A New Spin on Day Care

From the WebMD Archives

Dec. 22, 2000 -- When she put her 6-month-old child in day care, it was a quick fix, Linda Prevosti says. "Our helper at home had quit, but I wanted to work two days a week," she tells WebMD. "It was supposed to be a temporary arrangement."

But it turned into more than that, and not out of necessity, but by choice.

Like Prevosti, many more moms are opting to work after giving birth, according to U.S. Census statistics. In 1976, only 31% of new moms were in the workforce. But of the 3.6 million women who became new moms in 1997 and 1998, the percentage of new moms entering the workforce doubled as about three out of five returned to jobs within one year.

Who is taking care of their children? Data from The Urban Institute shows that in 1997, 32% of children under 5 were enrolled in day care centers -- whereas only 6% were placed with nannies and baby sitters. Parents, relatives, and other home-based providers are watching over the remaining 65% of preschoolers.

But what's best for the children ... the personal attention, with attention being the key word, provided by mom, a nanny, or a family member? Or if parents choose day care, is it always a compromising situation for the child? Well, not necessarily, and sometimes day care, it turns out, can actually have some benefits, if the facility meets certain criteria. What kind of criteria?

Since 1991, the National Institutes of Health has been conducting the most comprehensive study to date evaluating child care experiences and children's early development -- following 1,100 newborns in 10 cities across the country for the first 10 years of life, says Sarah Friedman, PhD, project scientist and scientific coordinator for the National Institute of Child Health and Human Development.

"We're finding that the better the quality of child care, the better outcome for children ... they're doing better regardless of what their home environment has given them," Friedman tells WebMD. "We're also finding that for cognitive and language outcome ... being in day care promotes cognitive and language development more than any other type of care. This may be because of the more structured teaching environment."

In their analysis, Friedman's researchers looked at child-staff ratios, group sizes, caregiver training, caregiver education, and children's development at 24 and 36 months. "We found that most schools did not meet all standards," she tells WebMD. For just 30% of children, the care was "somewhat" positive; for 9% it was "highly" positive, her report shows.

They also found that children in moderate-income families seem to suffer the most, typically because their options are limited. What they can afford may be low quality -- whether it's provided by a family member or a home-based day care provider, Friedman says. Affluent families and low-income families fare better, the first for obvious economic reasons, and the second largely because of child care subsidies given to poor families that allow them access to the better programs.

To help narrow the gap in quality, the U.S. Department of Education is urging school systems to develop more pre-kindergarten programs using Title 1 funds, says Fran Bond, head of the U.S. Department of Education's "Ready to Learn" program.

In the past year, only 17% of schools spent money on preschool services -- yet the importance is very evident, Bond tells WebMD. "In the last 10 years or so, an extraordinary amount of research has told us very clearly that children, even in the earliest months of their lives, have an extraordinary ability to learn."

At what age do children benefit most from a structured day care environment?

For Prevosti, day care proved to be a surprisingly positive experience for her very young child. She decided to keep him there -- even after she hired live-in help. "Those early years were more for safety ... a controlled environment where he was less likely to topple down a flight of stairs if a gate is left open," she tells WebMD.

But socialization proved to be very beneficial as well, she says. "Being in a group setting with one teacher for four or five children forces them to communicate their needs more effectively," she says. "His speech skills improved so much ... compared to his friends who stayed at home."

Whether day care is right for a very young child "depends on the child, certainly, but also on the child's family life," says Patricia Waters, assistant professor of early childhood education at Towson University in Towson, Md., and an educator since 1957.

"I realize that for some families, there may not be a choice whether to put a child in day care," she tells WebMD. "Some families want that extra stimulation, in addition to what they're providing at home. But if social activities are provided, if parents bring young children together for socialization, I see no need to put the child into a day care center before the age of 3. If there is conversation, books, labeling going on, if families are going places and having experiences, that's what's important."

Waters works with Baltimore public school pre-K programs set up for children with language needs. She's seen firsthand the difference a good program can make. "In September, the classrooms are very quiet and children speak in one-word replies, and they have very meager vocabularies. Some come in not knowing their own names. By May, those children have just blossomed. I put it all to the credit of that environment, that stimulation. Thank goodness those children are brought out of their nonstimulating environment. They have the potential, but it just has not been awakened."

Bond agrees that much cognitive stimulation can be accomplished at home. "I'm a great proponent of reading to children from birth, taking them to the bookstore, the library," she says.

If these "rich experiences" don't take place at home, Bond says, "we find that these children do extremely well when they get into a very enriching day care environment. The teacher can instill this love of learning and can also work with parents to see the importance of this.

"We find where children come from homes were language is limited, where it is not a high priority, children may have a 3,000-word vocabulary at age 6," she tells WebMD. "In homes where language is a high priority, children will have a 20,000-word vocabulary. Language development is an important predictor in how children will succeed in school."

So what constitutes an excellent pre-K or day care program?

The best programs "look at the whole child ... at the cognitive, social, emotional, motor development ... class size, adult-child ratio," Bond says. "All of these are mutually supportive to growth and development."

Building literacy skills should be the program's foundation, Bond tells WebMD. "The curriculum should be rich in vocabulary and literacy skills ... have lots of opportunities for children to interact, read books, talk."

Good day care programs foster interpersonal relationships between teachers and children, Bond tells WebMD. "The teacher responds to the child, is so attentive to child ... and can observe and identify the child's needs and interests ... the level the child is at, where the child needs to go."

Young children are "sponges," says Bond, a former kindergarten teacher. "They're so open to learning, to discoveries. All you have to do is put that tone in your voice ... they'll rush right over. You need to make sure that what you teach ... how you teach it meets their needs. You need to make it fun."

In a good day care setting, "There's always something to learn," Bond says. "A teacher can heighten the child's understanding and knowledge through play. A child may be playing with blocks at age 2, 3, 4, but they're not going play with them in the same way at each age. The teacher can enhance this experience with blocks so the child is making discoveries about math, science, balance."