As a direct result of demographic and sociologic changes, increasing numbers of children are attending day care in all industrialized countries. Unfortunately, the close physical contact among children in day care favors the transmission of infectious diseases. Previous studies have focused mainly on the risk of upper respiratory tract infection (URTI) and otitis media, which are reported to occur two to three times more frequently in children attending day care centers than in those cared for at home.1-7 Similarly day-care attendance has been found to be associated with an increased risk of lower respiratory tract infections (LRTI),8 gastroenteritis,9 as well as with the dissemination of infections caused by hepatitis A,10 cytomegalovirus,11 and H. influenzae type b.12Despite convincing evidence for a higher risk of infection in day-care centers, most parents do not have an acceptable alternative to day care. It may be more useful, therefore, to identify the types of day-care structures associated with lower infectious risks. Family day care, in which several children are cared for in another family setting, offers a viable alternative to group day care, but previous studies have provided conflicting information on the risk of respiratory infections and otitis media in this setting. In four studies, the risks observed in family day care were very close to those of children who remained at home3-5,8; in two, they were intermediate between the risks at home and those in formal day-care centers6,7; while in two others, they were very close to those in day-care centers.13 These conflicting results can be explained by several factors including the lack of strict definitions for the different types of day-care settings and failure to control for the potentially important confounding differences in the number of children attending each type, the age range (from 2 to 60 months), and the time per week spent in the setting.
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