Early Child Care Attendance and Asthma, Wheeze Risk: What’s the Link?

Early child care attendance increased the risk for wheeze in children aged ≤2 years , but decreased the risk for asthma in children aged 3 to 5 years and the risk for wheeze in children aged ≥6 years , according to the results of a meta-analysis published in the Journal of Asthma.

Researchers conducted a meta-analysis using peer-reviewed studies that were published between 1964 (the inception of PubMed) and January 9, 2017. Data were extracted from studies that had sufficient data to evaluate the likelihood of the development of asthma or wheeze in children who attended child care. Ultimately, 32 studies were selected for inclusion in the meta-analysis.

The findings demonstrated that early child care attendance protected against asthma in children aged 3 to 5 years, but did not protect children aged ≥6 years from developing asthma. In addition, early child care attendance increased the risk for wheeze in children aged ≤2 years but did not increase the risk for wheeze in children aged >2 years.

The pooled analysis demonstrated that children who attended child care at any age had higher odds of developing asthma compared with children who did not attend child care (odds ratio [OR], 1.17; 95% CI, 1.01-1.35; I² statistic=80.4%). However, no association was found between asthma in children and adolescents ages 0 to 18 who attended early child care vs children who did not attend child care (OR, 0.94; 95% CI, 0.70-1.27; I² statistic=64.4%). Conversely, there was an increased risk for asthma in children and adolescents ages 0 to 18 who attended late child care compared with children who do not attend child care (OR, 1.19; 95% CI, 1.01-1.41; I² statistic=32.5%).

The investigators concluded that in children aged ≥6 years early child care attendance is not statistically significantly associated with a risk for asthma or wheezing. They also pointed out that the variation among the studies in this review underscores the need for standardized definitions of child care exposure and asthma diagnosis in pediatric patients in order to increase the reliability and validity of the study findings.

Reference

Swartz A, Collier T, Young CA, et al. The effect of early child care attendance on childhood asthma and wheezing: a meta-analysis [published online April 9, 2018]. J Asthma. doi:10.1080/02770903.2018.1445268