Children In Home Care Research Articles

Day-care centers and diarrhea: A public health perspective

To assess the relation between morbidity from acute diarrhea and the form of day care. The design was a retrospective cohort study. The setting was the city of Espoo, an urban-suburban municipality in southern Finland with a population of 170,000. The study population comprised 2568 randomly selected children aged 1 to 7 years. The main outcome measure was the occurrence of diarrhea. Children in day-care centers (DCCs) had an increased risk for acute diarrhea compared with children in home care. In the whole group of children in DCCs, the relative risk was 1.20 (95% confidence interval [CI], 1.08 to 1.34). The risk was greatest in 1- and 2-year-old children, for whom the estimated relative risks were 1.76 (95% CI, 1.28 to 2.43) and 1.56 (95% CI, 1.16 to 2.09), respectively. The proportion of diarrhea episodes attributable to DCC care in 1-year-old children was 49% (95% CI, 18% to 91%), in 2-year-old children 37% (95% CI, 11% to 73%), and in the whole group 17% (95% CI, 7% to 29%). The infection risk did not differ between children in home and family care. The results provide quantitative evidence that the care in DCCs is a major determinant of acute diarrhea in children, whereas family day care does not increase the infection risk.

The impact of day care on ventilation tube insertion

Objective: To study the effect of day care and tube type, as well as other risk factors related to ventilation tube insertion and reinsertion. Design: A case series of 456 consecutive cases with 162 controls from a well-baby examination group evaluated for age, sex, smoking history and day care attendance. Setting: Private practice in a mid-sized, southeastern university town. Patients and controls: This was a referred sample of patients who were entered consecutively in a private-practice setting. All children were age five or less at entry into the study. Interventions: Children underwent ventilation tube insertion with or without adenoidectomy, using standing indications. Main outcome measures: The primary outcome measures were whether or not a child had the need for a second set of tubes, and also determining the status of the child's ears for at least 1 year after tubes had extruded. Results: Day care and young age were both identified as risk factors associated with initial ventilation tube insertion. Only 11% (seven out of 63) of home care children, as compared with 31% (108 out of 346) day care children, had the insertion of ventilation tubes ( P=0.000). Day care children who had tubes inserted and adenoidectomy (with or without tonsillectomy) had a significantly lower rate of reintubation than children who had tube insertion alone ( P=0.00). Day care and young age are significant risk factors for any child, both with a first set of tubes and for ventilation tube reinsertion. Children in day care had a reintubation rate of 36% as compared to 11% for those in home care. Parents should be aware that day care can represent a two-fold hazard-both in the observed connection between day care and tube insertion and the demonstrated increased probability of reinsertion. Any studies looking at ventilation tube outcomes need to make certain to monitor for day care attendance.

Care of the Ill Child in Day-Care Settings

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

A Home Is Not a School: The Effects of Child Care on Children's Development

Assessments of 150 2–4‐year‐olds in six different child care arrangements revealed that the social and intellectual development of children in centers (part time or full time) was advanced over that of the children in home care (with mother, sitter, or day care home provider). Previous research was reviewed to account for this finding. It was concluded that the most likely causes of the difference in children's development were educational lessons, opportunities to practice skills and follow rules with a variety of peers and nonparental adults, and encouragement of independence by nonauthoritarian teachers—experiences that are qualitatively different from the experiences most children have in home care environments.

A comparison of helping, sharing, comforting, honesty, and civic awareness for children in home care, day care, and preschool

Fifty-nine children, including 18 children (10 girls and eight boys) just entering preschool, 19 children (eight girls and 11 boys) just entering or reentering day care, and 22 children (10 girls and 12 boys) in home care were asked to give their solutions to helping, sharing, comforting, and honesty dilemmas and to identify public figures from their pictures (civic awareness). The three subsamples were retested three months later. Scores differed among groups for dependent variables only in civic awareness. Preschool children scored higher on civic awareness than day care or home care children.

INFECTIONS IN CHILDHOOD DAY CARE.

Children in day care have more respiratory infections during the first year of life than do children in home care, but this prospective study suggests

Frequency and severity of infections in day care: Three-year follow-up

This study was undertaken to compare prospectively the frequency, nature, and severity of infections in children participating in three types of child care arrangements: home care, group care (two to six children), and day care (seven or more children). Children were enrolled at birth and observed for at least 36 months. The families were telephoned every 2 weeks to record on a standardized form the type and severity of illness during the previous interval. Children remaining in their original child care group for 1, 2, or 3 years were compared with regard to the frequency and severity of illness. Each child care group had the highest number of infections in year 2. Children in day care had more respiratory infections during each year than children in home care, but the magnitude of the differences decreased in year 3. When the child care groups were compared for the proportion of children with more than six illness per year or more than 60 days of respiratory illness per year, significant differences observed in years 1 and 2 for day care children compared with home care children were no longer significant in year 3. We conclude that there is a trend toward stabilized or decreased rates of infection, duration of illness, and risk of hospitalization for children remaining in day care for 3 years.

Upper Respiratory Tract Infections in Young Children: Duration of and Frequency of Complications

This study was performed to determine the usual duration of community-acquired viral upper respiratory tract infections and the incidence of complications (otitis media/sinusitis) of these respiratory tract infections in infancy and early childhood. Children in various forms of child-care arrangements (home care, group care, and day care) were enrolled at birth and observed for 3 years. Families were telephoned every 2 weeks to record on a standardized form the type and severity of illnesses experienced during the previous interval. Only children remaining in their original child-care group for the entire study period were compared. The mean duration of an upper respiratory tract infection varied between 6.6 days (for 1- to 2-year-old children in home care) and 8.9 days (for children younger than 1 year in day care). The percentage of apparently simple upper respiratory tract infections that lasted more than 15 days ranged from 6.5% (for 1- to 3-year-old children in home care) to 13.1% (for 2- to 3-year-old children in day care). Children in day care were more likely than children in home care to have protracted respiratory symptoms. Of 2741 respiratory tract infections recorded for the 3-year period, 801 (29.2%) were complicated by otitis media. During the first 2 years of life, children in any type of day care were more likely than children in home care to have otitis media as a complication of upper respiratory tract infection. In year 3, the risk of otitis media was similar in all types of child care.

Caregiver behaviours and adaptive behavior development of very young children in home care and daycare

The purpose of this study was to determine the effect of home#shmother care and daycare caregiver behaviors on the adaptive behavior development of children #op18 to 24 months#cp. Other variables under investigation included two indices of socioeconomic status #opSES#cp: occupation and education of parents. The sample consisted of 72 children: 36 in a group daycare situation and 36 at home with the mother. The investigator measured adaptive behavior development using the revised Vineland Adaptive Behavior Scale by Sparrow, Balla, and Cicchetti #op1984#cp. The investigators administered The Family Daycare Rating Scale #opHarms & Clifford, 1984#cp to mothers and caregivers of children to measure growth‐facilitating behaviors. A 3 X 2 ANOVA was used with two levels for mothers and with three levels of care ‐‐ child in home, child in daycare where caregivers show high frequency, and child in daycare where caregivers show low frequency of growth‐facilitating behavior. Results revealed higher Adaptive Behavior ...

Frequency and severity of infections in day care

This study was undertaken to compare prospectively the frequency, nature, and severity of infections experienced by children in three types of child care arrangements: home care, group care (two to six children), and day care (seven or more children). Children were enrolled at birth and observed for 12 to 18 months. At entry there were 159 children in home care, 40 in group care, and 45 in day care. The families were telephoned every 2 weeks to record on a standardized form the type and severity of illnesses experienced during the previous interval. Severe illnesses were defined by high fever, duration exceeding 10 days, or physician visit. Children remaining in their original child care group for at least 1 year were compared with regard to the frequency and severity of illness. Children in group care and day care were more likely than children in home care to experience at least six respiratory infections, more than 60 days of illness, and more than four severe illnesses (P less than 0.01). Similarly, life table analyses showed that children in home care had fewer episodes of infection than did children in day care (P less than 0.01). Although no children were hospitalized because of acute infections during the first year of study, hospitalization for myringotomy and tube placement occurred in 21% of children in day care and 3% of children in home care (P less than 0.01).

FREQUENCY OF INFECTIONS IN VARIOUS DAY CARE SETTINGS

In the U.S. the number of day care facilities is large and rapidly increasing. The precise frequency, nature and age-distribution of infections have not been established for various types of day care. This study was undertaken to prospectively compare these variables in children in day care centers {(DC)> 7 children}, family day care { (FC) 2-6} children and home care (HC). Children born at Magee Women's Hospital from Jun '85 to Apr '86 were eligible for study if their parents had decided on a type of child care and were willing to maintain a daily health calendar. Children entering FC (30) and DC (36) were matched as closely as possible with children in HC (120) for SES, sex and number of siblings. The families were telephoned every 2 weeks; the type and severity of illnesses experienced during the previous interval were recorded utilizing a standardized questionnaire. “Severe” illnesses were defined by high fever (T> 102°F, >3 days), duration >10 days or a physician visit. Children have been followed for 7-16 months. The source of medical care and assessment were private practitioners in more than 90% of each group. Children in DC experienced a greater frequency (6.9 vs 3.1 days of illness/month) and more “severe” illnesses (35% vs 18%) than children in HC (p<.05) during their first year of life. Almost all infections involved the respiratory tract. Tympanostomy tube insertion was undertaken in 0.8% of children in HC, 0.0% in FC and 16.7% in DC. Continued follow-up is necessary to determine whether this pattern of infection will be maintained.

Infectious diseases and day care.

Infectious diseases often occurring in epidemics, are to be expected in group day care because of the susceptibility of infants and toddlers to infection and the ready transmission of infection in the day care setting. Children in day care have more respiratory and gastrointestinal infections and are at higher risk for meningitis due to Haemophilus influenzae than are children in home care. Infections acquired by the child in the day care center may spread to members of the household and to the community. Illness in the child in day care may necessitate care at home and a change in plans of the parents; family stress may result. Infections in the day care center can be limited by appropriate use of the physical facilities, education of personnel in standards of hygiene, and maintenance of recommended immunizations of children and adult care givers. Simple techniques of infection control, such as hand washing, are the most effective.

Parent—Child interaction and daycare: Does quality of daycare matter?

A Daycare Quality Assessment Instrument was developed and subsequently usedto select two high-quality and two poor-quality daycare centers. Three- to 5-year-old children from these centers as well as home-care controls were observed in the laboratory interacting with their mothers during three types of episodes: while ignored, while attended to, and while required to do a difficult task. Overall, behavior differed during the various episodes; more importantly, the three groups did not behave equivalently. Children in poor-quality daycare were less compliant with task instructions than were other children. Verbal interaction patterns differed as well, with home-care children carrying on more sustained dialogues, while children attending poor-quality daycare were more likely to have verbal interaction limited to numerous single statements—that is, less dyadic interchange. Children attending good-quality daycare were intermediate. Results were interpreted in terms of children learning patterns of adult interaction at daycare that affect interactions with their mothers.

Foster Care for Child Maltreatment. II. Impact on School Performance

At least 150,000 children currently reside in foster care in the United States because of child maltreatment. Nearly 15% of all confirmed maltreatment reports record foster care as one of the acute interventions. Yet, the impact of foster care has been largely unexamined. We conducted a historical cohort study of the impact of foster care on subsequent school performances for 114 children placed in foster care because of maltreatment. A comparison cohort was constituted of 106 maltreated children who were similar in age, race, sex, and year of diagnosis but who were left in their homes after report. School records were reviewed for 96 of the foster care children and 69 of the home care children. School attendance had improved for both groups at the time of follow-up nearly 8 years later. Children in school at the time of report who were then placed in foster care missed an average of 15.6% of the school year prior to the report compared with missing only 3.48% of the most recent school year. The children from the comparison group missed an average of 8.5% of the school year prior to their index maltreatment report and 7.2% of their most recent year in school. Forty-four percent of the foster care group achieved average or above average grades on follow-up compared with the passing rate for the home care group of 32% (P = .17). The foster care children were more likely to receive special education services. Overall, both groups were doing poor work in school an average of 8 years after maltreatment report. There appears to be no evidence for a significant rehabilitative effect of foster care as measured by subsequent school performance.

Foster Care for Child Maltreatment: Impact on Delinquent Behavior

Previous reports of child maltreatment sequelae have not systematically examined the effects of societal intervention. A historical cohort study has been undertaken to examine the impact of one intervention, foster care, on the subsequent development of juvenile delinquency among child victims. One hundred fourteen foster children, aged 11 to 18 years, in foster care for three or more years, and who were in foster care as a result of maltreatment were studied. A comparison cohort was composed of 106 victims of maltreatment who were left in their family home; these children were similar to the children in foster care with regard to age, race, sex, and year of diagnosis. Cohort differences in maternal education, type of abuse, history of prior maltreatment, sex, and race were controlled in the analysis. Foster children committed 0.050 crimes per person-year after age 11 years; home care children committed 0.059 crimes per person-year after age 11 years (P greater than .2). Foster children were more likely to have committed criminal assault. Among foster children, increased number of foster home placements correlated with increased number of delinquency convictions. Overall, there appears to be no support for the idea that foster care is responsible for a significant portion of later problems encountered by victims of maltreatment.

Childrenʼs perceptions of their siblingʼs death at home or hospital

Nineteen children whose sibling participated in a home care program for dying children and 17 children whose sibling died in the hospital were interviewed 1 year after the death. Questions were designed to assess three time periods: the weeks immediately preceding their sibling's death, the time of the death itself, and the year following the death. Children who participated in home care described a significantly different experience than those whose sibling died in the hospital. The majority of home care children reported that they were prepared for the impending death, received consistent information and support from their parents, were involved in most activities concerning the dying child, were present for the death, and viewed their own involvement as the most important aspect of the experience. Non-home care children generally described themselves as having been inadequately prepared for the death, isolated from the dying child and their parents, unable to use their parents for support or information, unclear as to the circumstances of the death, and useless in terms of their own involvement. The relationship of these perceptions to subsequent adaptation is discussed and provides insights into the factors which facilitate more positive adjustment for children following their sibling's death at home.

Four year old day care and home care children's parental perceptions

Four year old day care and home care children's parental perceptions

Increased Frequency of Cytomegalovirus Infection in Children in Group Day Care

The prevalence of cytomegalovirus (CMV) infection in 103 children attending a single day care center was compared with that of 62 children kept at home. Demographic features of the day care group were similar to those of the home care group; in both groups, most of the children were white, were from middle-income families with two or fewer children, and had parents with 15 or more years of education. Ten of 57 (18%) children in home care had serum antibody to cytomegalovirus (CMV) and 2/25 (8%) had viruria. In contrast, 59/103 (57%) of children from the day care center were shedding CMV in urine or saliva. Although less than 10% of infants aged less than 1 year were excreting CMV, 78% of infants studied between 12 and 18 months of age had CMV isolated from a saliva or urine specimen. Group day care appears likely to result in early acquisition of CMV. Excretion of CMV by children in day care centers could result in transmission of the virus to susceptible day care workers or mothers, with the potential risk of fetal infection.

Some Aspects of Identity Problems in Foster Families

There has been an increasing motivation for foster care and adoption within the last years; foster parents are seen as a positive alternative to home care; furthermore there seems to be a differentiated understanding for “factual parenthood” in public opinion. Nevertheless the social status of a foster child is a problematic one; in addition there is no relevant role script for foster parents at all. These deficits lead to identity problems: the research design, interpretated in this article, is asking for self-concepts to foster parenting. By interrogation of a sample of foster parents, belonging to the “Bundesverband der Pflege—und Adoptiveltern e.V.” in Western Germany, the basis of motivation and selfconcepts can be seen more distinctively. In spite of declining numbers of children in home care and increasing places in foster care the chance of identificational continuity will be a great task in future for foster children and parents as well. In general, there is too much administration involved in the matching of foster children and foster parents and too little psychological support concerning identity problems.

Peer and parent-child interaction before and after enrollment in nursery school

Forty-five three-year-olds and their parents participated in the research. Twenty-four of the children were observed two months and one week before, as well as two months after, enrollment in a nursery school. The others were observed at comparable intervals, but remained at home in the fulltime care of their parents. On all occasions, the children who were about to enter or had entered nursery school engaged in more positive interaction with and sought more proximity to their parents than the home care children did. These tendencies were unaffected by enrollment in nursery school. There were no differences between nursery school and home care children on measures of peer interaction eithe before or after nursery school began. The need to consider differences between nursery school and home care children that antedate enrollment is emphasized.