal childcare appeared to have elevated levels of internalizing symptoms between 7-9 and 10-13 years, respectively [β: 1.65 (95% CI: 1.25, 2.06); β: 1.25 (95% CI: 0.96, 1.54)]. Informal childcare attendance was also associated with increased levels of children's externalizing symptoms between 7-9 and 10-13 years, respectively [β: 2.84 (95% CI: 1.41, 4.26); β: 2.19 (95% CI: 0.54, 3.84)]. Early centre-based childcare is associated with decreased levels of children's internalizing symptoms compared to exclusive parental care. For informal childcare, opposite associations were observed. Overall, our results suggest that centre-based childcare attendance may be associated with slight positive impacts on children's emotional development and should be encouraged by public policies. In addition, children from socioeconomically disadvantaged families require special attention, as they may not sufficiently benefit from universal early childhood education and care (ECEC). This research was funded by the ERC Consolidator grant RESEDA (Horizon Europe, 101001420).

Centre-based childcare in early childhood and child obesity: systematic review and meta-analysis protocol

ObjectivesCentre-based childcare has been identified as a promising environment for obesity prevention in early childhood, but the longitudinal relationships between attending centre-based childcare and child obesity are not well understood....

Social Behaviors Associated with SARS-CoV-2 Test Positivity Among Children Evaluated in Canadian Emergency Departments, 2020 to 2022: A Cross-Sectional Survey Study

ObjectiveTo evaluate how social behaviors relate to SARS-CoV-2 test positivity across pediatric age groups. MethodsMulticenter, cross-sectional study recruiting children <18 years old tested for SARS-CoV-2 infection in emergency departments between 2020 and 2022. We used multivariate logistic regression to assess how self-reported social behaviors affect SARS-CoV-2 test positivity across four age groups. Causal mediation analysis quantified how mask-wearing and presence of an infected close contact mediated the SARS-CoV-2 risk of given behaviors. ResultsSeven thousand two hundred and seventy two children were enrolled and 1457 (20.0%) tested positive for SARS-CoV-2. Attending a social gathering was associated with increased odds (aOR 1.64, 95% CI: 1.05, 2.57) of SARS-CoV-2 positivity among children aged 5-<12 years. Those attending in-person school/daycare were less likely to test positive for SARS-CoV-2 across all age categories. Attending childcare was associated with 16.3% (95% CI: −21.0%, −11.2%) and 9.0% (95% CI: −11.6%, −6.5%) reductions in the probability of testing positive for SARS-CoV-2 infection, with 53.5% (95% CI: 39.2%, 73.9%) and 22.8% (95% CI: 9.7%, 36.2%) of the effects being mediated by the presence of a close contact among <1 year and 1-<5 year age groups, respectively. Masking in public mediated the association between childcare attendance and SARS-CoV-2 positivity in children aged <1 year. ConclusionsAttending social gatherings increased the risk of SARS-CoV-2 test positivity in 5-<12-year-old children, but in-person daycare/school was associated with a reduced odds of testing positive across all ages. Settings with high public health adherence (ie, schools) reduced the risk of testing positive for SARS-CoV-2, possibly from reduced close contact with SARS-CoV-2 positive individuals.

Does Childcare Attendance Moderate the Associations Between Mother-Child Depressive Symptoms and Children’s Peer Victimization Experiences?

Peer victimization experiences is suggested to play a mediating role in the transmission of depression symptoms between mothers and children. Childcare attendance has been found to reduce the association between mother and child depressive symptoms. However, it is not clear whether this protective effect unfolds via a reduction of peer victimization experiences in middle childhood. The aims of this study were to test (1) whether peer victimization in middle childhood mediated the association between exposure to maternal depressive symptomatology in early childhood and child depressive symptoms in late childhood, (2) whether childcare attendance moderate the direct associations between maternal depressive symptoms and children’s peer victimization experiences in middle childhood as well as depressive symptoms in late childhood and (3) whether childcare attendance moderates this mediated association. Data come from the Avon Longitudinal Study of Children and Parents (N = 5526) where exposure to maternal depressive symptoms and intensity of childcare attendance were assessed repeatedly during early childhood. Children’s peer victimization and depressive symptoms were self-reported at eight and 10 years of age, respectively. We used weighted structural equation modeling and found that the association between mothers and children’s depression was partially mediated by peer victimization. Childcare attendance did not moderate the indirect effect of maternal depression on child depressive symptoms via peer victimization. However, we found that for children who attended childcare, maternal depression was no longer associated child depressive symptoms in late childhood. In conclusion, peer victimization experiences partly explain the intergenerational transmission of depressive symptoms, but this mechanism is not altered by children’s childcare attendance. Future research should examine potential socio-emotional and school readiness mechanisms that may break the cycle of depressive symptomatology from mothers to children.

The Day-Level Association Between Child Care Attendance and 24-Hour Movement Behaviors in Preschool-Aged Children.

Twenty-four hour movement behaviors (ie,physical activity [PA], screen time [ST], and sleep) are associated with children's health outcomes. Identifying day-level contextual factors, such as child care, that positively influence children's movement behaviors may help identify potential intervention targets, like improving access to child care programs. This study aimed to examine the between- and within-person effects of child care on preschoolers' 24-hour movement behaviors. Children (N = 74, 4.7 [0.9]y, 48.9% girls, 63.3% White) wore an Axivity AX3 accelerometer on their nondominant wrist 24hours per day for 14days to measure PA and sleep. Parents completed surveys each night about their child's ST and child care attendance that day. Linear mixed effects models predicted day-level 24-hour movement behaviors from hours spent in child care. Children spent an average of 5.0 (2.9)hours per day in child care. For every additional hour of child care above their average, children had 0.3hours (95%CI,-0.3 to -0.2) less ST that day. Between-person effects showed that compared with children who attended fewer overall hours of child care, children who attended more hours had less overall ST (B = -0.2h; 95% CI, -0.4 to 0.0). Child care was not significantly associated with PA or sleep. Child care attendance was not associated with 24-hour PA or sleep; however, it was associated with less ST. More research utilizing objective measures of ST and more robust measures of daily schedules or structure is necessary to better understand how existing infrastructure may influence preschool-aged children's 24-hour movement behaviors. In addition, future research should consider how access to child care may influence child care attendance.

0840 Center-based Childcare Attendance and Sleep in Children Under Six Years Old: A Systematic Review

0840 Center-based Childcare Attendance and Sleep in Children Under Six Years Old: A Systematic Review

Diverse Parents Decision-Making to Vaccinate Their Child under Five Attending Childcare Programs.

Background: On 18 June 2022, Moderna and Pfizer-BioNTech COVID-19 vaccines were authorized under an Emergency Use Authorization by the United States Food and Drug Administration to prevent severe coronavirus disease in children six months to four years of age. Despite approval of the COVID-19 vaccinations for young children, there remain ongoing challenges reaching widespread coverage due to parental decision-making. Parental decision-making plays a pivotal, yet understudied, role governing vaccine adoption among this priority demographic. Methods: This cross-sectional analysis examined COVID-19 vaccine intentions for 320 predominately Hispanic parents of two to five-year-olds attending Miami-Dade County childcare programs in Florida USA, several months following the June 2022 emergency authorization. Parent's self-reported survey data encompassed vaccine choices and rationales, social determinants of health, and parent immigrant status. Data analyses illustrate the associations between parent decision-making and these variables. Regression modeling and tests of independence identified predicting factors for parental vaccine decision-making. Results: Only 25% of parents intended to vaccinate their young child, while 34% resisted and 41% felt unsure, despite 70% personal vaccination rates. Household income under $25,000, identifying as a migrant, or testing COVID-19-positive significantly predicted unsure decision-making. The majority of hesitant groups expressed concerns around side effects (20%), safety (2.9%), and sufficiency of vaccine knowledge (3.3%). Conclusions: In this sample, the predominance of parents were unsure and resistant rather than accepting of having their child vaccinated despite emergency approval of the pediatric vaccine. Associations and predictive factors are examined.

Exclusive breastfeeding practices and predictors among mothers attending child care immunization services in Ebonyi state, Nigeria

Background: Low adoption of exclusive breast feeding among mothers and its impact on the infants has been attributed to several factors. The im of the study was to assess exclusive breastfeeding practices and predictors among women attending child care immunization services at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). Methods: The design of this study is cross-sectional survey. The population of the study comprised of 2100 women who registered for child care immunization services at Federal Teaching Hospital Abakaliki from the month of January-March, 2023. Convenience sampling technique was used in selecting the participants. Data were analyzed using mean, standard deviation, frequency counts and percentages and t test statistics. Results: The results showed that the exclusive breastfeeding practices of the women were high (3.33±0.39). Also, EBP of the women was high based on age and parity. Although, there was no significant difference in the exclusive breastfeeding practices based on parity (p&gt;0.05). However, there was significant difference in the exclusive breastfeeding practices based on age of the mothers (p&lt;0.05). Conclusions: The study concluded that to sustain the high practices of exclusive breastfeeding among women attending child care immunization services at AE-FUTHA, there is need to continue to engage them on seminars, workshops and conferences by health workers on the days of immunization with special focus to the younger age of the mothers in order to sustain the high EBPs.

How is the association of childcare attendance in the first five years of life with psychological wellbeing between 11-17 years confounded by socioeconomic position?

How is the association of childcare attendance in the first five years of life with psychological wellbeing between 11-17 years confounded by socioeconomic position?

International differences in gradients in early childhood overweight and obesity: the role of maternal employment and formal childcare attendance.

There are significant cross-country differences in socio-economic gradients in later childhood and adulthood overweight/obesity; few studies assess whether this cross-national variation is evident from early childhood. Furthermore, the role of childcare in explaining overweight/obesity gradients might vary across countries, given differences in access, quality and heterogeneity within. Additionally, childcare is linked to parental characteristics such as maternal employment. The interplay between childcare and employment in producing early overweight/obesity gradients has received little attention, and might vary cross-nationally. Using harmonized data from six high-quality, large datasets, we explore the variation in gradients in early overweight/obesity (at age 3-4 years old) by parental education across several high-income countries (USA, UK, France, the Netherlands, Germany and Japan). We then assess whether differential formal group care use attenuates some of these gradients, and whether this varies across maternal employment. Gradients in early childhood overweight/obesity by parental education are evident across several developed countries. Countries with higher overall prevalence of early overweight/obesity did not have the largest inequalities across education groups. The contribution of formal group care to producing these gradients varied across countries and across maternal employment status. Early childhood inequalities in overweight/obesity are pervasive across developed countries, as noted for older children and adults. However, mechanisms producing these gradients vary across national contexts. Our study shows that, given the right context, quality childcare and maternal employment can successfully support healthy weight trajectories and not contribute (or even reduce) social inequalities in early overweight/obesity.

Evaluation of the association of birth order and group childcare attendance with Kawasaki disease using data from a nationwide longitudinal survey.

Kawasaki disease (KD) is a form of pediatric systemic vasculitis. Although the etiology remains unclear, infections have been identified as possible triggers. Children with a later birth order and those who attend childcare are at a higher risk of infections due to exposure to pathogens from their older siblings and other childcare attendees. However, longitudinal studies exploring these associations are limited. Thus, we aimed to elucidate the relationship between birth order, group childcare attendance, and KD, using a nationwide longitudinal survey in Japan. In total, 36,885 children born in Japan in 2010 were included. The survey used questionnaires to identify hospitalized cases of KD. We evaluated the relationship between birth order classification, group childcare attendance, and KD prevalence every year, from 6 to 66 months of age. For each outcome, odds ratios (ORs), and 95% confidence intervals (CIs) were estimated after adjusting for child factors, parental factors, and region of residence. Children with higher birth orders were more likely to be hospitalized with KD at 6-18 months of age (second child OR: 1.77, 95% CI: 1.25-2.51; third child OR: 1.70, 95% CI: 1.08-2.65). This trend was stronger for children who did not attend group childcare (second child OR: 2.51, 95% CI: 1.57-4.01; third child OR: 2.41, 95% CI: 1.30-4.43). An increased risk of KD hospitalization owing to the birth order was not observed in any age group for children in the childcare group. Children with higher birth orders were at high risk for hospitalization due to KD at 6-18 months of age. The effect of birth order was more prominent among the children who did not attend group childcare.

Comparing the Etiology of Viral Acute Respiratory Illnesses Between Children Who Do and Do Not Attend Childcare.

Childcare attendance is a common risk factor for acute respiratory illness (ARI) in young children. Our goal was to better understand the specific respiratory viruses that predominate in childcare, which may support the development of tailored illness prevention and intervention strategies in childcare settings. Using data from a prospective household cohort of ARI surveillance, we assessed specimen from 1418 ARIs reported by 359 childcare-aged children over 6 study seasons (2012/2013 through 2017/2018). Respiratory swabs were tested by polymerase chain reaction for 9 respiratory viruses. A mixed-effect logistic regression model was used to compare odds of various viral detection outcomes. The Shannon's Diversity index was used to compare the richness (ie, number of species) and diversity (ie, relative species abundance) associated with respiratory viruses detected in both groups. At least 1 virus was detected in 75.5% of childcare-associated ARIs and in 80.1% of homecare ARIs. Compared with illnesses among homecare children, childcare illnesses were associated with significantly higher odds of detected adenovirus (odds ratio = 1.86, 95% confidence interval = 1.05-3.28) and human metapneumovirus (odds ratio = 1.76, 95% confidence interval = 1.03-3.0). The pool of viruses associated with childcare ARI was found to be significantly richer and more diverse than that of viruses associated with homecare ARI ( P < 0.0001). Children attending childcare experience a higher risk of adenovirus and human metapneumovirus infection and are regularly exposed to a rich and diverse pool of respiratory viruses in childcare environments. Our results underscore the necessity of thorough and multifaceted viral prevention strategies in childcare settings.

Childcare attendance and risk of childhood acute lymphoblastic leukaemia: A register study based on the Danish childcare database.

Childhood acute lymphoblastic leukaemia (ALL) is suggested to result from a dysregulated immune response to infections in children with a preleukaemic state. Childcare in early life supposedly may protect against childhood ALL by facilitating sufficient exposure to infections to stimulate and ensure normal maturation of the immune system. We assessed the association between childcare attendance before age 2 years and risk of childhood ALL in a register-based cohort study, including all children aged 2 to 14 years born in Denmark during 1991 to 2014 with available childcare information recorded in the Danish Childcare Database (n=1 116 185). Cox regression was used to estimate hazard ratios (HRs) comparing children enrolled in childcare and children not enrolled before age 2 years. Further, we assessed the association according to age at enrolment, type of childcare facility and specific ALL subtypes. During 10 460 811 person-years of follow-up, 460 children developed ALL at ages 2 to 14 years. Of these, 57 (12.4%) never attended childcare before age 2 years compared with 10.6% in the total cohort. Compared with homecare, childcare attendance before age 2 years was associated with a statistically non-significantly, marginally decreased risk of childhood ALL with adjusted HR=0.87 (95% confidence interval [CI]: 0.65-1.16). Risk estimates did neither vary statistically significantly by age at enrolment nor by type of childcare facility and also not between childhood ALL subtypes, including frequently prenatally initiated ALL subtypes. Results from this large, nationwide register-based study provided no evidence that childcare attendance in the first years of life protects against childhood ALL.

Human bocavirus-1 infections in Australian children aged < 2years: a birth cohort study.

To determine human bocavirus-1 (HBoV1) infection characteristics in young Australian children. Data were from the Observational Research in Childhood Infectious Diseases (ORChID) study, a Brisbane, Australia-based birth cohort of healthy, term, newborns followed prospectively for 2years. Parents recorded daily symptoms, maintained an illness-burden diary, and collected weekly nasal swabs, which were tested for 17 respiratory viruses, including HBoV1, by real-time polymerase chain reaction (PCR) assays. Main outcomes measured were infection incidence, risk factors, symptoms, and healthcare use. One hundred fifty-eight children in the ORChID cohort provided 11,126 weekly swabs, of which 157 swabs were HBoV1 positive involving 107 incident episodes. Co-detections were observed in 65/157 (41.4%) HBoV1-positive swabs (or 41/107 [38.3%] infection episodes), principally with rhinovirus. Shedding duration was 1week in 64.5% of episodes. The incidence of HBoV1 infections in the first 2years of life was 0.58 episodes per child-year (95% confidence interval [CI] 0.47-0.71), including 0.38 episodes per child-year (95% CI 0.30-0.49) associated with respiratory symptoms. Recurrent episodes occurred in 18/87 (20.7%) children following their primary infection. In the first 2years of life, incidence of HBoV1 episodes increased with age, during winter and with childcare attendance. Overall, 64.2% of HBoV1 episodes were symptomatic, with 26.4% having healthcare contact. Viral load estimates were higher when children were symptomatic than when asymptomatic (mean difference = 3.4; 95% CI 1.0-5.7 PCR cycle threshold units). After age 6months, HBoV1 is detected frequently in the first 2years of life, especially during winter. Symptoms are usually mild and associated with higher viral loads.

Childcare attendance and risk of infections in childhood and adolescence.

It has been suggested that the transiently increased infection risk following childcare enrolment is compensated by decreased infection risk later in childhood and adolescence. We investigated how childcare enrolment affected rates of antimicrobial-treated infections during childhood and adolescence. In a register-based cohort study of all children born in Denmark 1997-2014 with available exposure information (n = 1 007 448), we assessed the association between childcare enrolment before age 6 years and infection risks up to age 20 years, using antimicrobial exposure as proxy for infections. Nationwide childcare and prescription data were used. We estimated infection rates and the cumulative number of infections using adjusted Poisson regression models. We observed 4 599 993 independent episodes of infection (antimicrobial exposure) during follow-up. Childcare enrolment transiently increased infection rates; the younger the child, the greater the increase. The resulting increased cumulative number of infections associated with earlier age at childcare enrolment was not compensated by lower infection risk later in childhood or adolescence. Accordingly, children enrolled in childcare before age 12 months had experienced 0.5-0.7 more infections at age 6 years (in total 4.5-5.1 infections) than peers enrolled at age 3 years, differences that persisted throughout adolescence. The type of childcare had little impact on infection risks. Early age at childcare enrolment is associated with a modest increase in the cumulative number of antimicrobial-treated infections at all ages through adolescence. Emphasis should be given to disrupting infectious disease transmission in childcare facilities through prevention strategies with particular focus on the youngest children.

Sapovirus Infections in an Australian Community-Based Healthy Birth Cohort During the First 2 Years of Life.

Sapovirus is an important cause of acute gastroenteritis (AGE) in young children. However, knowledge gaps remain in community settings. We investigated the epidemiology, disease characteristics, and healthcare use associated with sapovirus infections in Australian children during their first 2 years of life. Children in the Brisbane-based Observational Research in Childhood Infectious Diseases birth cohort provided daily gastrointestinal symptoms (vomiting/loose stools), weekly stool swabs, and healthcare data until age 2 years. Swabs were batch-tested for sapovirus using real-time polymerase chain reaction assays. Incidence rates and estimates of associations were calculated. Overall, 158 children returned 11 124 swabs. There were 192 sapovirus infection episodes. The incidence rate in the first 2 years of life was 0.89 infections per child-year (95% confidence interval [CI], .76-1.05), and the symptomatic incidence rate was 0.26 episodes per child-year (95% CI, .17-.37). Age ≥6 months, the fall season, and childcare attendance increased disease incidence significantly. Fifty-four of the 180 (30%) infections with linked symptom diaries were symptomatic, with 72% recording vomiting and 48% diarrhea. Prior infection reduced risk of further infections (adjusted hazard ratio, 0.70 [95% CI, .54-.81]) in the study period. Viral loads were higher and viral shedding duration was longer in symptomatic than asymptomatic children. Twenty-three (43%) symptomatic episodes required healthcare, including 6 emergency department presentations and 2 hospitalizations. Sapovirus infections are common in Australian children aged 6-23 months. Efforts to reduce childhood AGE after the global rollout of rotavirus vaccines should include sapovirus where estimates of its incidence in communities will be crucial.

89 Centre-based child care attendance in early childhood and adiposity in later childhood: a prospective cohort study

Abstract Background One in three children are living with overweight or obesity in North America. The burden of childhood obesity is disproportionately experienced by children from low-income families, who are more likely to have obesity. Centre-based child care attendance may influence important adiposity risk factors such as dietary intake, eating behaviour, and physical activity, but its impact on childhood obesity is unclear. Objectives The primary objective was to evaluate the relationship between the intensity of centre-based child care attendance between 1 and 4 years of age and Body Mass Index z-score (zBMI) from 4 to 10 years of age relative to non-centre-based child care (i.e., home-based, grandparents, relatives, and nanny’s). The secondary objective was to explore if family income modified the relationship. Design/Methods A prospective cohort study of children 1 to 10 years of age was conducted through the TARGet Kids! primary care research network. The primary exposure was intensity of centre-based child care attendance (hours/week). The primary outcome was zBMI, an age and sex adjusted measure of child adiposity. Interaction terms for child age and family income were explored. A linear mixed effects model and logistic generalized estimating equations were used to determine the association between centre-based child care attendance and child zBMI. Results 3,503 children were included (mean age: 2.7 years). Children who attended centre-based child care full time (40 hours/week) had a 0.11 lower zBMI at 4 years (95% CI -0.19, -0.03; p=0.005) and lower odds of obesity (zBMI &amp;gt; 2) at 4 (OR 0.58; 95% CI 0.34, 0.99; p=0.04) and 10 years of age (OR 0.52; 95% CI 0.29, 0.90; p=0.02) relative to children who attended non-centre-based child care. The relationship was modified by family income such that, children from families with an income of &amp;lt;$50,000CDN who attended centre-based child care full time had a 0.35 (95% CI -0.56, -0.15; p=0.001), 0.34 (95% CI -0.54, -0.13, p=0.001) and 0.29 (95% CI -0.50, -0.07, p=0.009) lower zBMI at 4, 7 and 10 years of age, respectively, relative to children who attended non-centre-based child care. Conclusion Centre-based child care attendance in early childhood was associated with lower adiposity and odds of obesity in later childhood. This relationship was stronger for children who were from lower income families. Centre-based child care may be an effective early intervention to prevent childhood obesity.