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Associate Professor of Sociology, University of Virginia 

Starting Daycare, Needing Antibiotics


Bryce J. Christensen and Nicole M. King


Few issues worry public-health officials more than the emergence of ever more pathogens resistant to antibiotics. Not surprisingly, epidemiologists have identified overuse of antibiotics as a cause of the problem. But physicians are especially likely to rely on antibiotics in what circumstances? Study after study has identified children who have contracted an illness while in daycare centers as a population significantly overrepresented among antibiotic recipients. Of course, because the daycare center has become an essential support for maternal employment, feminists are desperate for a de minimis interpretation of this issue. Even though it manifests the authors’ awareness of how politically sensitive their findings are, a study recently completed at Finland’s Turku University unmistakably indicates that putting young children into daycare centers can only compound the problem of antibiotic resistant microbes.  

In data collected for 1,827 children 24 months old and younger, the Turku scholars look for answers to two questions of acute interest to public-health officials: 1) how much does taking young children out of the home and putting them in daycare centers drive up the incidence of the respiratory illness among these children? 2) how much does placing children in daycare centers increase use of antibiotics?  

In addressing these questions, the researchers are aware that “daycare has been known to be a major risk factor for respiratory tract infections (RTIs) in children for over 30 years.” But they are also aware that “a considerable proportion of children in modern society attend daycare from the age of less than 2 years,” making it entirely predictable that “RTIs in this age group constitute an important health problem,” in part because of the elevated rates of antimicrobial medication use among such children “with subsequent impact on resistance patterns.” 

The researchers limn a “rapid increase in respiratory infections after start of daycare”: Sick days among children placed in daycare centers averaged just 3.79 days per month before daycare but soared to 10.57 sick days per month two months after entering daycare. But this spike in RTI-related sick days does not persist. Within nine months, the number of sick days reported for children in daycare centers (who have probably developed some natural immunity by this time) no longer runs significantly higher than the number of such days among children cared for at home.  

The researchers are eager to tell “families, daycare providers and paediatricians [that they] may be reassured of the transient nature of increased RTIs after the start of daycare.”

This curious reassurance perhaps suggests more concern for deflecting feminist criticism than commitment to protecting the health of children. After all, a serious bout with respiratory illness can leave lasting effects (such as loss of hearing when such illness affects the middle or inner ear). Why is the prime concern that of reassuring those who want to use daycare centers and not that of fostering optimal health for young children?  

In any case, the assurance that the Turku scholars offer looks especially suspect given that their data show that while the number of sick days declined markedly among the daycare children in their study, “for antibiotic use there was . . . a less pronounced decline,” with such use remaining well above that seen among children cared for at home. Given the gravity of the problem physicians are facing with antibiotic-resistant germs, this persistently elevated level of antibiotic use among daycare-center children ought to give them pause before they hastily reassure those putting young children in such centers that they are creating no long-term problems by doing so.  

If physicians and public-health officials are serious about combating the problem of antibiotic-resistant supergerms, perhaps it is time for them to frankly acknowledge that daycare centers are bad for young children, and bad for society at large.   

(Linnea Schuez-Havupalo et al., “Daycare Attendance and Respiratory Tract Infections: A Prospective Birth-Cohort Study,” BMJ Open 7.9 [2017]: e014635, Web.)