Daycare Attendance, Dense Traffic Linked to Elevated Childhood Respiratory Health Risk

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This new data expands upon limited current research on environmental elements that contribute to the extensive variation in symptoms and infection frequency seen in children.

Daycare attendance raises childrens’ respiratory morbidity risk, according to new findings, and the findings also indicated that damp environments and dense traffic are linked to wheeze increases, inhaler prescription increases, and elevated odds of bronchiolitis.1

The same research also showed that breastfeeding is linked to diminished risk of bronchiolitis, otitis media, and wheeze. Each of these findings and others were the results of the GO-CHILD multicentre prospective birth cohort study examining the effects of many different risk factors for

This study examined the impacts of various types of early impacts on respiratory health and symptoms at the time of childhood, given the limited information on epidemiology and environmental risk for this population.2 It was led by Tom Ruffles, BSc, from the Academic Department of Paediatrics at the University Hospitals Sussex NHS Foundation Trust’s Royal Alexandra Children's Hospital in Brighton, UK.

“We reviewed our findings in the context of the current literature to provide health care professionals with the latest evidence with respect to environmental risk factors for respiratory infection and wheeze in young children,” Ruffles and colleagues wrote.

Background and Findings

The investigators conducted the GO-CHILD prospective birth cohort study, and their research was done between August 2009 and November 2013 over 8 total NHS Trusts/Boards in both England and Scotland. The team sought to assess the influence of environmental elements and genetic variations on patient infections and atopy-related outcomes in 2,312 pregnant women and their children.

These women’s children were later followed up with at 12 and then 24 months of age, with the investigators utilizing postal questionnaires to determine both infection and respiratory symptoms as well as patient outcomes. The team’s Information on the participants’ home environments was gathered through antenatal and subsequent follow-up questionnaires.

The investigators’ questions covered several different risk factors including breastfeeding status and duration, attendance of daycare, environmental tobacco smoke exposure, presence of patients’ siblings, density of road traffic near the child's home, dampness in the patients’ homes, flooring type found in the child's bedroom, exposure to different animals, and the existence of coal or wood fires within homes.

The clinical data collected by the research team covered respiratory infections and respiratory symptoms—such as wheeze and dry cough—and this data was recorded using carer-completed postal questionnaires at 12 and 24-month time points. Also, the investigators documented healthcare use as well as prescriptions such as reliever inhalers and inhaled corticosteroids for wheeze.

They also recorded specific diagnoses based upon ICD-10 classifications, and the occurrence and frequency of flu or cold. The research team defined wheeze as breathing that leads to high-pitched whistling or leads to squeaking noises from patients’ chest and not throat. This was due to established criteria found in previous studies.

Overall, the research ended up involving 1344 children, with daycare attendance shown by the investigators to be linked to higher odds of developing bronchiolitis, pneumonia, otitis media, and visits to emergency departments for wheezing. They also found that breastfeeding for over 6 months was shown to have reduced the odds of bronchiolitis as well as otitis media.

Patients having siblings at home was found by the investigators to have raised patient odds of developing bronchiolitis and increased the risk of requiring a reliever inhaler prescription. The team also noted that visible dampness found in the home was linked with higher risk of developing wheeze, of needing a reliever inhaler, and of receiving inhaled corticosteroid prescriptions.

Lastly, the team noted that exposure to environmental tobacco smoke was found to be tied to more primary care visits for patients reporting cough or wheeze. Additionally, they found that dense traffic observed near the children’s homes was linked to a greater risk of bronchiolitis development.

“Larger multicentre studies with longer follow-up are required to test our findings in other populations, and this would help guide future public health interventions to reduce the significant impact of respiratory infections and wheeze in young children,” they wrote.


  1. 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. 2023; 1-12. doi:10.1002/ppul.26664.
  2. Vissing NH, Chawes BL, Rasmussen MA, Bisgaard H. Epidemiology and risk factors of infection in early childhood. Pediatrics. 2018; 141(6):e20170933.