CURRENT TOPIC Out - of - home day care and health

The latter half of the twentieth century has witnessed some striking changes in social fabric of British children's lives. The proportion of births outside marriage has increased dramatically, from 5% in 1960 to 30% in 1991.1 There are currently over one million lone parent families in Britain, nearly a fifth of all families with children. The number of mothers with children under 5 who work outside the home has also increased, by more than 15% in the 1 980s alone.1 None of these changes are unique to Britain and similar demographic processes have taken place throughout Europe. However, unlike many continental European countries, where the predominant social policy response to these changes has been the wider provision of out-ofhome day care, in Britain day care provision remains scant, essentially little more than a remedial measure for the most disadvantaged of children. For example, while Denmark provides publicly funded day care places for 48% of children under 3, the corresponding figure for Britain is 2%.1 Surprisingly, the voice of paediatricians, traditional advocates for children, has been uncharacteristically silent in the political debates surrounding child care. The aim of this paper is to critically review the effects of out-of-home day care on child health. Because the validity of evidence from randomised controlled trials is far more readily assured that with other study designs, particular emphasis is given to evidence from randomised experiments.