Research carried out by RIVM and UMC Utrecht has shown that children who go to a day care centre are more likely to develop gastroenteritis (stomach flu). This has medical and economic consequences. Day care attendees need to see the General Practitioner twice as often and are admitted to a hospital with complications twice as often. In the Netherlands the excess societal cost of gastroenteritis are estimated at 25 million Euro each year. Researcher Remko Enserink thinks that better implementation of existing infectious disease prevention measures would not only result in fewer sick children, but also in lower societal costs.

The younger the child, the greater the risk of gastroenteritis

Children are more likely to develop experience gastroenteritis at a day care centres. The younger the child, the greater the risk of developing gastroenteritis. This is because the immune systems of young children are still developing. For example, the risk of being admitted to a hospital for gastroenteritis complications is highest just after the first visit to the day care centre. “But in the long-term, children who attend day care centres do not develop any more resistance to severe gastroenteritis than children who are cared for at home”, says the researcher.

Lower parental productivity due to caring for child

The differences in societal costs arise predominantly from the lower productivity of parents due to their caring for their child. Enserink: “Parents who make use of child care services work more and, in general, earn more than parents who do not use these services. I suspect that the loss of productivity could actually be much higher as parents might be infected by their sick child. For example, we observed in another study that family members run a five-fold higher risk of being infected by their sick child. We have not taken account of this in our cost calculations.”

Animals and sandpits facilitate gastroenteritis

Large day care centres with a high concentration of children, the presence of animals, sand pits, paddling pools and centralised child changing rooms all appear related to an increased risk of gastroenteritis. Also, if staff move from group to group during the day, the risk of gastroenteritis is increased. This also appears to be the case if bedding and toys are not cleaned daily, if surfaces are not disinfected with bleach and if vomit is cleaned up with cotton cloths without using an all-purpose cleaning product. It appears that the risk of gastroenteritis is lower if, during an outbreak, sick children are looked after separately or are not allowed to attend the day care centre. In addition, Enserink’s research also indicates that in the event of an outbreak the staff should stay with their own group as much as possible and sick members of staff should stay at home.

Quality assurance mark for healthy childcare

The better implementation of already existing and simple measures for infectious disease prevention would probably not only result in fewer sick children, but also in lower societal costs. For this reason, RIVM researcher Enserink advocates that more research should be carried out to assess the effectiveness and feasibility of these measures in the future. In addition, a label advocating ‘healthy childcare’ might stimulate the implementation of those strategies that have been proven effective in the past. Research by RIVM has shown that there is sufficient support for such a label. Whether or how this label will be introduced, is not yet clear. An action plan for healthy childcare in the Netherlands is currently being developed, and the way in which the measures mentioned above can be included in this action plan is being studied.