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About this blog: I am a clinical psychologist, mother, and wife committed to using my life to help the lives of those around me. In addition to seeing clients in my private practice, I contribute to various training and research initiatives in cli...  (More)

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Contemplating Day Care

Uploaded: Jun 13, 2015
We recently faced a problem that plagues many families in the Bay area - what to do about day care?

For a while, we were enjoying a "too good to be true" scenario in which my in-laws came to our house like fairies from a Disney movie to watch our baby while I gradually returned to part-time work. The fairytale ended when circumstances required them to abruptly move out of state. We were suddenly in desperate need of a nanny, or perhaps a day care, or maybe even an exchange student.

I assumed that the effects of various day care options on child development would be well established and could at least point us in the right direction. The research might not be able to tell us if we could afford center-based care, but it could at least help us determine if a nanny was preferable to a home-based care center with a group of children or vice versa. Unfortunately, my assumption was wrong.

It turns out the child care literature is extensive and often contradictory. Below, I've highlighted what I consider to be the most consistent and relevant findings for those of you who are also struggling with this decision.

Most of these findings are from a study conducted by the National Institute of Child Health and Human Development. In 1991 they began collecting data on 1,364 children at birth in ten locations across the U.S. These kids were assessed and monitored in the care option chosen by their parents ?center-based day care, home-based day care (where day care is provided to a small group of children by a neighbor or family), at-home care (including maternal care and nanny care). The study has continued to monitor these children throughout and beyond grade school. This data thus provides insight into some of the long-term effects of various child care options.

Memory and cognitive development: Children who spent more time in day care outside of the home, particularly center-based care, scored higher on standardized tests of short-term memory. These advantages were maintained throughout grade school. These children also scored higher in math and reading. Children from low-income families showed the greatest benefit. Despite this boost in cognitive development, children in center-based day care showed significantly worse work habits (were less likely to complete assignments on time, work well independently, and use their time wisely) than those receiving home-based day care or at-home care.

Behavior problems: Children who spent more time in day care centers, showed more behavioral problems and aggressive behavior. Interestingly, this appears to be the case even for children who attend high quality centers. Thus, as far as behavioral problems go, the issue appears to concern the quantity of time spent in center-based care, rather than the quality of said care.

Physical health: Not surprisingly, children exposed to day care outside of the home (including center and home-based care) get more diarrhea, flu, rashes, colds, coughs, and ear infections. The rate of illness seems to correlate with the size of the day care facility with children in center-based care experiencing more illnesses than those in home-based programs. Interestingly, findings from The Tucson Child Recovery suggest that children who enter center-based care in infancy experience more colds than those reared at home at age 3, but fewer colds at age 6. They also had a reduced rate of asthma. It remains unclear whether children who suffer more physical illnesses as a result of day care experience delays in cognitive development.

In summary, group care (both center and home-based) seems to benefit children's cognitive development, particularly children from low-income families. However, children in center-based care show more behavioral problems and poorer work habits than those receiving home-based or at-home care; and these problems correlate with the amount of time a child spends in center-based care each week. Finally, children in group day care are more likely to be sick as toddlers, but potentially less sick than children their age who were raised at home by the time they reach kindergarten.

So what can parents make of this mess of information?

For starters, we must first keep in mind that all of these studies are correlational; they do not prove that day care causes anything, only that it correlates with certain outcomes. Correlational studies speak to averages. Things may appear better or worse for a group of kids on average, but this doesn't mean your specific child will experience these effects.

Perhaps even more important is that the observed effects were very small. We are talking about a small uptick in behavioral problems and a small uptick in standardized test scores. Generally speaking, the effects of day care pale in comparison to the effects of good or bad parenting.

After much research, thought, and discussion, we did decide to put our daughter in part-time day care. Given the research, we prioritized the following:

Quality: Day care programs with a high teacher to student ratio, with high rates of teacher-child interactions, and with teachers who had higher levels of education were associated with more positive outcomes for children.

Quantity: Given the correlation between amount of time in day care and behavioral problems, we decided on part-time day care in a home-based setting. This is obviously not an option for many families.

Setting: Again, we sought a home-based setting given the higher rates of behavioral and health problems associated with center-based care.

My take away from the child care research was that some small positive and negative effects have been associated with various child care arrangements. However, these effects appear far less powerful than the effects of parenting. Finding a child care solution that enables you to be a more effective and responsive parent, whatever that may be, may very well have the greatest effect on your child's development.
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