Children who attend day-care centers -- and their families -- face an increased risk of catching some diseases, including hepatitis, but the odds of getting sick could be lowered substantially with a few simple and inexpensive measures, reports a new study published in the journal Pediatrics.
"The country is not about to enter a period of widespread epidemic illness associated with day care," write Dr. Ron Haskins, a developmental psychologist, and Dr. Jonathan Kotch, a pediatrician, both affiliated with the Bush Institute for Child and Family Policy at the University of North Carolina at Chapel Hill.
"Most day-care facilities are usually safe places for children," they conclude, "and the overwhelming majority of children will not suffer adverse consequences if the current situation persists."
Yet children who attend day care "are at higher risk than kids who stay at home," said Haskins, who is now serving as a special congressional fellow for Sen. Paul Simon D-Ill. . "There is a reluctance among many people to accept any of day care's shortcomings . . . We ought to stop denying it and start doing something about it."
In a review of more than 170 different scientific studies on day-care illnesses, Haskins and Kotch found that children who attend day care are at increased risk for developing gastrointestinal diseases including Giardiasis and cryptosporidia, hepatitis A, and potentially fatal meningitis (usually as a complication of developing the bacterial illness called hemophilus influenza, or H. flu).
When a child attending day care becomes ill with one of these diseases and spreads it to his or her family, the result is higher family medical bills and often lost wages, the study found. If each mother or father of a day-care student missed two days of work per year because their child caught a cold or gastrointestinal ailment at a day-care center, a minimum of $400 million annually would be lost in salaries alone, Haskins and Kotch calculate.
With more and more women in the work force, that trend is likely to continue unless changes are made, they report. Today, 60 percent of children 6 and younger have mothers who work. Approximately six of every 10 of these youngsters -- about 5 million children -- are cared for outside the home in a variety of ways from staying with a neighbor who may take care of several children to attending a large, for-profit day-care center. By 1990, nearly 17 million children 6 and younger will be receiving care from someone other than their parents, they report, and about 6 million of these youngsters will attend some form of day care.
"Problems related to day care cannot be minimized by turning back the clock and reducing the amount of out-of-home care in the United States," Haskins and Kotch conclude.
Additional regulation of day-care centers is costly "and unlikely in the current political climate," Haskins said. But studies show that simple measures could help.
"We know what works and what doesn't work in minimizing disease," said Kotch. "For instance, we know that frequent handwashing works. It sounds trite, but it really works at reducing disease."
Studies show that when day center workers and children are trained to wash their hands after changing diapers and before preparing food, the risk of illness drops signficantly -- even for hepatitis A.
Other measures that help are better education and training for day-care center employes and strict adherence to isolating children who are ill.
"You might think of day care like we think of using cars," suggested Haskins. Automobile accidents injure and kill millions of people annually. "Yet we are not about to stop using cars. Instead, we say, 'Let's make cars and highways as safe as possible.' We want to do the same with day-care centers."
Two variables seem most related to risk. "One is having children in diapers in day-care centers ," said Kotch, a pediatrician and father who sends one of his children to nursery school. Diseases quickly spread from child to child through close contact and the added risk of contagion from soiled diapers. The second important risk factor for disease is congregating a large number of children together. The more children, the greater the risk of carrying and spreading disease.
To improve the standards of day care, Haskins and Kotch also recommend:
Greater parent participation. "Parents can work at the center, or participate on advisory boards, but whatever, we think that parent participation works to reduce disease," Kotch said. "Parents should also be able to drop in and visit any center at any time, unannounced. If you can't, I would be suspicious."
Good hygiene. Careful attention to design of day-care centers "reduces the likelihood of injuries and the likelihood of epidemics of infectious illness." Diaper changing areas should be separate from food areas, and the diaper changing surface should be disinfected after each child. There should also be a sink nearby for handwashing.
Ask how diapers are disposed, and "expect the same level of hygiene that in the center that you would wish for in your own home," Kotch said.
Toilet-trained children should have access to a bathroom and sink, not a potty seat. They should be taught to wash their hands after going to the bathroom.
Regular physical examinations to screen for vision and hearing problems and other physical illnesses, ranging from blood disorders to tooth decay. "We support regulations requiring parents to demonstrate that they have been following a schedule of health visits for their child," Haskins and Kotch write. "If they have not, their child's health history should be reviewed to identify any developmentally appropriate tests or procedures that are not up to date."
Up-to-date immunizations. Outbreaks of measles and mumps have been reported at day-care centers in recent years, yet these and other illnesses can be prevented with vaccines. H. flu is another contagious illness that appears at day-care centers from time to time, although there is now a vaccine available to protect children 18 months and older.
Improved handling of ill children and staff. "Exclusion doesn't work," said Kotch, although "isolation within a day-care center can help contain contamination." By the time a child has symptoms of a cold or other contagious disease, chances are they have already exposed other children. Studies show that children who are excluded from a day-care center because of illness often are taken to another center by their parents only to infect yet another group of kids.
Despite the risks, Haskins and Kotch note, the benefits of day care outweigh the drawbacks.
"I would start with the economic benefits," said Haskins. "There is no doubt that there are billions and billions of dollars of economic benefits from allowing female headed families and two career families to work."
In addition, studies show that children who attend day care "are more sociable," he said. And for children from lower income families, day care increases IQ by about eight points. Resources
More information on day-care centers is available from:
American Academy of Pediatrics, Department of Publications, 141 Northwest Point Rd., P.O. Box 927, Elk Grove Village, Ill. 60007. Publishes "Tips on Selecting the 'Right' Day-Care Center."
Centers for Disease Control's "What You Should Know About Contagious Diseases in the Day-Care Setting," a handbook for day care center directors, staff and parents, is available from the Government Printing Office. Send $4 to GPO, Superintendent of Documents, Washington, D.C. 20402; document number 017-023-00172-8. Phone: 783-3238.
National Association of Education for Young Children, 1834 Connecticut Ave. NW, Washington, D.C. 20009. "How to Choose a Good Early Childhood Program" and "Finding the Best Care for Your Infant or Toddler," both available free by sending a stamped, self-addressed envelope.
National Center for Clinical Infant Programs, 733 15th St. NW Suite 912, Washington, D.C. 20005; 347-0308.