Rethinking the early childcare agenda

Positive health outcomes for children attending childcare include the detection of vision and hearing problems, higher vaccination rates, appropriate nutrition, the detection of child abuse and neglect, primary health and dental care, psychosocial benefits, and opportunities for health promotion.²

The issue of socioemotional development, including attachment theory, has been debated in the literature. Cook cites Belsky, but Belsky has been noted as often citing research that did not take into account the specific characteristics and quality of care.³ It is probable that social and cognitive development are related to quality of care, and Caldwell's study suggests that childcare may provide better quality of care, at least for cognitive development, than home care.⁴ Thus, childcare does not appear to be consistently detrimental to cognitive and language development and may have a positive influence.⁴ The investigation of the influence of childcare on children's development is complex and should be considered in interpreting such research. Harvey,⁵ in an extensive longitudinal study, found that parental employment had "minimal effects on children's later functioning", and that increased early parental income could positively affect childhood development.

We do agree with Cook that increased flexibility for working parents should be encouraged. Flexible options, such as parental leave and part-time work for parents of young children, are often advantageous. In addition to increasing work options for parents, it is important that we strive for high quality childcare, subsidised if necessary, so that all families have the choice of providing such care for their children.

Linda M Slack-Smith
Senior Lecturer, School of Oral Health Sciences
179 Wellington Street, Perth, WA 6000
lindasATcyllene.uwa.edu.au

Anne W Read
Senior Research Officer, Division of Psychosocial Research
TVW Telethon Institute for Child Health Research, Perth

Stephen R Zubrick
Associate Professor, and Head, Division of Psychosocial Research
TVW Telethon Institute for Child Health Research, Perth

1. Cook P. Rethinking the early childcare agenda. Med J Aust 1999; 170: 29-31.
2. Andersson B. Children's development related to day-care, type of family and other home factors. Eur Child Adolesc Psychiatry 1996; 5: 73-75.
3. Melhuish E, Moss P. Current and future issues in policy and research. In: Melhuish E, Moss P, editors. Day care for young children. London: Tavistock/Routledge, 1991: 225.
4. Caldwell B. Impact of day care on the child. Pediatrics 1993; 91(1 Pt 2): 225-228.
5. Harvey E. Short-term and long-term effects of early parental employment on children of the National Longitudinal Survey of Youth. Dev Psychol 1999; 35: 445-459.

In reply: A literature review was beyond my purpose, but I summarised findings of a major meta-analysis, and explained why psychological outcomes are of most concern. Benefits of childcare are often publicised, but risks, proven or probable, should not be concealed from parents and policy-makers.¹

Notwithstanding the 1971 New South Wales child psychiatrists' memorandum,² it became politically incorrect to express concerns about childcare. In social sciences, the now-discredited ideology of cultural determinism prevailed, denying the relevance of evolutionary biology to human behaviour, even mothering.

A pro-childcare "spin" has pervaded research reports. Slack-Smith and colleagues' statement that "childcare does not appear to be consistently detrimental to cognitive and language development . . ." is a typical childcare-advocacy "straw man". The reply is: nobody said it was! Ochiltree's review³ seemed to me to have eight such statements within five paragraphs, and was so "unbalanced" that I wrote a book,¹ to which I refer readers. It covers the points made by Slack-Smith et al, which cannot be answered in a few words.

Childcare advocates seldom acknowledge that "high quality childcare" is not reliably achievable. They quote overseas studies when favourable, but, when not, they claim Australian childcare is of higher quality.³ But one carer to five infants is "nobody's definition of quality".⁴

I argue that the early childcare agenda is misconceived and needs rethinking. Qualitatively better outcomes should be achievable without the associated risks.^1,5,6

Peter S Cook
Child Psychiatrist (retired)
PO Box 84, Repton, NSW 2454

1. Cook PS. Early child care -- infants and nations at risk. Melbourne: News Weekly Books, 1997.
2. New South Wales Branch of the Child Psychiatry Section of the Australian and New Zealand College of Psychiatrists. Memorandum on some aspects of the welfare of children aged under three years whose mothers are in full-time employment. Med J Aust 1971; 1: 446-448.
3. Ochiltree G. Effects of child care on young children: forty years of research. Melbourne: Australian Institute of Family Studies, 1994: 65-66. (Early Childhood Study Paper No. 5.)
4. Hope D. Spare the non-maternal care and nurture the child. The Australian 1998; June 4.
5. Cook PS. Home truths absent in early childcare debate: we need parent-friendly options [opinion]. The Australian 1999; March 24.
6. Cook PS. The role of myth in childcare policy [letter]. The Australian 1999; April 14.

ª 1999 Medical Journal of Australia.