Child Care--When is it Good or Bad for Children?

Child care is a helpful option for adults. It lets them, especially mothers, have more possibilities after choosing to have a child--free time to work or to get a respite away from children. However, under what conditions is child care good or bad for the children? When do children in pre-kindergarten child care have outcomes as good as those raised by a parent or other primary caretaker?  The Study of Early Child Care and Youth Development (link here) by the National Institute of Child Health and Human Development (NICHD) gives complex answers to these two questions.

Why look at another government study? "The NICHD Study of Early Child Care and Youth Development (SECCYD), is the most comprehensive study to date of children and the many environments in which they develop" (P. 6). This longitudinal (16-year), national project studied more than 1,000 children from one-month of age.What are the findings?

On the one hand the NICHD study finds that children "who were cared for exclusively by their mothers did not develop differently than those who were also cared for by others" (P.5). On the other hand, "children with higher quantity (total combined number of hours) of experience in non-maternal child care showed somewhat more behavior problems in child care and in kindergarten classrooms than those who had experienced fewer hours" (ibid.) How can we reconcile both statements? One may conclude from this study that longer hours of child care was correlated with children behaving slightly worse--less socialized and less ready for the rules of the classroom. But parent characteristics, that is, whether the parents were emotionally supportive and created a cognitively enriched environment, whether parents had higher education and family income, whether both parents were together and raising the child, and, and whether the parents were psychologically well-adjusted and sensitive to the child's needs (P.25) were more important than the child care (P.5).

If parent characteristics are most important and if middle class families are, in the aggregate, less chaotic than disadvantaged families, child care quality becomes critical primarily for disadvantaged, chaotic households if one takes the research to its logical conclusions. The NICHD study does not support this conclusion (P.15), but other studies do, especially the longitudinal Abecedarian project, which showed cognitive improvements in disadvantaged children up to young adulthood. These disadvantaged kids also developed better health habits, were more likely to go to college and make more money, and were less likely to end up in trouble. The Abecedarian study also positively affected the behaviors of the teenage mothers of these children, making it more likely they would finish their schooling and be self-supporting.

Yet, how many disadvantaged mothers are able to take advantage of high-quality child care such as that offered by the Abecedarian project? Most disadvantaged parents do not have access to high-quality child care, using instead a relative or friend down the street. This care is not as bad as that of Uncle Ernie (in The Who's rock opera, Tommy), but unlicensed and unregulated care by relatives or friends is often poor quality, and, of course, unlicensed and unregulated care at centers is often poor quality as well. The NICHD authors admit that most child care is not high quality (P. 1 5). Low-quality care and low-quality parenting can be poor combination.

Children were somewhat more likely to be insecurely attached to their mothers if they were in lower quality care, but only if their mothers were also lower in sensitivity during interactions with their children (P.13).

These effects were less strong in the NICHD study, stronger in other studies. Insecurely attached children have increased stress and coping problems (Spangler 1993) and are less equipped to handle the rigors of public school. I will give more data on the dangers of low-quality care below.

Now let us leave the world of research and enter the even more murky universe of psychological theory. John Bowlby, founder of attachment theory, wrote that children belong with their mothers. Here is a summation of his famous book, Child Care and the Growth of Love:

• Maternal deprivation is a key cause of mental ill-health.
• Mothers are central to a child’s development with fathers and extended family members providing a supporting role.
• Any maternal separation will adversely affect a child to some degree.
• Efforts should be made to avoid family failure but even state support may not be enough where the fundamental problem is failing parents.
• Adoption should be undertaken as soon as possible.
• Where possible, the mothers of illegitimate children should be given the support to care for their children.
• Fostering, if possible with the extended family or neighbors, should be used for short term emergencies.
• Group care should be confined to treatment, the care of adolescents or the short-term care of younger children and sibling groups.
• In both fostering and group care parental contact should be encouraged.
• Treatment, whether for physical or mental illnesses, should if possible be provided in the child’s natural home and otherwise in homes close enough for parental contact.

NICHD researchers do not find differences in attachment security between kids in day care or at home, but Bowlby, interviewed well after his WWII orphanage observations that were the crux of his theory, was not a proponent of center-based care! And it is a stretch to imagine either Bowlby or (famous attachment researcher) Mary Ainsworth approving of center-based care where the child's primary (love) object can change day-to-day.

As a son and brother of academic researchers, I trust the scientific method over theory or other forms of evidence in determining the efficacy of child care. However, the most vociferous criticisms against child care come from heavily emotional personal stories. Conservative writer Karl Zinsmeister supplies plenty of anecdotal fodder in his article, The Problem with Day Care (The American Enterprise, May/June 1998). Much of it bemoans the lack of ANY high-quality child care.

Author Linda Burton is another person who has described in detail what she came across while scouring her hometown (the Washington, D.C. area) for day care:

In one instance, I found the "absolutely marvelous" family day care provider, recommended by trusted friends, sleeping on her sofa while 11 children (she had informed me that she only cared for five) wandered aimlessly around in front of the blaring TV. Another time, on an unannounced visit, I found that the "highly recommended" licensed day care provider confined seven preschoolers to her tiny dining room. I found them huddled together, leaning over a barricade to watch a TV program showing in the adjacent room.

These are not isolated anecdotes. Anyone investigating the world of full-time day care quickly amasses files of such testimony. A few years ago the Metropolitan Toronto Social Planning Council investigated a sample of 281 day care homes. They reported that a small number were genuinely stimulating, and another small number were out-and-out abusive. The large majority, however, provided care that was merely indifferent. Only a few of the caregivers studied were able to make themselves genuinely interested in each of their individual enrollees. In a significant minority of cases, youngsters were simply ignored most of the time.

Despite the doubts of Bowlby, despite how children cared by multiple caregivers would be a unrecommended practice according to attachment theory, and despite anecdotal evidence, NICHD research has shown few negative attachment effects on children in child care. By 2005, the American Academy of Pediatrics had revised its policy. Based on the NICHD and Abecedarian studies, it's publication, Quality Early Education and Child Care from Birth to Kindergarten (Volume 115, No. 1, January 1) stated a change in favor of child care but only high-quality care (or parenting).

When care is consistent, developmentally sound, and emotionally supportive, there is a positive effect on the child and the family.^8–21 Children exposed to a poor-quality environment, whether at home or outside the home, are less likely to be prepared for school demands and more likely to have their socioemotional development derailed.^8–21 The inadequate outcomes of children in poor-quality care often cannot be fully remedied in the formal structure of the K-12 educational system because of the need for noneducational services such as mental and behavioral health care.

As seen in the Abecedarian study above, lasting positive affects were seen when low-income children experience high-quality care. However, as noted by NICHD researchers, the authors of Quality Early Education and Child Care from Birth to Kindergarten write, "most child care centers in the United States are rated poor to mediocre in quality, with almost half meeting less than minimal standards" (ibid.).

Until child care improves in quality, low-income children will continue to suffer. Economically disadvantaged but "good-enough" parents (as Winnicott would say) may get better outcomes by avoiding low-quality child care if they have an economic choice.