Colby Stong
Breastfeeding was associated with a decreased risk for bronchiolitis, otitis media, and wheeze in children aged 2 years and younger.
Daycare attendance is associated with a 2-fold increased risk for pneumonia and wheeze in young children, according to study findings published in Pediatric Pulmonology.
The GO‐CHILD prospective birth cohort study evaluated young children to determine how environmental factors affected respiratory infections and symptoms during the first 2 years of life.
The birth cohort involved 2312 pregnant women, recruited from August 2009 to November 2013, whose children were followed up for infection and respiratory symptoms and outcomes at 12 and 24 months with use of postal questionnaires.
Data obtained from August 2010 to January 2016 included postnatal follow‐up from 1552 children; of those, 1344 children had at least 1 carer follow‐up questionnaire completed. The cohort included 50.7% male children and 91% of children were White. Also, 51.0% were breastfed beyond age 6 months, 58.2% attended daycare, and 60.4% had a sibling present at home.
Daycare was associated with greater than 2-fold increased odds for pneumonia (odds ratio [OR], 2.39; 95% CI, 1.04-5.49; P =.040) and increased odds of bronchiolitis (OR, 1.40, 95% CI, 1.02-1.90; P =.035) and otitis media (OR, 1.68; 95% CI, 1.32-2.14; P <.001). The investigators also found a 2-fold increased odds for wheeze (OR, 2.16; 95% CI, 1.62-2.87; P <.001) and dry cough (relative risk [RR] 2.01, 95% CI, 1.47-2.21; P <.001).
Breastfeeding after age 6 months was associated with a decreased odds of bronchiolitis (OR, 0.55; 95% CI, 0.39-0.77; P <.001) and otitis media (OR, 0.75; 95% CI, 0.59-0.99; P =.040), as well as reduced odds of wheeze (OR, 0.52; 95% CI, 0.39-0.75; P <.001) and primary care attendance for cough or wheeze (OR, 0.69; 95% CI, 0.55-0.86; P =.001).
Having a sibling at home was associated with increased odds of bronchiolitis (OR, 1.65; 95% CI, 1.18-2.32; P =.004), primary care attendance for cough and wheeze (OR, 1.25; 95% CI, 1.02-1.53; P =.030), and reliever inhaler prescription (RR, 1.37; 95% CI, 1.02-1.85; P =.037).
About 8.3% of carers reported visible dampness, which was associated with an increased risk of dry cough (RR, 1.76; 95% CI, 1.02-3.04; P =.042), reliever inhaler use (RR, 1.73; 95% CI, 1.04-2.89; P =.036), and inhaled corticosteroid prescription (RR, 2.61; 95% CI, 1.03-6.59; P =.043).
Exposure to environmental tobacco smoke occurred in 13.5% of children and was associated with greater odds of primary care attendance for cough or wheeze (OR, 1.52; 95% CI, 1.11-2.08; P =.009). Dense traffic near the home was reported by 9.3% of carers and was linked to 30% increased odds of bronchiolitis (OR, 1.32; 95% CI, 1.08-9.22; P =.011).
Carpet in the bedrooms, animal exposure, and household exposure to coal or wood smoke from an open or closed fire were not associated with respiratory outcomes.
Limitations include the use of retrospective carer questionnaires. Also, diagnoses were reported by carers and not always confirmed by a physician, and changes in risk factors over time were not specifically accounted for.
“[D]aycare attendance is the environmental factor associated with the greatest respiratory morbidity, more than doubling the odds of pneumonia and was associated with a severe wheeze phenotype with elevated risk of reliever inhaler prescription and primary care, secondary care and emergency department attendance,” and “breastfeeding was associated with reduced odds of bronchiolitis, otitis media and wheeze,” said the study authors. These results underline the importance of appropriate support structures for families, they added.
References:
Ruffles T, Inglis SK, Memon A, et al. Environmental risk factors for respiratory infection and wheeze in young children: a multicentre birth cohort study. Pediatr Pulmonol. Published online September 10, 2023. doi:10.1002/ppul.26664