A case-control study of risk factors for acute
diarrhea was conducted among children under 3 years of age attending a health maintenance organization clinic in Houston, Texas. During a 19-month period from September 1985 through March 1987, 339 children with
diarrhea and 363 age- and season-stratified controls were enrolled. A total of 90% of cases were under age 2 years. Compared with children cared for at home, the risk of
clinic visits for
diarrhea was significantly greater for children receiving child day care and was similar for those attending
day care centers (odds ratio (OR) = 2.4, 95% confidence interval (CI) 1.6-3.7),
day care homes (OR = 2.0, 95% CI 1.3-3.1), mother's day out (OR = 1.8, 95% CI 0.8-4.2), or when cared for by a relative (OR = 2.0, 95% CI 1.2-3.2). Rotavirus-positive
diarrhea was also significantly greater in child day care (OR = 2.4, 95% CI 1.1-5.1). The
day care-associated risk was highest during the first month of enrollment (OR = 3.1, 95% CI 1.8-5.4). In this population, where 40% of children receive child care, 19% of the
clinic visits for acute
diarrhea were attributable to child care. These data indicate that child day care increases the risk of acute
diarrhea, whether in a center or in a home, and the risk is highest in the first month of enrollment.