Pediatric Acute Respiratory Infections Lead to Lost Workdays for Active-Duty Servicemembers

BETHESDA, MD — Pediatric acute respiratory infections result in absenteeism for both children and their caregivers who are active-duty servicemembers, leading to lost duty days and reduced military readiness, according to a recent study.

The study published in Military Medicine examined pediatric acute respiratory infection-related absenteeism among active duty servicemembers and their children and associated factors such as infecting pathogen, child’s age and medical care sought.¹

The study authors were affiliated with Uniformed Services University and Walter Reed National Military Medical Center, both in Bethesda, MD.

In pediatric populations, acute respiratory infections are common, and young children have an average of five to six respiratory infections per year, with some having up to 10. These infections can range from mild cough and cold symptoms to severe disease requiring hospitalization and even mild acute respiratory infections can result in absence from school or childcare. Studies have found that, among 1,000 children, more than 2,000 days of school were missed over the course of three respiratory seasons. The frequency and duration of absences is associated with poorer academic achievement, the investigators explained.

With about one-third of active-duty military personnel being parents, child absenteeism from acute respiratory infections also impacts adult caregivers, causing them to be absent from work so they can care for sick children at home. In a study of 100 school-aged children with influenza, parents missed a total of 20 days from work. Other respiratory viruses, including respiratory syncytial virus (RSV), rhinovirus, coronavirus and adenovirus, also contribute to missed school days. Parents and caregivers in the military are uniquely impacted, but few studies have examined the effect of pediatric viral acute respiratory infections on absenteeism in military-connected children and the impact to military readiness of active duty service member (ADSM) caregivers, the researchers pointed out.

In this study, the authors used data from the Pediatric Respiratory Co-infection and Immunologic Response (Peds RECON) study, a prospective, longitudinal cohort study of pediatric responses to infection with viral respiratory pathogens. Healthy children (1 month to 17 years old) were enrolled in the cohort study between January 2024 and March 2025 at the Uniformed Services University and followed for up to 2 years. Demographic data including military affiliation of caregivers, participant medical history and immunization records were collected at baseline.

Study participants were enrolled before acute respiratory infection, and when symptoms developed, they were tested for 22 respiratory pathogens by multiplex PCR. For participants older than 1 year of age, an acute respiratory infection was defined as having at least two of the following symptoms: rhinorrhea, cough, sore throat, nasal congestion, increased respiratory rate, headache, poor oral intake, fatigue and/or fever. In infants 1 to 11 months old, an acute respiratory infection was defined as having at least two of the following: rhinorrhea, cough, poor oral intake, vomiting, lethargy, fever and/or increased respiratory rate or work of breathing.

With each acute respiratory infection, all participants completed a 10-day symptom questionnaire that included whether medical care was sought, how many days the child was absent from school or childcare, and how many lost workdays caregivers experienced. Statistical analyses were used to evaluate differences in absenteeism between age, infecting respiratory pathogen and medical care utilization.

“Pediatric ARIs result in child absenteeism as well as adult caregiver absenteeism from work, resulting in lost duty days. Younger children with an ARI are more likely to result in caregiver absenteeism,” the authors concluded. “Given the frequency of infections, common pediatric ARIs likely impact overall ADSM readiness.”

Of the 47 study participants, 22 presented for at least one acute respiratory infection visit, accounting for 27 acute visits and completed symptom questionnaires. For 70% of acute visits, children had at least one ADSM caregiver. The study determined the child’s age or pathogen detection wasn’t associated with increased child absenteeism. Also, there weren’t statistically significant differences in frequency or length of childhood absenteeism based on whether the ill participant was school-aged or younger. However, caregiver absenteeism was higher when the participant was between 0 to 5 years old.

The overall rate of child absenteeism was 67%, with 16 out of 24 acute respiratory infections being associated with any absence from school or childcare. Among ADSM caregivers, an average of 0.8 duty days and a maximum of three duty days were lost per pediatric acute respiratory infection, the authors pointed out.

Participants in the study included 20 children aged 5 years old and younger and 27 school-aged children aged 6 to 17 years old. Four participants had more than one acute visit. Forty-nine percent had at least one ADSM caregiver, and the other 51% had caregivers who were retired military.

Military personnel caring for younger study participants tended to be junior enlisted (E1-E4) and junior officers (O1-O4). Military caregivers for 6 to 18 year old participants were more likely to be senior (O5+) officers, according to the study.

Only 33% of participants sought medical care for their acute respiratory infection, showing the risk of underreporting those infections if relying on electronic health records.

The study measured nine of the 22 respiratory pathogens, with co-detection of multiple viruses more frequent in younger children. In school-aged children, 50% of participants with acute respiratory infection symptoms didn’t have a pathogen detected. Older children were more likely to have negative PCR results, but since PCR testing was limited to 22 of the most common respiratory pathogens, it’s possible they were infected with an untested pathogen, the authors noted.

For the nine measured pathogens, endemic coronaviruses (OC43 and NL64), human rhinovirus/enterovirus (HRV/ENT), influenza and RSV were predominant. Among 0 to 5 year olds, HRV/ ENT was the predominant pathogen detected. In acute visits for 6 to 17 year olds with an identified pathogen, influenza predominated.

While the length of child absenteeism from school or childcare wasn’t associated with a pathogen being detected, total workdays missed by caregivers per acute respiratory infection was higher when the child had a detectable respiratory pathogen. However, caregiver absenteeism wasn’t statistically significant. On the other hand, as child age increased, caregiver absenteeism significantly decreased.

The study’s results suggested that ADSM should expect to miss more duty days if they have a younger child with an acute respiratory infection, compared to having an older child.

In the future, the investigators recommended expanding the study population and across a range of military bases. Since children aged 0 to 5 years old contributed to the greatest number of missed days for caregivers, future analyses should examine risk factors for prolonged absenteeism to develop strategies to reduce respiratory infection transmission and associated absenteeism. These interventions could significantly improve force readiness by minimizing duty days lost among ADSMs, the authors proposed.

 

1. Gadziala M, Dimick V, Banoub A, Crecelius EM, et. Al. Impact of Acute Respiratory Viral Infections on Absenteeism in Military-Connected Children and Caregivers. Mil Med. 2026 May 11:usag214. doi: 10.1093/milmed/usag214. Epub ahead of print. PMID: 42113917.