Siblings, day-care attendance, and the risk of asthma and wheezing 
during childhood.

Ball TM, Castro-Rodriguez JA, Griffith KA, Holberg CJ, Martinez FD, 
Wright AL.

Department of Pediatrics, University of Arizona College of Medicine, 
Tucson, USA.

BACKGROUND: Young children with older siblings and those who attend day 
care are at increased risk for infections, which in turn may protect 
against the development of allergic diseases, including asthma. However, 
the results of studies examining the relation between exposure to other 
children and the subsequent development of asthma have been conflicting. 
METHODS: In a study involving 1035 children followed since birth as part 
of the Tucson Children's Respiratory Study, we determined the incidence 
of asthma (defined as at least one episode of asthma diagnosed by a 
physician when the child was 6 to 13 years old) and the prevalence of 
frequent wheezing (more than three wheezing episodes during the 
preceding year) in relation to the number of siblings at home and in 
relation to attendance at day care during infancy. RESULTS: The presence 
of one or more older siblings at home protected against the development 
of asthma (adjusted relative risk for each additional older sibling, 
0.8; 95 percent confidence interval, 0.7 to 1.0; P=0.04), as did 
attendance at day care during the first six months of life (adjusted 
relative risk, 0.4; 95 percent confidence interval, 0.2 to 1.0; P=0.04). 
Children with more exposure to other children at home or at day care 
were more likely to have frequent wheezing at the age of 2 years than 
children with little or no exposure (adjusted relative risk, 1.4; 95 
percent confidence interval, 1.1 to 1.8; P=0.01) but were less likely to 
have frequent wheezing from the age of 6 (adjusted relative risk, 0.8; 
95 percent confidence interval, 0.6 to 1.0; P=0.03) through the age of 
13 (adjusted relative risk, 0.3; 95 percent confidence interval, 0.2 to 
0.5; P<0.001). CONCLUSIONS: Exposure of young children to older children 
at home or to other children at day care protects against the 
development of asthma and frequent wheezing later in childhood.

PMID: 10954761 [PubMed - indexed for MEDLINE] 

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