NCEDL Spotlights
No. 5 November 1998
Respiratory Infections |
 |
| Excerpts from a paper presented during
the "Research Into Practice in Infant/Toddler Care" synthesis
conference by the National Center for Early Development & Learning
(NCEDL) in the fall of 1997 in Chapel Hill, NC. Drs. Albert M. Collier
and Frederick W. Henderson presented their data and surveyed current
literature for their paper, "Respiratory Disease in Infants and
Toddlers," which is expected to be part of a book to be published
later. |
Respiratory Infections Challenge Child Care
Centers The prevention of respiratory infections
in child care centers remains a public health challenge. A survey
of current literature reveals no published data describing a successful
intervention to reduce the risk of upper respiratory diseases in
child care centers. |
Respiratory infections account for 75% to 90% of infections in child
care settings, according to several large studies. In a study at the
FPG Child Development Institute (FPG), Chapel Hill, NC,
of 206 children followed for 864 child-years, infants less than a
year old had an average of nine respiratory illnesses a year of which
46% were associated with otitis media and 13% with lower respiratory
manifestations.
Research shows that viral respiratory tract infections peak during
the second six months of life, between seven months and one year.
During this period, the level of antibodies is at its lowest level
in life. That's because of the decreasing level of antibodies passed
across the placenta from the child's mother during pregnancy and
the fact that it takes the child's immune system about two years
to begin producing antibody levels approaching those of a mature
child. |
Child care
and respiratory infections
- Children under the age of three who attend child care have
more respiratory infections than children of the same age who
are cared for at home. The severity of these infections in young
children is also greater.
- Children who are routinely in contact with only three children
daily rather than 30 children have less of a chance of coming
into contact with an infectious agent. Children attending child
care will be infected with viral respiratory infections earlier
than children living at home with no siblings in school.
|
Attempts to reduce infections in child care centers
Curiously enough, a synthesis of research reveals
no evidence that excluding sick children from a child care center
reduces the incidence of acute respiratory disease. Children with
viral respiratory infections excrete the infectious virus two to
four days before they show signs and symptoms of the infection.
In a study by FPG researchers, a hygienic intervention was conducted
at a random selection of child care centers at the same time as
another random group of centers received no intervention. The intervention
included such things as
- handwashing of children and staff;
- disinfecting the toilet and diapering area;
- physical separation of diapering area from food preparation
and service areas;
- hygienic diaper disposal;
- daily washing and the disinfecting of toys, sinks, and kitchen
and bathroom floors;
- daily laundering of blankets, sheets, dress-up clothes, and
other items; and
- hygienic preparing, serving and cleaning up of food.
No significant difference in the rates of illness
from respiratory tract infections was found in centers with interventions
and those without. (It should be noted that while hygiene measures
such as those above have not been proven effective in preventing
respiratory tract infections, they have been in diarrheal diseases.) |
Future Research Suggestions
One strategy for future research in the control of respiratory
tract infections in child care would be to increase the individual
child's immunity to the most important respiratory agents. This
should be approached first by making sure that the children and
child care staff are fully vaccinated on schedule for vaccine-preventable
respiratory illness. |
| In the near future, vaccine development
will certainly focus on the respiratory syncytial, parainfluenza,
and influenza viruses. Adenoviruses could also be an important
target for prevention. |
|
Second, research could focus on maternal immunization during pregnancy
to optimize the level of antibodies in the mother to a particular
respiratory tract pathogen. Passive antibodies would then be at
a high level to pass across the placenta to the newborn. As the
mother’s passive antibodies disappear, the child might then
be immunized with new vaccines against common respiratory pathogens.
Drs. Collier and Henderson are pediatricians
at UNC-CH. NCEDL is administratively housed at UNC-CH. This project
is supported under the Education Research and Development Centers
Program, PR/award number R307A60004, as administered by the Office
of Educational Research and Improvement, US Department of Education.
Opinions expressed in these reports do not necessarily represent
the positions or policies of the National Institute on Early Childhood
Development and Education, the Office of Educational Research and
Improvement, or the US Department of Education. Permission is granted
to reprint this; we ask that you attribute the author(s) of the
study and the National Center for Early Development & Learning.
Other articles in the Spotlights Series include
For more information, or to request printed copies ,
contact
Lloyd Little
UNC-CH CB # 8185
Chapel Hill NC 27599-8185
919-966-0867
loyd_little@unc.edu
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