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Abstract
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).