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Early Daycare Is Associated with an Increase in Airway Symptoms in Early Childhood but Is No Protection against Asthma or Atopy at 8 Years

¹ Department of Pediatrics/Respiratory Medicine, Erasmus University, Rotterdam; ² Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven; ³ Institute for Risk Assessment Sciences, University of Utrecht, Utrecht; ⁴ Department of Epidemiology, and ⁵ Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen; ⁶ Department of Pediatrics, Wilhelmina Children's Hospital and ⁷ Institute for Risk Assessment Sciences, and Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands

Correspondence and requests for reprints should be addressed to Prof. Dr. J. C. de Jongste, M.D., Ph.D., Erasmus MC/Sophia Children's Hospital, Department of Pediatric Respiratory Medicine, PO Box 2060, 3000 CB Rotterdam, The Netherlands. E-mail: j.c.dejongste{at}erasmusmc.nl

Rationale: Daycare exposes young children to more infections early in life and may thereby prevent the development of asthma and allergy.

Objectives: To prospectively study the effect of daycare on the development of asthma and allergic sensitization during the first 8 years of life.

Methods: In the Prevention and Incidence of Asthma and Mite Allergy birth cohort 3,963 newborn children were followed prospectively for 8 years. Daycare use and respiratory health were assessed yearly by questionnaires. At 8 years, sensitization to airborne allergens and airway responsiveness were measured. Daycare was defined as early (aged 0–2 yr), late (aged 2–4 yr), or none (no daycare before age 4 yr). Associations of daycare and/or older siblings with asthma symptoms (wheezing, shortness of breath, and inhaled steroids taken in the last year), airway responsiveness, and allergic sensitization were assessed in a longitudinal repeated-event analysis.

Measurements and Main Results: Children with early daycare had more wheezing in the first years of life, but less wheezing and steroid use between 4 and 8 years of age. At the age of 8 years, early daycare was not protective for asthma symptoms (adjusted odds ratio [aOR], 0.99; 95% confidence interval [CI], 0.74–1.32), allergic sensitization (aOR 0.86; 95% CI, 0.63–1.18), or airway hyperresponsiveness (aOR, 0.80; 95% CI, 0.57–1.14). The transient reduction in airway symptoms between age 4 and 8 years was only observed in children without older siblings.

Conclusion: Early daycare is associated with an increase in airway symptoms until the age of 4 years, and fewer symptoms between the ages of 4 and 8 years. We found no protection against asthma symptoms, hyperresponsiveness, or allergic sensitization at the age of 8 years.

Key Words: daycare • siblings • allergic sensitization • airway hyperresponsiveness • childhood asthma

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Daycare exposes young children to more infections early in life, and may thereby prevent the development of asthma and allergy. Only a few longitudinal studies have investigated this association and these have given conflicting results. What This Study Adds to the Field Our study suggests that children who attend daycare experience more airway symptoms at an early age, but do not develop fewer asthma symptoms and/or allergies at the age of 8 years.

 

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