Daycare brings major societal, family costs

Putting children in day care while one or both parents work is an expensive proposition. A new study from the Boston area, discussed today at the PAS Annual Meeting, suggests that illness associated with children in day care costs the US economy more than $1.5 billion annually in direct health services, lost productivity, and other costs.

"We clearly need to increase targeted interventions in this population to reduce the illness burden and transmission of disease in this population," said lead author Fabienne Bourgeois, MD, of Children's Hospital in Boston. "Families face a high economic burden as a result of these illnesses associated with daycare."

About 4.2 million children are enrolled in daycare in the US, Dr. Bourgeois said. It has long been observed that children in daycare seem to be sick frequently. Many of these illnesses appear to be transmitted between children in the daycare setting and then transmitted to primary caregivers and other family members. What was not known, she said, is the cost of these daycare-associated illnesses.

The study group randomly selected 208 families from five pediatric practices in the Boston area and followed them prospectively from November 2000 through May 2001. Each family had at least one child between 6 months and 5 years old enrolled in daycare. Families kept an illness diary to track illness dates, symptoms, medication use, health care utilization, and missed days of school or work.

The 834 participants in the study reported 2,072 cases of viral illness, 1,683 upper respiratory infections, and 389 gastrointestinal infections. Diaries showed that 17% of URIs resulted in a physician office visit, compared to 10% of GI infections, with the number of visits significantly higher for children than for adults.

The typical URI episode cost each family $49, Dr. Bourgeois said. Lost productivity accounted for half the cost, direct health care services accounted for one-third, and other elements made up the remainder. The typical GI infection cost $56, two thirds made up of lost productivity and most of the balance divided between health services and medication.

The total cost per family over the study period came to $400 for URIs and $105 for GI infections. Expanded to include the 4.2 million children in daycare nationwide and their families, that translates into $1.2 billion for URIs in 2005 dollars and $320 million for GI infections, Dr. Bourgeois said.