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Rethinking the early childcare agenda

Who should be caring for very young children?

Peter S Cook

MJA 1999; 170: 29-31

Introduction - High-quality childcare - Evidence of undesirable outcomes - Being with mother - Many mothers want to care for their own children - A rethink is needed - Acknowledgement - References - Authors' details
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Introduction In Western societies, mothers often seek paid employment because of societal or economic pressures or a desire to continue a career, and place their infants in childcare centres. There is a perception that trained carers can rear children as well as, or perhaps better than, the mothers themselves.1 The Australian Child Care Task Force2 has recommended subsidised expansion of the "childcare industry", saying that all families should have access to affordable, high quality childcare by trained, professional carers.

"Childcare" in this article refers to institutional day centre care, but in research studies it may variously mean any regular non-maternal care or non-parental care. Theoretically, children can spend as many hours in childcare by the age of five as they will spend in school over the next 12 years.3

I argue here that for children up to 2½ to 3 years of age, and particularly during infancy, this agenda of subsidised, universally available, high quality professional childcare is misconceived, and a rethink is needed. Evidence suggests that this agenda:

  • Is unrealistic (eg, high quality childcare for all is not affordable);

  • Overlooks accumulating evidence of risks of undesirable outcomes sometimes associated with early childcare;

  • Is contrary to much expert opinion about what is likely to be best for infants;

  • Is contrary to the desire of many working mothers to care for their own children, if they could afford it; and

  • Relies partly on the now-discredited ideology of cultural determinism.


High-quality childcare for all is unrealisable
Morgan concluded that "Affordable care is low-quality care" and the "difficulties and cost of providing good quality care, with its highly involved and trained staff, small group size, caregiver stability and low infant to caregiver ratios, should surely demonstrate how 'affordable, universally available, good-quality, easily accessible childcare' . . . is a chimaera, unrealisable in the real world."1

Australian standards require one carer for five infants under two, which professionals consider inadequate.1,4,5 Moreover, although Australian governments subsidise 60% of childcare costs,2 Loane found "mediocrity more prevalent than excellence",4 reporting that an assessment of half of Australia's 2400 childcare centres showed 13% failed the national accreditation3 and 40% achieved only the minimal standard, with frequent inadequacies in areas such as child management, safety, health, and nutrition.4


Evidence of undesirable outcomes, sometimes independent of quality
Evidence about the effects of childcare, beneficial or harmful, is incomplete and sometimes contradictory. Research into outcomes (whether by standardised tests, or behavioural or socioemotional ratings) is inherently complex, with imperfect instruments, and many confounding variables. Longitudinal studies, showing longer term outcomes, require dedication, expertise, time and money.

The interpretation of outcome studies has been hotly debated.6-9 While many infants in childcare apparently thrive, Morgan has reviewed the "mounting evidence of adverse side-effects",1 and some of the evidence pointing to risks is outlined here.

Not surprisingly, children in childcare have an increased risk of infectious diseases,10 but the psychological effects are of most concern, as the foundations of the human mind and emotional development are laid in these early years.11 An enduring aspect of the child's world is the parent-child relationship, and one central feature of this relationship is the infant-mother attachment. As mammals, secure attachments between infants and their mothers (and/or effective surrogate mothers) have been vital for our species' survival.7,8,12 Research shows that the security or insecurity of this attachment provides the foundation upon which subsequent relations with adults and peers are built.12 According to Rutter, moderate but significant associations have been found between insecure attachment and various forms of psychopathology both in childhood and adult life.13

To settle some controversies, a multicentre, longitudinal US childcare study is currently investigating the influence and interactions of selected variables on childcare outcomes. These variables include child's sex and temperament, mother's psychological adjustment and sensitivity in the home and at play, and type of childcare, age of child at entry, amount and stability of childcare, and childcare quality assessed for the individual child. This study has established that the security of infant-to-mother attachment can be reliably and validly assessed at 15 months of age.14 Some findings associated with increased risk are shown in the Box. While some of these differences were modest or small, they were consistent in direction. Further analysis through the course of this major study may illuminate the longer-term significance of these findings.

Meanwhile, although earlier research had limitations (eg, sample bias and lack of standardised measures of childcare quality), a meta-analysis17 of the 101 childcare outcome studies from many countries published in peer-reviewed journals between 1957 and 1995 found robust evidence of adverse outcomes associated with non-maternal care in the areas of children's infant-mother attachment security, their socioemotional development (including increased anger, anxiety, and hostility in boys, and overdependency, anxiety, and depression in girls), and in their behaviour (including hyperactivity, aggression and non-compliance). They found no support for the belief that high quality day care is an acceptable substitute for parental care.

Statistical analysis of group findings can obscure individual reactions. Harsman18 studied 26 infants before they commenced Swedish quality long daycare centre at ages ranging from 6 to 12 months. She followed them through five months in childcare, comparing them with 26 controls (matched pairwise for age, sex and socioeconomic background) cared for by their mothers. Although many infants adjusted easily to childcare, at one stage 11 of the children were assessed as "sad and depressed" in the childcare situation. By the end of the study, the childcare group showed significantly lower scores than the mother-care group in the hearing, speech, and personal-social subscales of the Griffiths' Mental Development Scale.18

Space precludes discussion of the adverse effects on parents, but many mothers in two-income families are overloaded and "stressed-out".1,2


Being with mother is likely to be best
This childcare agenda, in disregarding the child's age, is contrary to much expert professional opinion that, ideally, it is likely to be best for very young children to be mostly with their mothers. Of 904 professional members of the World Association for Infant Psychiatry and Allied Disciplines from 56 countries, 402 responded anonymously to a survey asking what kinds of care, at various ages up to 36 months, they considered likely, ideally, to be best from the infants' viewpoint.19 A majority of the respondents believed that it is "very important" for infants "to have their mothers available to them through most of each 24 hours" for more than one year, and to be cared for "principally by mother" until over two years. Only 11% selected full-day group care as the best option for children aged up to 30 months. The author concluded: "The findings show that the polled professionals consider that the development and well-being of children under 3 would be served best by patterns of care that are diametrically opposed to those politicians promise, policy-makers aspire to provide and parents strive to find".19


Many mothers want to care for their own children
According to extensive surveys of mothers seeking or using childcare in order to work, many mothers would prefer to care for their young children at home if they could afford to do so.1,20,21 Moreover, in 1993, 65% of Australians reportedly thought it preferable that mothers of preschool children should not take paid employment outside the home.22 Yet when, as in Australia, taxation systems largely disregard childrearing costs23 and favour two-income families, the latter can outbid single-income families in acquiring homes. Prices rise to the level the market will bear and, to compete, more mothers seek paid employment and childcare.1,24 Childcare subsidies aggravate this vicious circle, unless balanced by equal help to home-caring parents through "family-friendly" taxation policies.23,25


A rethink is needed
This childcare agenda relies partly on the now-discredited ideology of cultural determinism,26-28 which taught that human nature is culturally determined by social conditioning, denying evolutionary and biological influences. Yet the needs of infants and their mothers, as mothers, are based in our genes and cannot be refashioned to suit ideologies. We need social patterns of support for parenting which respect the human givens, recognising that we each have a pedigree of mothers who, overall (through millions of years), were selected for success in all the essential processes of primate mothering -- including childbirth, breastfeeding, and bonding/attachment, as well as the carrying and rearing of a baby girl who would grow up to do likewise -- not in isolation but within a related social group.8,29,30 Research increasingly illuminates the long-term significance of optimal early maternal nurture for healthy cognitive, emotional and physical development.11,31-35 The precautionary principle -- primum non nocere -- is fundamental in healthcare. Large-scale institutional, long-daycare rearing of babies and very young children by professionals offering no continuing relationship with them is without successful precedent in the history of our species.

When the evidence and professional opinion agree that mothers are the best people to care for their young children, it seems neither wise nor cost-effective15 for governments to spend large sums of money subsidising childcare for mothers who would prefer to be helped to care for their infants themselves.

Perhaps "How can we provide quality childcare for everybody?2" asks the wrong question. Taking into account the biologically determined needs of young human beings and their mothers, we should be asking "How -- in our detribalised societies -- can we best help and support those parents who wish to do a mutually satisfying job of mothering and fathering their infants and young children without jeopardising their own futures?". Some proposals have been offered,1,8,20,23,30,36 and I suggest that if some of the resources directed towards providing childcare were creatively redirected to supporting high quality parenting we would be more likely to achieve our real goal of enhancing the well-being of mothers, young children, and society.


Acknowledgement
I am indebted to Professor Jay Belsky, Distinguished Professor of Human Development and Family Studies at Pennsylvania State University, for his generous willingness to communicate with me, but responsibility for the text is mine.

References
  1. Morgan P. Who needs parents? The effects of childcare and early education on children in Britain and the USA. London: Institute of Economic Affairs, 1996: 1-15, 48-58, 90-98, 114-118.
  2. Economic Planning Advisory Commission Child Care Task Force. Future child care provision in Australia. Canberra: AGPS, 1996: xv, xvi, 16, 37.
  3. National Childcare Accreditation Council. Putting children first: quality improvement and accreditation system handbook. Sydney: National Childcare Accreditation Council, 1993.
  4. Loane S. Who cares? guilt, hope and the child care debate. Melbourne: Reed, 1997: 120-152.
  5. Hope D. Spare the non-maternal care and nurture the child. The Australian 1998 4 June.
  6. Belsky J. Consequences of child care for children's development: a deconstructionist view. In: Booth A, editor. Child care in the 1990s: trends and consequences. New Jersey: Lawrence Erlbaum, 1992: 83-94.
  7. Karen R. Becoming attached: unfolding the mystery of the infant-mother bond and its impact on later life. New York: Warner, 1994.
  8. Cook PS. Early child care -- infants and nations at risk. Melbourne: News Weekly Books, 1997: 26-31, 76-89, 154-158, 182-190.
  9. Ochiltree G. Effects of child care on young children: forty years of research. Melbourne: Australian Institute of Family Studies, 1994. (Early childhood study paper No. 5.)
  10. Ferson MJ. Control of infections in child care. Med J Aust 1994; 161: 615-618.
  11. Cockburn F. The minds of our children: sensory input and the development of the human infant brain and mind. The British Association of Perinatal Medicine Founder's Lecture. Proceedings of the XVth Congress of Perinatal Medicine; Sep 1996; Glasgow. London: Parthenon, 1997: 53-60.
  12. Belsky J, Cassidy J. Attachment: theory and evidence. In: Rutter M, Hay D, editors. Development through life: a handbook for clinicians. Oxford: Blackwell Scientific Publications, 1994: 373-402.
  13. Rutter M. Clinical implications of attachment concepts: retrospect and prospect. J Child Psychol Psychiatry 1995; 36: 549-571.
  14. National Institute of Child Health and Human Development. Early Child Care Research Network. The effects of infant child care in infant-mother attachment security: results of the NICHD study of early child care. Child Dev 1997; 68: 860-879.
  15. Belsky J. Early childcare, parenting, and the parent-child relationship. Invited testimony delivered to the US Senate Subcommittee on Children and Families, 23 Jan 1998.
  16. National Institute of Child Health and Human Development. Early Child Care Research Network. Mother-child interaction and cognitive outcomes associated with early child care: results of the NICHD study up to 36 months. Bethesda, Maryland: NICHD, April 1997.
  17. Violato C, Russell C. A meta-analysis of the published research on the effects of non-maternal care on child development. In: Violato C, Genuis M, Paolucci E, editors. The changing family and child development. London: Ashgate. In press.
  18. Harsman I. Dagliga separationer och tidig daghemsstart. (Daily separations and early entry into day care). Stockholm: HLS Forlag, 1994 (ISBN 91-7656-334-0).
  19. Leach P. Infant care from infants' viewpoint: the views of some professionals. Early Dev Parent 1997; 6: 47-58.
  20. Leach P. Children first: what society must do -- and is not doing -- for children today. Harmondsworth, Middlesex: Penguin, 1994: 68-102: 240-265.
  21. Vandenheuvel A. Mothers with young children: should they work? Do they want to work? Family Matters 1991; 30: 47-49. (Melbourne: The Australian Institute of Family Studies.)
  22. Evans MDR. Norms on women's employment over the life course: Australia 1989-1993. Worldwide Attitudes, International Social Science Survey, Australia, ISSN 1323-9589, Canberra: Research School of Social Sciences, Australian National University, 1995.
  23. Sullivan L. Tax injustice: keeping the family cap-in-hand. Sydney: Centre for Independent Studies, 1998. (Issue analysis No. 3.)
  24. Ochiltree G, Edgar D. Today's child care, tomorrow's children. Melbourne: Australian Institute of Family Studies, 1995. (Early childhood study paper No. 7.)
  25. Casey DJ. Economic justice for the family. The Australian Family 1996; 17(3): 11-17. (Melbourne: The Australian Family Association.)
  26. Freeman D. The debate at heart is about evolution. In: Fairburn M, Oliver WH, editors. The certainty of doubt: Tributes to Peter Munz. Wellington: Victoria University Press, 1996.
  27. Freeman D. Margaret Mead and the heretic: the making and unmaking of an anthropological myth (Foreword). Melbourne: Penguin, 1996: vi-xiv.
  28. Freeman D. The fateful hoaxing of Margaret Mead: an historical analysis of her Samoan researches. Boulder, Colo: Westview, 1998.
  29. Werner EE. Infants around the world: cross-cultural studies of psychomotor development from birth to two years. J Cross-Cult Psychol 1972; 3: 111-134.
  30. Cook PS. Childrearing, culture and mental health: exploring an ethological-evolutionary perspective in child psychiatry and preventive mental health, with particular reference to two contrasting approaches to early childrearing. Med J Aust 1978; Spec Suppl 2: 3-14.
  31. Lucas A, Morley R, Cole TJ, et al. Breast milk and subsequent intelligence quotient in children born pre-term. Lancet 1992; 339: 261-264.
  32. Prescott JW. Affectional bonding for the prevention of violent behaviors: neurobiological, psychological, and religious/spiritual determinants. In: Hertzberg AJ, et al, editors. Violent behavior, Vol 1: Assessment and intervention. New York: PMA Publishing, 1990: 110-142.
  33. Prescott JW. The origins of human love and violence. J Prenat Perinat Psychol 1996; 10(3): 143-188.
  34. Higley JD, Thompson WW, Champouz M, et al. Paternal and maternal genetic and environmental contributions to cerebrospinal fluid monoamine metabolites in Rhesus monkeys (Macaca mulatta). Arch Gen Psychiatry 1993; 50: 615-623.
  35. Meaney MJ, Bhatnagan S, Dioria J, et al. Molecular basis for the development of individual differences in the hypothalamic-pituitary-adrenal stress response. Cell Mol Neurobiol 1993; 13: 321-347.
  36. Cook PS. Antenatal education for parenthood, as an aspect of preventive psychiatry: some suggestions for programme content and objectives. Med J Aust 1970; 1: 676-681.

For comment see Slack-Smith et al's Letter to the Editor 2 August 1999

Authors' details 62 Greycliffe Street, Queenscliff, NSW 2096.
Peter S Cook, FRANZCP, MRCPsych, Child Psychiatrist (retired).

Reprints: Dr P S Cook, c/o PO Box 84, Repton, NSW 2454.
Email: pcookATmidcoast.com.au

©MJA 1999

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Some findings of a major longitudinal childcare study in the United States

Analysis of children aged 15 months found: 14,15
  • Quality of care was important, assessed, not globally, but by how sensitive, responsive, affectionate and (cognitively) stimulating the carers were in the individual carer-child relationship. Children in lower quality childcare risked adverse outcomes. 15
  • Evidence for whether quality childcare compensated for lower quality maternal care was mixed, but the less time children of insensitive mothers spent apart from them in childcare the more likely they were to be securely attached.
  • Regardless of childcare quality and other variables, boys in more than 30 hours of non-maternal care per week had an increased risk of insecure attachment.
  • Infants whose mothers rated in the lowest 25% for "sensitivity" (summarising extensive observational assessments) had an increased risk of insecure attachment if they had over 10 hours' non-maternal care per week.
  • Childcare of low quality, or instability (more than one change of arrangement), each independently increased an infant's risk of insecurity.
  • Separate risk factors appeared to be cumulative in their effects.

Analysis of children aged 36 months found: 16

  • Family and child characteristics were major influences in predicting outcomes, both in mother-child relationships and in cognitive and language areas.
  • Childcare variables had smaller, but consistent, additional effects on mother-child relationships. Poorer-quality childcare had adverse influences, and more hours in non-maternal care (mean weekly hours recorded across 0-6, 0-15, 0-24, and 0-36 months) were associated with less sensitive and engaged mother-child interactions across the first three years, and with the child showing less affection towards the mother at 24 and 36 months.
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