Can outdoor kindergarten reduce infections in young children?

Can outdoor kindergarten reduce infections in young children? | Image Credit: Contemporary Pediatrics

Can outdoor kindergarten reduce infections in young children?

Alas, a study in Danish kindergarteners determined that the answer to this question is no. Investigators based this conclusion on the finding that children enrolled in conventional kindergartens were no more likely than those enrolled in outdoor kindergartens to have their prescriptions for antibiotics filled. Denmark was an ideal place to conduct this study because it provides 2 types of kindergartens: outdoor kindergartens, where children spend almost all their time outdoors; and conventional kindergartens, where youngsters spend time both inside and outdoors.

Investigators obtained data from a national prescription registry of all filled prescriptions for both systemic antibiotics (narrow spectrum and broad spectrum) and topical antibiotics that were prescribed for kindergarten children during a 9-year period. The sample included 2132 children who were enrolled in an outdoor kindergarten and 2208 children who were enrolled in a conventional kindergarten.

The 2 groups did not differ in how likely they were to fill at least 1 prescription of any antibiotic while enrolled in kindergarten: an adjusted absolute risk of 59.5% for children in outdoor kindergartens and 61.1% for those in conventional kindergartens. The risk of filling at least 1 prescription for all antibiotics up to 1 year after leaving kindergarten also was similar for the 2 groups: 32.4% for children enrolled in outdoor kindergartens and 34.2% for those in conventional kindergartens. In addition, an analysis of fulfillment of at least 3 prescriptions for all antibiotics while enrolled in kindergarten found that this figure was 23.9% for children in outdoor kindergartens and 25.1% for conventional kindergartens—again, not significantly different.

Confounders that investigators considered in their statistical analyses included highest maternal educational level, household size, maternal birth region (western or nonwestern), preterm birth, parity, sex, child age at starting kindergarten, total number of filled prescriptions for all antibiotics before attending kindergarten, and total years enrolled in kindergarten.

The authors concluded that their results “do not support outdoor kindergartens as a structural intervention to reduce the use of antibiotics among children.”

THOUGHTS FROM DR FARBER

I don’t understand why they explored this. I assume they had the data for more useful studies, such as comparing how many antibiotics were prescribed, sick days missed, or a plethora of other approaches. I do like the idea of outdoor kindergarten, though (and in Denmark, no less); I remember the occasional outdoor college class fondly.

Reference:

Olsen NJ, Larsen SC, Koster-Rasmussen R, et al. Does attendance in outdoor kindergartens reduce the use of antibiotics in children? Acta Paediatr. 2023;112(9):1944-1953. doi:10.1111/apa.16869