A number of months ago, a letter appeared in Binah that caught my attention. A mother wrote about the dangerous effects of childcare on babies and toddlers based on studies that measur ed cortisol, a stress hormone, and showed that children in day care seem to have higher levels of stress than children cared for by their mothers. As a working mother of five, all of whom experienced some form of childcare in their early years, and as a therapist dealing with an array of family issues, I wanted to find out more.
Clearly, the topic of childcare is a very charged issue for many mothers. We love our children, and want the very best for them. In today’s economy many mothers do not have the option of staying home full-time. For other families, non-economic factors may affect their daycare/homecare decision. When a mother is struggling with illness or a difficult pregnancy, or caring for an elderly parent, quiet morning hours can make the difference between managing and not managing. Some women need child-free hours just to keep up with the needs of a large household, or to use the time for creative expression.
Is it fair to weigh parents down with guilt if they do choose daycare? Is all the research on the topic of childcare clearly against it? Do the studies apply to all childcare settings, or just large daycare centers? Do researchers know what causes the cortisol increase in the studies where it was observed? Are there are any significant long-term effects? Were the results in large daycare centers the same as those in family settings?
Before going into details about the cortisol research, it is important to take a look at the theoretical orientation that motivated it. Various studies over the last century have shown that children need to build an attachment with one or more primary caregivers in order to feel safe and confident and to build an internal sense of what a healthy relationship feels like.[1] There is a wealth of research on the subject[2] that is beyond the scope of this article, but I will bring one powerful example.
In the 1990s, the world was shocked when Romanian orphanages opened their doors and 40,000 children were found to be seriously neglected. While some of the babies had received adequate nutrition, none of them had received love and normal bonding with their caregivers. Even the older children had no language skills, and did not seem interested in connecting with people. Follow-up studies indicated that the lack of early attachment had left permanent damage. The children did not develop physically or emotionally, even those who were subsequently adopted and received love and personal attention. MRI brain scans showed serious deficiencies in brain growth[3] [4], IQ scores were lower, and relationship skills suffered.[5] This study joined the many others that show the importance of meaningful attachment in the first two years of life.[6]
The opposite is also true. Children who form healthy attachments and whose caregivers are attentive to them in their early years develop better both physically and emotionally. They form an internal imprint of what a healthy relationship is supposed to feel like, and will seek out and form meaningful bonds throughout their lives. The mutual enjoyment that exists between a well-attached baby and his mother creates a foundation for a lifetime of success physically,6 emotionally,[7] and academically[E1]
If it is so essential for a child to connect to a primary caregiver, what happens when he or she is sent to childcare in the formative years? This is where the cortisol studies come in. Numerous studies have shown that cortisol levels rise throughout the day when children are in daycare − more than they do at home.[8] However, there is no conclusive evidence that any damage is done by this increase in the hormone. In fact, cortisol elevations in many circumstances are adaptive,[9] and a marker of social competence, particularly in new situations.[10]
Other studies show that children who experienced high quality daycare were more successful in third grade in the areas of math, memory, and vocabulary. One study by the National Institute of Children’s Health and Development revealed some behavioral problems in children who had been in daycare, but also indicated the academic benefits mentioned above. As the children aged, the behavioral problems faded, but the academic successes did not. Children six months of age and older who had more experience in childcare centers showed somewhat better cognitive and language development through age three, and somewhat better pre-academic skills involving letters and numbers at age four-and-a-half than children who were at home with their mothers. Apparently, there is a benefit to daycare that outlasts any problems that it may have caused. In fact, long term studies of children who were in daycare in their early years show some advancement in academic success later on in school, particularly among children from difficult family situations.[11] [12]
As frum mothers, these studies do not necessarily tell us much about our available childcare options. For the most part, the children studied were from low-income, minority populations in high-crime areas, and in family settings in which both parents were working, or only one parent was present. The studies were done in large centers where each caregiver was responsible for many children, and the staff was underpaid and unmotivated. Unfortunately, for some of these children, even this less-than-ideal daycare facility still may be better than what they experience at home.[13] This, baruch Hashem, is far from the reality in our communities.
Dr. Josh Rocker, a pediatric emergency doctor at the Cohen Children’s Medical Center at LIJ hospital does not give much credence to the cortisol studies. “In order to draw conclusions about the effects of stress hormones in children you would need a very large-scale study in which many children from various backgrounds and family situations were included. Then you would have to take into account all the other things that may be causing stress for the child. Perhaps in daycare they are receiving foods that they are not used to; maybe the smells of the cleaning fluids used in daycare, or even the different type of lighting is bothering them. Who knows? There are so many factors to be considered that it is hard to say that daycare causes stress. Even if children in daycare situations do have higher cortisol levels, there is no proof that that will have any detrimental long-term effects. Saying that daycare is bad and mothering is good is over-simplistic and even silly. What kind of daycare? What kind of mothering? What is the child’s personality type? Some children thrive in stimulating social situations, while others are happiest near their mothers. Sometimes the home situation is not ideal and daycare is a safe haven. There are many facets to the childcare question that parents must take into account in order to make the best decision for their family.”
The most recent and comprehensive study of the long-term effects of daycare on children was done at the Center on the Developing Child at Harvard University. They found that the factor that most significantly affects children’s long-term success is the type of parenting they receive at home, no matter how many hours they spend in daycare. Children whose parents are responsive, sensitive, and supportive are more successful in school, score higher in reading, math, and vocabulary, have better work habits and social skills, and have fewer behavioral problems in the classroom. While in general, kids who were in childcare have slightly more behavioral problems than children who were mothered full-time, they are still in the normal range. [14]
While moms who need or choose to work are not necessarily compromising their babies’ development by placing them in childcare, they do have to be careful when selecting a childcare provider. Some mothers choose to hire a private caregiver, a neighbor, or a grandmother, but for many, a group setting is the best option. Deciding whether or not to put a child in daycare is a very personal decision that each couple must make for each child. However, it is clearly possible for children to have very positive, nurturing experiences in childcare What can parents do to ensure that their child will have the best experience possible?
The first step is picking the right childcare provider. While there are practical factors to consider such as price and location, it is essential to get information about a babysitter and her background, and to speak to parents who have sent their babies to her. A babysitter who is well-trained and confident in her skills will not have any problem giving references and inviting parents to visit.
Nechama Adler, who runs the K’tantan playgoup in Monsey and holds a degree in early childhood special education, recommends that parents consider the following questions when checking out a childcare provider:
The Physical Space:
· What are the facilities like?
· Is there enough room?
· Does it look and smell clean?
· Is it warm and inviting?
· Are there plenty of colorful and stimulating toys in good condition?
· Are there both indoor and outdoor spaces for the kids to play?
· Does it look safe? (Are there proper fences, guardrails, etc…?)
Staff Qualifications:
· Does the teacher have training in infant and toddler development so that she understands the developmental and emotional needs of the age group that she is working with?
· Does she have certification in First Aid and CPR?
· Does the teacher seem attuned to the children’s needs?
· What is the staff to child ratio?
· Is there a high turnover rate? Is it safe to assume the child will have the same caregivers for the duration of the year?
· What is the policy about phone calls and visits during the day? You don’t want a babysitter to be on her phone all day long, ignoring the children, but if you do need to reach her for some reason, how can that be arranged? Knowing that parents can visit during the day gives confidence that the caregiver has nothing to hide.
Staff Behavior:
· Do caregivers speak to the children, even babies? Do they sing and read to the children? Do they hug, rock, cuddle, seek eye contact, and enjoy the children? Do they respond to the babies’ smiles and emerging skills and interests?
· Do they answer children’s questions patiently? Do they ask the children questions? Do the teachers seem to understand what the children are trying to communicate, even when they don’t have full verbal skills?
· Is there a lot of crying? How does the caregiver react when a child cries?
· While you are visiting the facility and the teacher is speaking to you, what are the children doing? Does the teacher seem to be paying attention to them?
· If there is an assistant, how is she treated? Does she seem warm and enthusiastic, or is she just a worker?
Educational Philosophy:
· Is each baby allowed to eat and sleep according to his/her own rhythms, not according to a schedule imposed by the caregiver?
· Does the caregiver handle conflicts without losing patience, shaming a child, or displaying anger?
The bottom line is: Is it an environment where your child will feel secure and happy? Will you feel confident about leaving your child there?
Once you have chosen a childcare provider, you can ease your child’s transition by sending some familiar objects, a blanket or toy, or even a small picture album with family pictures. It is helpful to communicate with the staff so that they continue your baby’s routines around naptimes and feedings.[15] Exchanging a few sentences with the babysitter at pick-up and drop-off can make a world of difference. In a childcare center that I sent my child to, they kept a log for each child and recorded the times and types of feedings and diaper changes. If a child’s elimination cycle is somehow disturbed, this information can be essential in understanding and resolving the problem.
Sometimes even with parents’ best efforts in finding proper childcare, problems do arise. The following are some red flags that signal that the parents need to investigate further.
Does your child suddenly not want to go to playgroup?
Does your baby come home irritated and upset?
Have there been significant changes in your baby’s eating or sleeping patterns?
Has recurrent diaper rash or diarrhea become an issue for your child since starting daycare?
When something seems to be “off,” the first step is to speak to the babysitter. In my experience as a mother and teacher, most teachers really care about the children that they work with, and are willing to discuss what needs to be done for the child’s benefit. A competent professional will be curious and responsive and not defensive if issues come up. If after a few conversations things do not seem to be improving, or if the sitter seems to get defensive and is unwilling to deal with the child’s distress, it might be time to consider looking for a different childcare situation. There are various ethical and halachic issues involved in absolving a childcare arrangement in the middle of the year, and a Rav should be consulted. If there is reason to suspect abuse or maltreatment, it is important to have some proof. Again, a rabbi or social worker should be consulted, and parents must proceed carefully. It is not possible to give general guidelines in such situations, and each one must be examined individually to see how it should be dealt with. Childcare is just one aspect of the complex world of parenting. As parents, we strive to do all that we can to educate our children and nourish their souls. When we have done our due diligence to ensure that our children are in a nurturing environment, there is no reason to feel guilty for placing them in childcare. Whether or not we will be able to let go of the traditional Jewish maternal guilt is a different question! [1] Ainsworth, 1973; Bowlby, 1969 [2] A wonderful resource for parents and child care providers is www.zerotothree.org. They provide a wealth of research-based information in language that parents and others concerned for children can understand and implement. [3] Ross Thomson “Development in the First Years of Life” from www.futureofchildren.org [4] Child Abuse and Neglect and the Brain—A Review, Danya Glaser 2003 Journal of Child Psychology and Psychiatry [5] Rutter et al, 1998 [6] Attachment Theory, Saul McLeod 2009 [7] Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health, Allen Schore - Infant Mental Health Journal, 2001 [8] Watamura, Sarah E., Erin M. Kryzer, and Steven S. Robertson, “Cortisol patterns at home and child care: Afternoon differences and evening recovery in children attending very high quality full-day center-based child care.” Journal of Applied Developmental Psychology 30.4 (2009): 475-485. [9] Sapolsky, 2004 [10] Gunnar et al., 1997 [11] Cognitive and School Outcomes for High-Risk African-American Students at Middle Adolescence: Positive Effects of Early Intervention, Frances A. Campbell, American Educational Research journal [12] Caughy, M. O., DiPietro, J. A. and Strobino, D. M. (1994), Day-Care Participation as a Protective Factor in the Cognitive Development of Low-Income Children. Child Development [13] NICHD study of Early Child Care and Youth Development − Government publication [14] http://developingchild.harvard.edu/ -A wonderful research based parent friendly website [15] “Your Child’s Behavior” www.Zerotothree.org