Attending Child Care Research Articles

A Scoping Review of Relationship-based Training Programs for Early Childhood Educators.

Aim and Background: An increasing rise in childcare attendance has resulted in children spending additional time with non-parental caregivers, such as Early Childhood Educators (ECE’s). Strong relationships between children and ECE’s are important as these relationships impact on children’s development. Relationship-based training programs offered by occupational therapists, are one way of supporting educators with building and maintaining positive relationships with children in their care. This scoping review aimed to provide a summary of the features and outcomes of relationship-based training with ECE’s. Methods: After a systematic search and following PRISMA guidelines, a total of 26 studies were included. Results: A wide range of relationship-based training programs were described, with multiple components and group-based training, as well as individual consultation/coaching reported. All included studies reported that relationship-based training programs resulted in positive outcomes for children and/or educators. This review provides a foundation for designing relationship-based training programs for ECE’s.

Child Care Attendance and Educational and Economic Outcomes in Adulthood.

To test associations between onset of formal child care (in infancy or as a toddler), high school graduation, and employment earnings from ages 18 to 35 years. A 30-year prospective cohort follow-up study, with linkage to government administrative databases (N =3020). Exposure included formal child care, if any, by accredited caregivers in centers or residential settings at ages 6 months and 1, 1.5, 2, 3, and 4 years. A propensity score analysis was conducted to control for social selection bias. Of 2905 participants with data on child care use, 59.4% of male participants and 78.5% of female participants completed high school by age 22 to 23. Mean income at last follow-up (n = 2860) was $47 000 (Canadian dollars) (SD = 37 700) and $32 500 (SD = 26 800), respectively. Using group-based trajectory modeling, we identified 3 groups: formal child care onset in infancy (∼6 months), formal child care onset as a toddler (after 2.5 years), and never exposed. After propensity score weighting, boys with child care started in infancy had greater odds of graduating than those never exposed (odds ratio [OR] 1.39; 95% confidence interval [CI]: 1.18-1.63; P < .001). Boys attending child care had reduced odds of low income as young adults (infant onset: OR 0.60 [95% CI: 0.46-0.84; P < .001]; toddler onset: OR 0.63 [95% CI: 0.45-0.82; P < .001]). Girls' graduation rates and incomes revealed no significant association with child care attendance. For boys, formal child care was associated with higher high school completion rates and reduced risk of adult poverty. Benefits for boys may therefore extend beyond school readiness, academic performance, and parental workforce participation.

High-Quality Child Care as an Effective Antipoverty Strategy: Emerging Evidence From Canada.

In their article, “Child Care Attendance and Educational and Economic Outcomes in Adulthood,” Domond et al1 confirm extant literature revealing the lifelong impact of high-quality early care and education participation. Specifically, 2 seminal early intervention studies conducted in the United States, the HighScope Perry Preschool Program2 and the Carolina Abecedarian study,3 have revealed the academic, social, economic, and health benefits of early childhood education, especially for children placed at risk primarily because of poverty.4 These studies, which were based on a small sample of primarily African American children in specific communities, make it challenging to generalize the findings, and the lack of rigorous examination of the core components makes it difficult to replicate. The current study extends and expands our current knowledge about the impact of regulated early care and education, specifically child care, on children’s education attainment and economic stability. Of particular note … Address correspondence to Iheoma U. Iruka, PhD, HighScope Educational Research Foundation, 600 N River St, Ypsilanti, MI 48198. E-mail: iiruka{at}highscope.org

No obvious impact of caesarean delivery on childhood allergic outcomes: findings from Australian cohorts

Background and objectiveAs caesarean delivery and childhood allergy continue to rise, their inter-relationships may change. We examined whether caesarean delivery predicts allergic disease and impaired lung function in two contemporary...

Associations of childcare type, age at start, and intensity with body mass index trajectories from 10 to 42 years of age in the 1970 British Cohort Study.

Attending childcare is related to greater childhood obesity risk, but there are few long-term follow-up studies. We aimed to examine the associations of childcare type, age at start, and intensity with body mass index body mass index (BMI) trajectories from ages 10 to 42 years. The sample comprised 8234 individuals in the 1970 British Cohort Study, who had data on childcare attendance (no, yes), type (formal, informal), age at start (4-5, 3-3.99, 0-2.99 years old), and intensity (1, 2, 3, 4-5 days/week) reported at age 5 years and 32 563 BMI observations. Multilevel linear spline models were used to estimate the association of each exposure with the sample-average BMI trajectory, with covariate adjustment. A combined age at start and intensity exposure was also examined. Attending vs not attending and the type of childcare (none vs formal/informal) were not strongly related to BMI trajectories. Among participants who attended childcare 1 to 2 days a week, those who started when 3 to 3.99 years old had a 0.197 (-0.004, 0.399) kg/m2 higher BMI at age 10 years than those who started when 4 to 5 years old, and those who started when 0 to 2.99 years old had a 0.289 (0.049, 0.529) kg/m2 higher BMI. A similar dose-response pattern for intensity was observed when holding age at start constant. By age 42 years, individuals who started childcare at age 0 to 2.99 years and attended 3 to 5 days/week had a 1.356 kg/m2 (0.637, 2.075) higher BMI than individuals who started at age 4 to 5 years and attended 1 to 2 days/week. Children who start childcare earlier and/or attend more frequently may have greater long-term obesity risk.

Parental Acculturation Attitudes: Direct and Indirect Impacts on Children’s Second Language Acquisition

ABSTRACT The goal of the present study was to investigate the relationship between parental acculturation attitudes and second language (L2) skills and acquisition in immigrant children and to identify the mechanisms that potentially mediate between parental acculturation attitudes and children’s L2 skills and acquisition. Our longitudinal study is based on a sample of 252 children with German as L2 (age t1: M = 41 months; t2: M = 57 months) and their parents. Research Findings: Results revealed that parental acculturation attitudes toward the country of origin negatively correlated with children’s L2 skills at t1 and at t2. Furthermore, time spent in early childcare predicted L2 skills at t1 and at t2. Parental L2 proficiency and children’s contact with German language speakers outside of childcare were related to children’s L2 skills at t1. Parental L2 proficiency mediated the relationship between parental acculturation attitudes and children’s L2 skills. Practice or Policy: The findings support the importance of early childcare attendance and parental acculturation for L2 skills and acquisition in children with an immigrant background.

Maternal dietary inflammatory potential and quality are associated with offspring asthma risk over 10-year follow-up: the Lifeways Cross-Generation Cohort Study

Asthma is the most common childhood chronic health condition. Maternal antenatal diet has been associated with offspring asthma risk, but studies investigating maternal whole diet quality and inflammatory potential with long-term offspring follow-up (>5 y) are rare. We aimed to elucidate these associations in a prospective cohort study in Ireland. Early pregnancy diets were assessed using a validated FFQ from which energy-adjusted Dietary Inflammatory Index (E-DII) and Healthy Eating Index (HEI)-2015 scores were computed. Doctor-diagnosed offspring asthma status (general practitioner or parent reports) for the first 10 y of life was collected at 3-y, 5-y, and 9-y follow-up. A total of 862 mother-child pairs with information on maternal diet and ≥1 offspring asthma data points were included. The longitudinal associations between maternal E-DII and HEI scores and offspring asthma status were assessed using generalized estimating equations. Cumulative offspring asthma incidence was 21% over the 10-y period. In the main models, adjusted for maternal lifestyle and sociodemographic factors, a higher E-DII score, indicating a more proinflammatory diet, was associated with higher risk of offspring asthma (OR: 1.35; 95% CI: 1.10, 1.65; per 1-SD score increment), whereas a higher HEI-2015 score, indicating better dietary quality, was associated with lower risk (OR: 0.77; 95% CI: 0.64, 0.93) (both P<0.01). Results persisted with further adjustment for childhood factors (e.g., breastfeeding, diet, and childcare attendance) and parental asthma history. Similar associations were observed when E-DII and HEI-2015 scores were modeled in quartiles (both P-trend<0.05). Associations for HEI-2015 were attenuated after adjustment for E-DII, suggesting the importance of anti-inflammatory pathways. Our results suggest that a proinflammatory and low-quality diet during pregnancy is associated with a higher risk of offspring asthma. Pending confirmation from other studies, optimizing these aspects of maternal diet can be a promising strategy for reducing childhood asthma risk. This prospective observational study was registered at the ISRCTN Registry as ISRCTN16537904.

Maternal depressive symptoms and children's cognitive development: Does early childcare and child's sex matter?

BackgroundMaternal depressive symptoms (MDS) have been associated with poorer child cognitive development. Some studies have shown that childcare attendance moderates associations between MDS and child behavior problems, but we do not know if this is the case for children’s cognitive development. Furthermore, few studies have evaluated whether associations between MDS and child cognitive development differ for boys and girls at school entry.MethodsThis study used data from a population-based cohort study (n = 1364) comprising well-validated measures of children’s cognitive development including academic readiness and language development in kindergarten and reading and mathematics achievement in first grade. Information on MDS was collected repeatedly from the child's age of 5 months to 5 years and on childcare from 5 months to 4.5 years. Moderation analyses were conducted to evaluate the differential associations of MDS with children’s outcomes depending on the type of childcare attended and the child’s sex.ResultsChildcare type or child’s sex did not moderate associations between MDS and children’s cognitive outcomes except for MDS being associated with lower scores on reading achievement in first grade for girls with a very small effect size (sr2 = .003). Childcare attendance was associated with higher scores for children’s cognitive development, however these associations disappeared after adjusting for covariates including child, mother and family characteristics. Regardless of MDS and childcare type, boys had, even after adjusting for covariates, lower scores on academic readiness (sr2 = .029) and higher scores on mathematics achievement (sr2 = .004).ConclusionsChildren’s cognitive development at school entry was more strongly associated with maternal education, children’s age in kindergarten and number of months of schooling in first grade than MDS. Contrary to associations between MDS and child behavior problems, childcare attendance did not moderate associations between MDS and children’s cognitive development at school entry.

Associations of household environmental tobacco smoke exposure with respiratory symptoms and utilisation of medical services in healthy young children in Hong Kong.

INTRODUCTIONYoung children are especially vulnerable to environmental tobacco smoke (ETS) exposure. This study was carried out to determine whether household ETS exposure was associated with respiratory symptoms and medical service utilisation among Hong Kong healthy children in their first eighteen months of age.METHODSA secondary analysis was done on the data obtained from our previous cross-sectional territory-wide pneumococcal carriage surveillance study in Hong Kong in 2013–2014. All measures were reported by caregivers. Univariable and multivariable analyses were performed to examine the associations between ETS exposure and outcome measures. Covariates included children’s sex, age, body mass index z score, history of breastfeeding, gestational age at birth, birthweight, maternal age, living region, overcrowding of living area, household income, child care attendance, and presence of siblings. Additional adjustment for season and households’ respiratory symptoms were made to ascertain the association between ETS and children’s respiratory symptoms.RESULTSThe analysis included 1541 children (mean age: 11.2 ± 6.4 months; males: 50.7%). Current household ETS exposure (AOR=1.30; 95% CI: 1.00– 1.66; p=0.050) and postnatal maternal smoking (AOR=2.21; 95% CI: 1.06–4.64; p=0.035) were independently and significantly associated with all-cause doctor consultation in the past 3 months. Children living with more than one household smoker were more likely to have all-cause doctor consultation compared with the non-exposed children (AOR=1.70; 95% CI: 1.04–2.77, p=0.028). Postnatal maternal smoking was associated with all-cause hospitalisation in the past 3 months (AOR=2.48; 95% CI: 1.05–5.86; p=0.039). Children living in a household, where the daily consumption by household smokers was more than 20 cigarettes, were more likely to have respiratory symptoms compared with non-exposed children (AOR=1.99; 95% CI: 1.12–3.52; p=0.016).CONCLUSIONSHousehold ETS exposure in young children was associated with respiratory symptoms and all-cause outpatient or inpatient medical service utilisation. The associations were potentially dose-dependent.

Child care arrangements and gender: A national portrait of preschool-aged children

Gender disparities in academic achievement are of longstanding scholarly and societal concern. In the extensive literature on this topic, however, relatively few studies have considered the non-parental child care contexts where children spend their earliest years. This state of the evidence differs from disparities by race-ethnicity and socioeconomic status, where differences in types of child care attended have been considered. The current study provides a national portrait of gender differences in the type of child care attended among preschool-aged children in the United States. Framed by the accommodation model, we found boys were more likely than girls to attend centers in higher socio-economic status families, but the reverse was true among less affluent families. Parents’ general perspectives that center-based or home-based child care was better for preschool-aged children’s development and safety also differed when the study child was a boy versus girl in these higher and lower socio-economic status families. Because preschool-aged children’s center-based child care attendance has been associated with academic school readiness, we encourage future studies to probe these findings as part of continued efforts to understand and address gender disparities in average levels of school progress and achievement.

CHAMP: A cluster randomized-control trial to prevent obesity in child care centers

Foundational elements of lifelong health are formed during the preschool years. Child care attendance has nearly doubled in the past 5 years making child care centers an ideal setting to establish healthy habits that prevent pediatric obesity. Despite the promising evidence of efficacy of child care-based obesity prevention interventions, limited attention has been directed to criteria needed for implementation at scale. There is potential to improve children's dietary and physical activity behaviors in diverse communities through theory-based, culturally appropriate, manualized interventions, delivered by child care staff. CHAMP (Creating Healthy Habits Among Maryland Preschoolers) is a 3-arm cluster randomized controlled childhood obesity prevention trial, aiming to improve motor skills, physical activity and willingness to try new foods among 864 preschoolers (age 3–5 years) enrolled in 54 child care centers in 10 Maryland counties. CHAMP is informed by social-cognitive and bioecological theories and based on an evidence-based program, The Food Friends®. The two intervention arms include: 1) child care-center based lessons (18-week gross motor and 12-week nutrition) administered by trained child care staff, and 2) a web-based intervention for caregivers in addition to center-based lessons. Evaluations are conducted among children, caregivers, and child care staff at fall enrollment, midline, and spring, following intervention completion. Analyses include linear mixed-models, accounting for clustering and repeated measures, incorporating center-arms as moderators. CHAMP will provide evidence-based information to inform wellness guidelines and policies that can be disseminated broadly, to ensure that child care centers provide opportunities for children to develop healthy eating, and physical activity habits.Trial Registration: NCT03111264; https://clinicaltrials.gov/ct2/show/NCT03111264

Maternal depression symptoms, child behavior problems, and their transactional relations: Probing the role of formal childcare.

Among children exposed to elevated maternal depression symptoms (MDS), recent studies have demonstrated reduced internalizing and externalizing problems for those who have attended formal childcare (i.e., center-based, family-based childcare). However, these studies did not consider whether childcare attendance is associated with benefits for the child only or also with reduced MDS. Using a four-wave longitudinal cross-lagged model, we evaluated whether formal childcare attendance was associated with MDS or child behavior problems and whether it moderated longitudinal associations between MDS and child behavior problems and between child behavior problems and MDS. The sample was drawn from a population-based cohort study and consisted of 908 biologically related mother-child dyads, followed from 5 months to 5 years. Attending formal childcare was not associated with MDS or child behavior problems but moderated the association between MDS at 3.5 years and child internalizing and externalizing problems at 5 years as well as between girls' externalizing problems at 3.5 years and MDS at 5 years. No other moderation of formal childcare was found. Findings suggest that attending formal childcare reduces the risks of behavior problems in the context of MDS but also the risk of MDS in the context of girls' externalizing problems.

Cryptosporidiosis outbreaks — United States, 2009–2017

Cryptosporidium is a parasite that causes cryptosporidiosis, a profuse, watery diarrhea that can last up to 3 weeks in immunocompetent patients and can lead to life-threatening malnutrition and wasting in immunocompromised patients.* Fecal-oral transmission can occur by ingestion of contaminated recreational water, drinking water, or food, or through contact with infected persons or animals. For the period 2009-2017, public health officials from 40 states and Puerto Rico voluntarily reported 444 cryptosporidiosis outbreaks resulting in 7,465 cases. Exposure to treated recreational water (e.g., in pools and water playgrounds) was associated with 156 (35.1%) outbreaks resulting in 4,232 (56.7%) cases. Other predominant outbreak exposures included contact with cattle (65 outbreaks; 14.6%) and contact with infected persons in child care settings (57; 12.8%). The annual number of reported cryptosporidiosis outbreaks overall increased an average of approximately 13% per year over time. Reversing this trend will require dissemination of prevention messages to discourage swimming or attending child care while ill with diarrhea and encourage hand washing after contact with animals. Prevention and control measures can be optimized by improving understanding of Cryptosporidium transmission through regular analysis of systematically collected epidemiologic and molecular characterization data.

Parechovirus A Infections in Healthy Australian Children During the First 2 Years of Life: A Community-based Longitudinal Birth Cohort Study.

BackgroundHospital-based studies identify parechovirus (PeV), primarily PeV-A3, as an important cause of severe infections in young children. However, few community-based studies have been published and the true PeV infection burden is unknown. We investigated PeV epidemiology in healthy children participating in a community-based, longitudinal birth cohort study. MethodsAustralian children (n = 158) enrolled in the Observational Research in Childhood Infectious Diseases (ORChID) study were followed from birth until their second birthday. Weekly stool and nasal swabs and daily symptom diaries were collected. Swabs were tested for PeV by reverse-transcription polymerase chain reaction and genotypes determined by subgenomic sequencing. Incidence rate, infection characteristics, clinical associations, and virus codetections were investigated. ResultsPeV was detected in 1423 of 11 124 (12.8%) and 17 of 8100 (0.2%) stool and nasal swabs, respectively. Major genotypes among the 306 infection episodes identified were PeV-A1 (47.9%), PeV-A6 (20.1%), and PeV-A3 (18.3%). The incidence rate was 144 episodes (95% confidence interval, 128–160) per 100 child-years. First infections appeared at a median age of 8 (interquartile range, 6.0–11.7) months. Annual seasonal peaks changing from PeV-A1 to PeV-A3 were observed. Infection was positively associated with age ≥6 months, summer season, nonexclusive breastfeeding at age <3 months, and formal childcare attendance before age 12 months. Sole PeV infections were either asymptomatic (38.4%) or mild (32.7%), while codetection with other viruses in stool swabs was common (64.4%).ConclusionsIn contrast with hospital-based studies, this study showed that diverse and dynamically changing PeV genotypes circulate in the community causing mild or subclinical infections in children.Parechovirus can cause severe illnesses in children. However, studies focus mainly on hospitalized populations. True disease burden in the community remains largely unknown. From our community-based cohort, we found diverse parechovirus genotypes in the community, causing mild or subclinical infections in children.

Prevalence of Early Childhood Caries in Children Aged 1 to 5 Years in the City of Quito, Ecuador

Background: Early childhood caries is an aggressive pathology that can destroy the teeth in a short time, reaching the proximal surfaces, causing discomfort, pain and affecting the dental pulp, causing premature loss of deciduous teeth. Objective: The purpose of this research is to determine the prevalence of early childhood caries in children aged 1 to 5 years of the Metropolitan District of Quito. Materials and Methods: This is a cross-sectional study including a sample of 557 children attending child care centers in Quito, Ecuador, between May and July 2018. The sample was evaluated clinically registering the data in a simplified dental file containing the odontogram and the result of decayed, lost and sealed teeth, according to the dmft index, as well as data such as age and gender. Data were tabulated and analyzed statistically by independent t-test. Results: The prevalence of early childhood caries was found to be 59.61%. Children affected by early childhood caries presented a mean age of 2.83 years, the ones suffered the most from this pathology were those of 2 years (35.54%), followed by those of 3 years (34.94%) and 4 years (22.5%). Boys presented more early childhood caries (53.92%) in relation to the girls (46.08%). Conclusion: The early childhood caries presented a prevalence of 59.61% and a general dmft index of medium level of severity according to the classification of the World Health Organization, in children from 1 to 5 years of age in Quito, Ecuador.

O2 Participation in the Food Program Ensures Availability of Nutritious Foods but not Intake in Children Attending Childcare

Background Childcare programs participating in the federal Child and Adult Care Food Program (CACFP) serve nutritious foods and beverages to children. Most of these studies however, report on food served but not in comparison with the updated 2017 CACFP meal pattern and foods consumed. Objective The purpose of this study is to assess if CACFP-funded childcare centers are meeting the updated CACFP meal pattern and age-specific Dietary Guidelines for Americans (DGA) 2015-2020 regarding foods served and consumed by children, respectively. Study Design, Settings, Participants Cross-sectional study using dietary observation in childcare method. Children ages three to five years old (n = 108) from three CACFP childcare centers were recruited by convenience sampling. Measurable Outcome/Analysis Food served and food consumed were measured for five food groups during observed lunch. Amounts of food served from each food group were compared with age-specific minimum serving size requirement by CACFP using one-sample t-test. Amounts of food consumed from each food group were compared with age-specific recommendations by DGA using one-sample t-test. Proportions of foods consumed from the served amounts were calculated using descriptive statistics. Results Foods were served and portioned by the childcare providers for 81.5% (n = 88) of the children. Foods served were consistent with CACFP recommendations. Children were over-served whole grains, milk, fruits and vegetables (FV) than the CACFP requirement (P Conclusion Although childcare centers are serving foods based on CACFP requirements, children are not meeting DGA recommendations. CACFP childcare programs may benefit from training regarding best practices related to encouraging children's healthier food choices and managing food refusal. Funding USDA Hatch Project 1011204; Nebraska Agricultural Experiment Station.

Cryptosporidiosis Outbreaks — United States, 2009–2017

Cryptosporidium is a parasite that causes cryptosporidiosis, a profuse, watery diarrhea that can last up to 3 weeks in immunocompetent patients and can lead to life-threatening malnutrition and wasting in immunocompromised patients.* Fecal-oral transmission can occur by ingestion of contaminated recreational water, drinking water, or food, or through contact with infected persons or animals. For the period 2009-2017, public health officials from 40 states and Puerto Rico voluntarily reported 444 cryptosporidiosis outbreaks resulting in 7,465 cases. Exposure to treated recreational water (e.g., in pools and water playgrounds) was associated with 156 (35.1%) outbreaks resulting in 4,232 (56.7%) cases. Other predominant outbreak exposures included contact with cattle (65 outbreaks; 14.6%) and contact with infected persons in child care settings (57; 12.8%). The annual number of reported cryptosporidiosis outbreaks overall increased an average of approximately 13% per year over time. Reversing this trend will require dissemination of prevention messages to discourage swimming or attending child care while ill with diarrhea and encourage hand washing after contact with animals. Prevention and control measures can be optimized by improving understanding of Cryptosporidium transmission through regular analysis of systematically collected epidemiologic and molecular characterization data.

Maternal Dietary Inflammatory Potential and Quality Are Associated with Offspring Asthma Risk over 10-year Follow-up: The Lifeways Cross-Generation Cohort Study (OR35-05-19)

ObjectivesAsthma is the most common childhood chronic health condition. Maternal antenatal diet has been associated with offspring asthma risk, but long-term offspring follow-up (> 5 years) and studies investigating maternal whole diet quality and inflammatory potential are rare. We thus aimed to elucidate these associations using data from a prospective birth cohort study in Ireland. MethodsEarly pregnancy dietary data were obtained using a validated food frequency questionnaire. The Dietary Inflammatory Index (DII®) is a literature-based method to quantify dietary inflammatory potential; a higher score indicates a more pro-inflammatory diet. The Healthy Eating Index (HEI) 2015 contains 9 adequacy and 4 moderation components; a higher score indicates better dietary quality. Doctor-diagnosed offspring asthma status (general practitioner or parent reports) for the first 10 years of life was collected at 3-, 5-, and 9-year follow-up. A total of 862 mother-child pairs (singleton pregnancy with information on maternal diets and offspring asthma status) were included. The longitudinal association between maternal energy-adjusted DII and HEI scores and offspring asthma status was assessed using generalized estimating equations. Missing covariates were accounted for using 20 multiple imputations. ResultsCumulative offspring asthma incidence was 21% over the 10-year period. In the main models, adjusted for maternal lifestyle and sociodemographic factors, a higher DII score was associated with higher risk of offspring asthma (OR: 1.34; 95% CI: 1.10, 1.65; P = 0.004; per 1 SD score increment), while a higher HEI score was associated with lower risk (OR: 0.77; 95% CI: 0.64, 0.93; P = 0.006). Results persisted with further adjustment for childhood factors (breastfeeding, childcare attendance, dietary quality, active and sedentary time), damp in house and parental asthma history. Similar associations were observed when DII and HEI scores were modeled in quartiles (both P-trends < 0.05; Figure 1). ConclusionsOur results suggest that a pro-inflammatory and low-quality diet during pregnancy is associated with higher risk of offspring asthma. These results add to the knowledge base for informing maternal pregnancy dietary recommendations to optimize offspring health. Funding SourcesIrish Health Research Board, Science Foundation Ireland, and the European Union. Supporting Tables, Images and/or Graphs▪

Systematic Review of Early Child Care Centers in Low- and Middle-Income Countries and Health, Growth, and Development Among Children Aged 0–3 Years (P11-052-19)

ObjectivesTo examine associations between child care center attendance and child health, growth, and development in low-income and middle-income countries. MethodsSearches were conducted in the following databases: PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and ERIC. Inclusionary criteria were comparison of child care center participation with a nonparticipation group, aged 0–3 years, publication 2000–2018, and an English translation. Exclusionary criteria were specialized groups, co-intervention, or studies focused exclusively on children over 3 years of age. Eleven studies met criteria: 7 from South America (Brazil), 2 from Africa (Nigeria), and 2 from Asia (Turkey and Nepal). ResultsChild care centers, often implemented to enable mothers to work, included private, nongovernmental, and public programs. Children of older, better-educated mothers tended to enroll in private centers, and children from low-income communities and backgrounds in public centers. Child care center participation was associated with discontinued breastfeeding and increased infections. In some cases, longer duration of child care attendance was associated with improved immunity and normal growth, especially for the youngest children. Child development findings were mixed. Policies guiding the programs varied across the countries where studies were conducted; most countries were underdeveloped. ConclusionsMany LMIC are increasing their attention and support for early child care programs, often in support of maternal employment. By providing child care centers that are accessible, available, and affordable; that ensure safe and hygienic environments; and that include opportunities for age-appropriate activities and interactions with consistent and responsive caregivers, countries can promote young children’s health, growth, and development. Policies, programs, and investments that support high-quality child care can not only support mothers in the work force, but also enhance the country’s future by ensuring that young children receive the care and support needed to advance their development. Funding SourcesRTI International.Partial funding from the National Institutes of Health - National Institute of Diabetes and Digestive and Kidney Diseases

Human Parechovirus Infections in Healthy Australian Children During the First 2-Years of Life: A Community-Based Longitudinal Birth Cohort Study

Background: Hospital-based studies identify human parechovirus (HPeV), primarily HPeV3, as important causes of severe infections in young children. However, few community-based studies have been published and the true HPeV infection burden is unknown. We therefore investigated HPeV epidemiology in healthy children participating in a community-based, longitudinal birth cohort study. Methods: Australian children (n=158) enrolled in the Observational Research in Childhood Infectious Diseases (ORChID) study were followed from birth until their second birthday. Weekly stool and nasal swabs, and daily symptom diaries, were collected. Swabs were tested for HPeV by reverse-transcription polymerase chain reaction and genotypes determined by subgenomic sequencing. Incidence rate, infection characteristics, clinical associations, and virus co-detections were investigated. Findings: HPeV was detected in 1423/11127 (12·8%) and 17/8100 (0·2%) stool and nasal swabs, respectively. Major genotypes amongst the 306 infection episodes identified were HPeV1 (47·9%), HPeV6 (20·1%), and HPeV3 (18·3%). The incidence rate was 144 episodes/100 child-years (95% CI 128-160). First infections appeared at a median age of 8·0-months (interquartile range 6·0-11·7). Annual seasonal peaks changing from HPeV1 to HPeV3 were observed. Infection was positively associated with age ≥6-months, summer season, non-exclusive breastfeeding at age <3-months, and formal childcare attendance before age 12-months. Sole HPeV infections were either asymptomatic (38·4%) or mild (32·7%), while co-detection with other viruses was common (64·4%). Interpretation: Unlike in hospital-based studies, diverse, dynamically changing HPeV genotypes circulate in the community causing mild or subclinical infections in children. Funding: Australia National Health and Medical Research Council (GNT615700) and Children's Hospital Foundation Queensland (5006). Declaration of Interest: All authors declare no competing interests. Ethical Approval: The Children’s Health Queensland, Royal Brisbane and Women’s Hospital, and The University of Queensland Human Research Ethics Committees approved the study.