The Hot Zone

We unexpectedly had our childcare arrangements change at the start of this year. We transitioned both girls to 4 days in daycare at the center where Lydia had been attending pre-school part-time. We were anxious about the change for lots of reasons: How would Anna adjust to being in group care? How would the girls (who love to play together) react to being separated in care settings? Would Anna bond with her new primary care giver? How would the girls react emotionally to not seeing their former care giver (who they were very much attached to)? Would Lydia, an introvert, be able to establish closer bonds with the kids in her pre-school class, where she insists she has no friends and likes no one? I lost sleep due to the persistent anxiety and worries. However, it never occurred to me to worry about the thing that would end up breaking all of our spirits most - the disease hot zone of daycare. I had assumed that because Lydia had been in pre-school part time, we had already begun our exposure to the germ factory of daycare. I. Was. Wrong.

The first month that the girls were in daycare four days a week (March), they were actually only in attendance on average every other day. We were paying through the nose for daycare we weren't able to use while at the same time losing productivity at work and depleting all of our sick days. We were struck by one illness after another (respiratory, gastrointestinal, you name it) and to make things worse, we had two children each getting the illnesses that were brought home, which doubled the duration of our collective misery. After their bouts with norovirus, Anna learned what "puke" means and Lydia began obsessing about not kissing people in order to avoid contracting illnesses. Jeff has to insist now that he wants to kiss Lydia despite the risk of catching her germs. This complicated a lot of the emotional adjustment issues we had worried about, especially for Lydia, who learned that if she complained of an ailment, she could stay home from "school." For a month afterwards, she periodically proclaimed she had a stomach bug in the hopes of staying home for the day. April we had some reprieve, but now in the month of May we have had a wave of successive viruses. First Anna was sick with an extreme fever for a week, followed by Lydia catching a bug with high fever. We assumed it was the same bug, until Anna spiked a fever again starting yesterday. I haven't slept well in three weeks now due to the night parenting that comes with fever discomfort awakening kids throughout the night, and as anyone who has experienced prolonged sleep deprivation can understand, I am on the verge of a breakdown. We are all so emotionally exhausted from it that I think at least once daily that I should just quit my job so that we can have some semblance of health and happiness in our lives. During this past week, I saw a post on a friend's Facebook page complaining of the constant illnesses her infant in daycare was contracting, and chimed in with supportive words. I also carefully read the other responses, hoping desperately to see more experienced parents saying it is all worth it to build up immunity (something I often hear from parents of older kids). Some asserted that to be the case and I wanted to believe them, but it got me wondering. Is it at all worth it? Are the anecdotes of improved immunity supported by data? Or is this toll on our family's health just a huge sunk cost that will never be repaid?

I started to dig (thankful for my U-M library privileges!). Several articles (Haskins et al., 1989; Carabin et al., 1998) that I found focused on the financial costs (individually and socially) of illnesses contracted in group daycare. The policy prescription was to better educate daycare centers about good hygiene practices. Considering Anna sucks her fingers all day long and touches everything with those figures, and that most kids have similar habits, I have little faith that hand washing education is going to help with this problem. Maybe my public health expert friends will persuade me otherwise, but the spread of illness in large group settings at this young age seems largely out of the control of daycare centers. Taking the significant costs of these illnesses as a given, I tried to find articles that spoke to the long-term impact (if any) of child care on a child's health. The first such article I found was a study (Wald et al., 1991) that compared illness frequency in children in home care, group care (2-6 kids) and day care (7 or more kids) over 3 years. What they found was a significant difference between kids in day care compared to home care for the first 2 years, and that those increased rates for kids in day care only stabilized by the 3rd year in care. Considering we are 2 months in to our stay in the hot zone, I just about cried imagining that this hell of constant infections is going to continue for 2 full years. A systemic review (Ochoa Sangrador et al., 2007) of studies of the relationship between daycare attendance and infectious disease depressingly noted, "Child day-care attendance could be responsible for 33%-50% of the episodes of respiratory infection and gastroenteritis among the exposed population. In conclusion, it can be said that the risk for childhood health attributable to the child day-care attendance is discreet but of high-impact." (Insert my groan of despair.)

Sick Bento by Amorette Dye. This cheered me up a bit.

However, I thought it would be useful if I could find similar studies with a longer-term scope, given I often hear parents saying that the daycare hot zone pays off in elementary school years. Along those lines, I found Ball et al.'s (2002) article, "Influence of Attendance at Day Care on the Common Cold From Birth Through 13 Years of Age," and my desperation lifted a bit. These researchers similarly compared in home care, group care and day care kids and the frequency of common colds from 0-13 years of age. They found: "Attendance at large day care was associated with more common colds during the preschool years. However, it was found to protect against the common cold during the early school years, presumably through acquired immunity. This protection waned by 13 years of age." A similar conclusion is drawn from a German cohort study (Zutavern et al., 2007) that studied children from ages 0-6. It found children attending day care were more likely to have a variety of infections (common cold, bronchitis, pneumonia, and diarrhea) within the first 2–3 years of life. From 4 years onward, this relationship between day care attendance and infectious disease rate was not significant anymore and even reversed for many of the infections. The authors conclude, "We interpret our findings that children in day care centres acquire infections at a younger age resulting in a certain level of immunity for some infections. In children who have not attended day care centres within the first years of life acquired immunity gets delayed."

The day care hot zone is real. The desperation and pain of children and parents during this time is real. The financial and career costs to families are real. The immunity payoff also appears to be real. I'm not sure if that is cold comfort or a silver lining right now... the answer probably will depend on how sleep deprived I am at any given moment.