Infectious Diseases and Injuries in Child Day Care

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Abstract
Objective. —To provide pertinent background information on infectious diseases and injury in child day care and outline measures to address these health care needs. Design. —We reviewed published English-language literature identified through a MEDLINE bibliographic search, major literature summaries, and bibliographies from identified articles. Setting. —Child day-care settings reviewed included family child care homes, centers, special facilities for ill children, and facilities for children with special needs. Patients or Other Participants. —Primarily children in a variety of day-care settings, often compared with children cared for at home. Main Outcomes. —The occurrence of outbreaks and illness related to infectious disease and injury. Results. —Compared with preschool-aged children reared at home, among children in day care the risk of some infectious diseases was two to four times greater. Rates of both intentional and unintentional injuries in day-care settings were somewhat lower than those for children cared for at home. Conclusions. —Because preschool-aged children spend increasing time in structured day-care settings, the risk for some infectious diseases has increased. At the same time, child day-care settings present opportunities for ensuring healthier children through enhanced development, safer environments, better nutrition, increased vaccination coverage, and health promotion. (JAMA. 1992;268:1720-1726)