Children In Day Care Centers Research Articles

Child Care and the Well-being of Children

To evaluate studies of child care with specific attention to the impact of age at entry and amount, quality, and type of care on children's adaptive functioning. MEDLINE, PsychINFO, and the SAGE Full-Text Collection. The review considers correlational and experimental research conducted throughout the world that includes an adequate description of the type of care provided. Main Exposures Amount, quality, and type of child care. Language, cognitive and social competence, achievement, behavioral problems, relationships with parents, communicable illnesses, and asthma. Children who began care early in life and were in care 30 or more hours a week were at increased risk for stress-related behavioral problems. Elevated risk was more likely if they had difficulties interacting with peers or had insensitive parents. Children in day care centers had higher language scores and early school achievement, especially if they came from disadvantaged backgrounds and the centers offered high-quality care. Attending arrangements with 6 or more children increased the likelihood of communicable illnesses and ear infections, albeit those illnesses had no long-term adverse consequences. Child care is a multidimensional phenomenon. Guidance on when to place a child in nonparental care and what kind of care to use is complicated because of the multiplicity of sometimes offsetting effects on children. Child care experiences interact with experiences at home and the child's own characteristics, and research indicates that the quality of child care matters.

Height and weight of urban preschool children in relation to their mothers’ educational levels and employment status in Rasht City, northern Iran

This study determined the relationship between anthropometric status of 3-5-year-old urban children and theirs mothers' educational levels and employment status in Rasht City, northern Iran. A total of 1319 children (638 girls and 681 boys) at the ages of 3 and 6 years in all day-care centres in Rasht City were studied, using a cross-sectional design. Height and weight of the children were measured, and data on mothers' educational levels, employment status and duration of any breastfeeding were collected. Height for age, weight for age and weight for height of the children were compared with the National Center for Health Statistics (NCHS) reference population of the United States, and z-values <or=-2 were considered as stunted, underweight and wasted, respectively. The data showed that the prevalence of stunting, wasting and underweight were 8.6%, 8.0% and 7.1%, respectively. Our findings indicated that children of both less educated mothers (<5 years of schooling, OR = 2.54; 95% CI: 1.54-4.87) and college-educated mothers (>12 years of schooling, OR = 1.87; 95% CI: 1.08-2.4) had higher relative risk for underweight than children of mothers with an intermediate level of education (5-12 years of schooling). Children of mothers with college education were also more at risk for development of stunting (OR = 1.41; 95% CI: 1.14-4.22). In addition, children of employed mothers were more likely to be underweight (OR = 1.52; 95% CI: 1.05-2.31), stunted (OR = 2.42; 95% CI: 1.21-6.35) and wasted (OR = 3.35; 95% CI: 1.21-5.58) than children of non-employed mothers. The relative risk for undernutrition was higher in the children of both less and highly educated mothers compared with children of mothers with an intermediate level of education. Mothers' employment was also negatively related to nutritional status of these children in day-care centres in Rasht City.

Food Safety Revisited

Two papers in this issue of the Journal of Infectious Diseases focus on food safety from 2 different angles. First, in an elegant work from Finnish investigators [1], the culprit behind an epidemic caused by Yersinia pseudotuberculosis was uncovered: grated carrots. The same serotype and pulsed-field gel electrophoresis (PFGE) type of Y pseudotuberculosis was isolated from patients and from the farm where the carrots were grown and processed. The epidemic, which involved an estimated 558 patients, had its root in 1 kitchen preparing food for some 7400 individuals, mostly children in day-care centers or schools. The grated carrots were used in a raw salad without further processing. This first-time isolation of Y pseudotuberculosis from a contaminated food ingredient resulted from a rapid and relevant reaction from health authorities, as well as sound epidemiological and microbiological work, for which the authors are to be congratulated. Although there have been few published reports on this subject, it is not the first time that Y pseudotuberculosis has caused epidemics: they have been reported from Russia [2], Japan [3, 4], Canada [5], and even previously in Finland [6]. Several food ingredients have been incriminated-for example, carrots [3], lettuce [2], other vegetables [3], and even pickled products [4]. Y pseudotuberculosis has also been isolated from water and meat products [4]. The bacterium has been found in a range of animals, such as pigs, sheep, deer, hares, rabbits, wild boar, jackal, rodents, birds, and others [7-13]. In these animals, the organism can be cultured from tonsils, tongues, and all larger organs, as well as from the gut [11 ]. The animal reservoir probably explains how carrot plants can be contaminated on the ground or at any stage of storage if the carrots are not secluded from contact with animals or their feces. Another mode of contamination

Effect of Fortification of Drinking Water with Iron plus Ascorbic Acid or with Ascorbic Acid Alone on Hemoglobin Values and Anthropometric Indicators in Preschool Children in Day-Care Centers in Southeast Brazil

Iron-deficiency anemia currently is the most frequently occurring nutritional disorder world-wide. Previous Brazilian studies have demonstrated that drinking water fortified with iron and ascorbic acid is an adequate vehicle for improving the iron supply for children frequenting day-care centers. The objective of this study was to clarify the role of ascorbic acid as a vehicle for improving iron intake in children in day-care centers in Brazil. A six-month study was conducted on 150 children frequenting six day-care centers divided into two groups of three day-care centers by drawing lots: the iron-C group (3 day-care centers, n = 74), which used water fortified with 10 mg elemental iron and 100 mg ascorbic acid per liter, and the comparison group (3 day-care centers, n = 76), which used water containing only 100 mg ascorbic acid per liter. Anthropometric measurements and determinations of capillary hemoglobin were performed at the beginning of the study and after six months of intervention. The food offered at the day-care centers was also analyzed. The food offered at the day-care center was found to be deficient in ascorbic acid, poor in heme iron, and adequate in non-heme iron. Supplementation with fortified drinking water resulted in a decrease in the prevalence of anemia and an increase in mean hemoglobin levels associated with height gain in both groups. Fortification of drinking water with iron has previously demonstrated effectiveness in increasing iron supplies. This simple strategy was confirmed in the present study. The present study also demonstrated that for populations receiving an abundant supply of non-heme iron, it is possible to control anemia in a simple, safe, and inexpensive manner by adding ascorbic acid to drinking water.

Trends in drug resistance, serotypes, and molecular types of Streptococcus pneumoniae colonizing preschool-age children attending day care centers in Lisbon, Portugal: a summary of 4 years of annual surveillance.

Of the nasopharyngeal cultures recovered from 942 day care center (DCC) attendees in Lisbon, Portugal, 591 (62%) yielded Streptococcus pneumoniae during a surveillance performed in February and March of 1999. Forty percent of the isolates were resistant to one or more antimicrobial agents. In particular, 2% were penicillin resistant and 20% had intermediate penicillin resistance. Multidrug resistance to macrolides, lincosamides, and tetracycline was the most frequent antibiotype (17% of all isolates). Serotyping and molecular typing by pulsed-field gel electrophoresis were performed for 202 out of 237 drug-resistant pneumococci (DRPn). The most frequent serotypes were 6B (26%), 14 (22%), 19F (16%), 23F (10%), and nontypeable (12%). The majority (67%) of the DRPn strains were representatives of nine international clones included in the Pneumococcal Molecular Epidemiology Network; eight of them had been detected in previous studies. Fourteen novel clones were identified, corresponding to 26% of the DRPn strains. The remaining 7% of the strains were local clones detected in our previous studies. Comparison with studies conducted since 1996 in Portuguese DCCs identified several trends: (i) the rate of DRPn frequency has fluctuated between 40 and 50%; (ii) the serotypes most frequently recovered have remained the same; (iii) nontypeable strains appear to be increasing in frequency; and (iv) a clone of serotype 33F emerged in 1999. Together, our observations highlight that the nasopharynxes of children in DCCs are a melting pot of successful DRPn clones that are important to study and monitor if we aim to gain a better understanding on the epidemiology of this pathogen.

D1.2 Nasopharyngeal carriage of antimicrobial resistant Streptococcus pneumoniae and Haemophilus influenzae amongst children in day-care centers in Singapore

D1.2 Nasopharyngeal carriage of antimicrobial resistant Streptococcus pneumoniae and Haemophilus influenzae amongst children in day-care centers in Singapore

Does probiotic milk prevent infections in children attending daycare centres?

Objective: To examine whether long term consumption of a probiotic milk could reduce gastrointestinal and respiratory infections in children in daycare centres.

Behavior problems in young children: An analysis of cross‐informant agreements and disagreements

This study examined (a) convergence between parents' and day care teachers' ratings of children's behavior problems, and (b) whether agreements and disagreements were associated with characteristics of the informant, context, or measures. Parents of 241, 2-4-year old children in day care centers serving low-income families completed measures of child behavior problems, parenting style, stress, depression, and self-efficacy. Teachers completed a measure of classroom behavior problems. There was a low correlation between parents' and teachers' ratings of child behavior (r=.17), and few children (2.5%) received high behavior problem scores from both parents and teachers. Cross-informant agreement on high behavior problem children was related to characteristics of the informants and home context. Implications for identifying children at risk are discussed.

Commentary: Supersized vans: A supersized problem

Commentary: Supersized vans: A supersized problem

An intervention programme for improving the nutritional status of children aged 2-5 years in Alexandria

We assessed the effect of a selected intervention on the nutritional status of 2-5-year-old children in day care centres. Using a longitudinal prospective pretest/post-test intervention design, 974 children from 3 day care centres in Alexandria were followed for 1 year. Anthropometric measurements and 3-day 24-hour recall data were gathered at base line and dietary intake was calculated and compared with recommended daily allowances. An intervention programme was implemented through the establishment of kitchens in the 3 centres, provision of 2 meals/day, nutrition education for parents and training of supervisors. Baseline data revealed deficient intake of most nutrients especially calcium, calories, vitamin C and iron. Post-intervention test revealed improvement in mothers' nutrition knowledge and the percentage of anaemic children decreased from 47.3% to 14.2%. A decrease in the percentage of underweight, stunted and wasted was also observed. The cost of the programme per child per year was US$ 20.5.

Pesquisas contextuais e seus desafios: uma contribuição a partir de investigações sobre arranjos espaciais em creches

Objetivando caracterizar pesquisas ecológicas, diferenciando-as de pesquisas não ecológicas, são apresentados pressupostos compartilhados por vários autores, apesar de suas divergências na análise da relação pessoa-ambiente (nas dimensões focalizadas, metodologia ou teoria). Uma breve visão introdutória da abordagem ecológica em psicologia é descrita. São discutidos dois critérios, interligados entre si e conectados aos pressupostos básicos, que diferenciam pesquisas ecológicas ou contextuais das não ecológicas ou não contextuais. Nossa experiência de condução de pesquisas contextuais, sobre a relação entre arranjo espacial e ocupação do espaço por crianças em creches, ilustra vários aspectos abordados; são descritos, resumidamente, três conjuntos de variáveis contextuais adicionais, estudadas para verificar se afetariam a ocupação espacial. São apresentados certos desafios metodológicos em pesquisas contextuais.

Gut Microflora Changes and Probiotics in Children in Day-Care Centers

Background: This study was designed to assess gut microflora changes in children in Finnish day-care centers (DCCs). Methods: Ninety-four children in four DCCs were randomised to receive a combination of Lactobacillus acidophilus La 5 and Bifidobacterium lactis Bb 12 or placebo for six months. Faecal samples were collected monthly and during bouts of diarrhoea. The parents kept a daily record. These groups were similar to infections and antibiotic treatments during the last month before the study. Altogether 14/76 (18%) children developed diarrhoea, and 13 healthy children who did not were studied as controls from the same DCCs at the same time. The gut microflora of altogether 26 children was examined by fluorescent in situ hybridisation at the start of the study, and before and after diarrhoea. Results: Twelve of 26 subjects (46%) had initially an aberrant microflora as determined by high levels of clostridia, the remaining 14 (54%) had balanced microflora. In the group with aberrant microflora, 9/12 (75%) manifested diarrhoea during follow-up, whereas in the group with balanced microflora, 4/14 (29%) fell ill with diarrhoea (p = 0.04). Diarrhoea reduced the number of all bacteria for at least a month. Antibiotic therapies increased the numbers of bacteria, mostly the number of clostridia. The initial total number of bacteria in the probiotic group decreased significantly in the late follow-up samples; p = 0.0075, this being due to the stabilising effect of probiotics. During treatment with probiotics aberrant microflora tended to approach the pattern in balanced microflora. Conclusions: A smaller and more stable amount of bacteria in the gut microflora was associated with healthy outcome of children during the study. Not only infections and antibiotics caused disruption of the gut microflora; aberrance of the gut microflora itself seems to predispose a child to diarrhoea episodes and other infections. Probiotics reduced the aberrance.

Low hepatitis B prevalence among pre-school children in Denmark: saliva anti-HBc screening in day care centres.

Although Denmark has a low hepatitis B virus (HBV) prevalence, HBV transmission has been reported in Danish day-care centres. The aim of this study was to validate saliva anti-HBc testing as a method for HBV screening, the applicability of saliva sampling to pre-school children, and to determine the HBV prevalence in Danish day-care centres with a high proportion of immigrants. For validation, paired saliva and plasma samples were obtained from blood donors and injecting drug users. Employees and children in day-care centres with a high proportion of immigrant children were offered saliva screening followed by blood test if positive. The specificity and sensitivity of anti-HBc tests on saliva was 100% (102 blood donors and four injecting drug users) and 85.9% (61 of 71 anti-HBc-positive injecting drug users), respectively. In all samples from HBsAg (n = 7) or anti-HBc IgM-positives (n = 9), anti-HBc was detected in saliva. Adequate saliva samples were obtained from 93% (588/634) of children and 100% (166/166) of employees participating in the day-care centre survey. Among children 55% were of non-Scandinavian origin and only one (0.2%, 95% CI [0.0; 1.0]) was HBV positive. Among employees the corresponding values were 22% and 7 (4.2%). The positive predictive value of the saliva test was 25% (1/4) among children and 88% (7/8) among adults. In conclusion, saliva testing is feasible for HBV screening among children in low prevalence populations, but any anti-HBc reactivity should be confirmed by plasma analysis. The HBV prevalence in pre-school children in Denmark is low even among immigrants from endemic areas.

Incidences of nasopharyngeal colonization of respiratory bacterial pathogens in Japanese children attending day-care centers.

In Japan, many younger children attending day-care centers tend to frequently experience acute respiratory infections and prolonged otitis media. To evaluate the carriage rate of respiratory bacterial pathogens in children attending day-care centers in our district. Nasopharyngeal cultures of 156 healthy children between the ages of 1 month and 5 years were conducted at two day-care centers in Japan, in April 1999. The carriage rates of four major pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus) and the antibiotic susceptibilities of the isolates were examined. Streptococcus pneumoniae, H. influenzae, M. catarrhalis and S. aureus were detected in 94 (60.3%), 83 (53.2%), 54 (34.6%) and 28 (17.9%) children, respectively. A total of 141 (90.4%) children carried at least one pathogen among these four pathogens and 87 (55.8%) children carried more than one pathogen. Fifty-seven of the 94 (60.6%) S. pneumoniae isolates were penicillin-intermediately or highly resistant strains of S. pneumoniae (PISP/PRSP). Beta-lactamase producing H. influenzae was not detected. Twelve of the 28 (42.9%) S. aureus isolates were methicillin-resistant. The incidence of colonization by PISP/PRSP in children younger than 3 years (43/69, 62.3%) was significantly higher than that in children aged 3-5 years (14/87, 16.1%) (P < 0.0001). We conclude that the rates of colonization by respiratory bacterial pathogens, especially by antibiotic-resistant strains, were high in children attending day-care centers in our district, suggesting their horizontal spread among children in day-care centers. Considering that the majority of children attending day- care centers carried one or more of the bacterial pathogens, the judicious use of antimicrobials will be required to prevent the increase of antibiotic-resistant rates among the colonizing pathogens.

Factors determining weight and height in children aged 3 months to 6 years enrolled in a public municipal day-care center in Brazil

To assess factors determining growth in a group of children between 3 months and 6 years old enrolled in a public municipal (i.e., government-supported, not private) day-care center, in comparison to a group of children with similar characteristics but who were not enrolled in the center. A quasi-experimental study was designed to observe 444 children aged 3 to 72 months from a low-income neighborhood in the city of Sorocaba, in the state of São Paulo, Brazil. Two groups were studied: 164 children enrolled in a local municipal day-care center (intervention group) and 280 not receiving care at the center (nonintervention, comparison group) but instead being cared for at home. Both groups were seen four times over a period of 16 months. At each observation session, the children's weight and height were measured. Information was also collected on the mother's sociodemographic characteristics and the illnesses she had suffered as well as the child's weight and other health characteristics at birth, the child's illnesses in the 15 days before each observation, and any hospitalizations. The children in both groups were from low-income families, with 65% of the families having an average monthly income below US$ 100; 80% of the mothers had received 8 years of schooling or less. Multivariate linear regression analysis showed that at the first observation (just before enrollment in the day-care center), birth weight was the only factor that explained the nutritional differences between the two groups. Subsequent analyses showed that being in day care was the factor that best explained the differences between the groups, especially in terms of the adequacy of weight for age, after controlling for birthweight, sex, age at the beginning of the study, and illnesses in the 15 days before an observation session. The nutritional impact of the intervention was significant as early as 3 months after being enrolled in day care. The nutritional benefits of the care provided at the center outweighed the negative effects sometimes seen in such centers, such as the greater morbidity that children in day-care centers often experience in comparison to children receiving care at home.

Nasopharyngeal penicillin-resistant Streptococcus pneumoniae strains among young children in Japan.

A rapid increase of penicillin resistance in Streptococcus pneumoniae has recently been reported in most areas of the world. Penicillin-resistant S. pneumoniae and other resistant bacteria are the principal causes of recurrent acute otitis media (AOM). Penicillin-resistant S. pneumoniae was examined so that we could investigate the bacteriologic and clinical interpretations of nasopharyngeal flora from healthy children. We obtained nasopharyngeal swab specimens from healthy children attending a day care center and from children attending a public health examination in Kanazawa, Japan. We also obtained clinical specimens from children with AOM who visited the Kanazawa University Hospital and 4 other hospitals in Ishikawa Prefecture in Japan. The chief bacteria from the children were S. pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Penicillin-resistant S. pneumoniae was identified in 75% of children attending a day care center. On the other hand, S. pneumoniae was identified in 37% of children who were not attending day care. Of the children with AOM, penicillin-resistant S. pneumoniae was identified in 77%. Our results suggest that there is a strong relationship between day care attendance and nasopharyngeal carriage of S. pneumoniae. The carriage rate of penicillin-resistant S. pneumoniae in healthy children in day care centers was very high and similar to the carriage rate of young patients with AOM in Japan.

Detection of anti-Giardia lamblia serum antibody among children of day care centers.

To detect anti-Giardia lamblia serum antibodies in healthy children attending public day care centers and to assess serological tests as tools for estimating the prevalence of G. lamblia in endemic areas. Three separate stool specimens and filter paper blood samples were collected from 147 children ranging from 0 to 6 years old. Each stool sample was processed using spontaneous sedimentation and zinc sulfate flotation methods. Blood samples were tested by indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) for Giardia IgG. Of 147 individuals tested, 93 (63.3%) showed Giardia cysts in their feces. Using IIF and ELISA, serum antibodies were detected in 93 (63.3%) and 100 (68%) samples, respectively. Sensitivity of IIF and ELISA was 82% and 72%, respectively. However, ELISA revealed to be less specific (39%) than IIF (70%). IIF also showed a higher concordance with microscopic examination than ELISA.

Carriage of penicillin-resistant Streptococcus pneumoniae by children in day-care centers during an intervention program in Malmo, Sweden

An increasing incidence of penicillin-resistant Streptococcus pneumoniae (PRP) was detected in Malmo in 1994. To evaluate clonality and factors facilitating the spread of PRP among children in day-care centers (DCCs). We used phenotypic and DNA-fingerprinting methods in conjunction with epidemiologic data from the South Swedish Pneumococcal Intervention Project's investigation of 63 DCCs during a 3-year period (1995 to 1997) in the Malmo region. A questionnaire about building and hygiene standards disclosed no statistically significant risk factor for carriage of pneumococci. However, age younger than the mean age at the DCC or in the child group was positively associated with carriage. Contrary to expectations no association with the number of children, either at the DCC or in the individual groups, was found. Of 2912 investigated children 1224 (42%) were carriers of S. pneumoniae, and 373 (12.8%) were PRP carriers (MIC > or = 0.1 microg/ml). Among isolates with MIC > or = 0.5 microg/ml 9 serogroups and 30 genetic types were found. Two clones in serogroups 9 (33%) and 19 (24%) were dominant in most municipality districts, and dominance was sustained during the whole study period. The previously internationally recognized serotype 9V clone seemed to be very stable, with a single DNA type and resistance pattern during the study period. In contrast the serogroup 19 isolates and other serogroups had diverse DNA types and resistance patterns, supporting the hypothesis that DCCs have a unique microenvironment facilitating the recombination of penicillin-binding protein genes among streptococci. In five DCCs we found PRP isolates with two different serogroups but an identical genetic type, indicating that serotype shift may be a common phenomenon in DCCs. Multivariate logistic regression of risk factors disclosed that young age of the children in the child groups was a significant risk factor for carriage of S. pneumoniae.

Susceptibility of S. pneumoniae to various antibiotics aong strains isolated from patients and healthy carriers in different regions of Brazil(1999-2000).

Resistance of microbes to commonly used antibiotics became a major concern at the end of the last century. Because Streptococcus pneumoniae is the most common pathogen in respiratory infections, we conducted microbiological assessment of drug susceptibility patterns among strains collected from two different population groups: 1) adult and pediatric patients (375 isolates) with different infections, and 2) healthy children in day care centers (<5 years old; 350 isolates). High level resistance to penicillin was not identified in either group. Intermediate resistance levels were similar in both groups (adults: 9.9%; children: 9.2%). The Central West region of Brazil tended to have lower susceptibility of S. Pneumoniae from infected adults and children to penicillin (81% vs. 93% in the South and 90% in the Southeast), tetracycline (64% vs. 80% and 76%), and trimethoprim/sulfamethoxazole (14% vs. 34%). Susceptibility was similar among strains from nasal cultures of healthy children tested in each of 4 regions of Brazil. All isolates were susceptible to cefaclor, cefotaxime and amoxacillin/clavulanate. This study, in two distinct populations, allowed characterization of local microbiological resistance patterns. This data is expected to be of use in guiding empiric therapy in the different regions of Brazil.

Cytomegalovirus DNA among children attending two day-care centers in Tokyo.

In the USA, a high prevalence rate of cytomegalovirus (CMV) excretion among children in day-care centres was reported. However, there is no research about the prevalence rate of CMV among children in day-care centres in Japan. The CMV excretion was studied in 54 children's saliva samples, collected from two different day-care centres in Tokyo. As a control, the prevalence of CMV was studied among 61 healthy children who did not attend any day-care centers. The CMV DNA in saliva were examined by polymerase chain reaction (PCR) analysis with one pair of primers for the immediate early region. The sequence of CMV genomes were examined in CMV PCR positive samples. Of the 54 saliva samples, 20.6% (6/29) and 24% (6/25) were CMV PCR positive in children at A and B day-care centres, respectively. The overall positivity of CMV PCR in saliva was 22.2% (12/54). Of the 61 saliva samples as the control study, 6.5% (4/61) were CMV PCR positive. There was a difference in the positivity in each age group of day-care centres and normal control. Each sample of the same day-care center gave conclusive and identical sequence results. We suspected that in each day-care center that there was one prevailing viral strain. We suppose that CMV infections were acquired inside the day-care centres. This is a first report which described viral transmission in day-care centres in Japan.