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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
Register to be notified of new articles by e-mail -
Current contents list -
More articles on Paediatrics
| 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:
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High-quality childcare for all is unrealisable | ||||||||||
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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 | ||||||||||
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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 |
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For comment see Slack-Smith et al's Letter to the Editor 2 August 1999
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| 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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Analysis of children aged 36 months found:
16 | |||||||||