Day Care

Health and Safety

The effects of day care on children's health and safety vary by the quality of the setting and the attention paid to these issues. Because their immune systems are not yet fully functional, infants and toddlers are more susceptible to illnesses than older children. Infectious diseases (mainly upper respiratory and gastrointestinal) are higher among children in family day care and day-care centers than among children cared for in their own homes. However, scrupulous attention to hand washing and hygiene can cut the rate of infectious disease transmission substantially. Children in day-care centers may also be prone to injuries if the playground equipment is unsafe. This risk can be reduced by paying attention to the height of playground structures and the resilience of the surface under the equipment. The American Association of Public Health and the American Academy of Pediatrics developed a document entitled "Caring for Our Children" that provides comprehensive health and safety guidelines for day-care facilities.

Cognitive Development

The effects of day care on cognitive development are also related to the quality of the setting. The CQO study found that children in higher quality day care demonstrated more advanced cognitive skills than children in lower quality care. Specifically, their language development was more advanced, and they had better premath skills. In addition, compared to children who received low quality care, children who received high quality care in their preschool years continued to show heightened cognitive skills into the early school years.

The NICHD study researched this issue further by examining both day care quality and family characteristics. This study also found care quality to be related to language development as well as school readiness. However, family characteristics (such as family income, mother's vocabulary, and the home environment) were more strongly associated with children's cognitive development than day-care experience. This study also compared children who were and were not in day care and found that when family factors were controlled for, few differences between the groups existed. Comparisons showed that children in high quality care sometimes scored higher than children in exclusive maternal care, and children in low quality care sometimes scored lower. More frequently than not, however, children in exclusive maternal care and children in day care scored similarly on cognitive measures.

Effects on Social Development

The effects of day care on social development are also associated with care quality. The CQO study found that children in higher quality day care had more positive attitudes about themselves, their relationships with peers were more positive, and their social skills were more advanced than were those in lower quality care. Further, the quality of the day care they had attended continued to be related to their social development in the early school years. Children who had close relationships with their day-care providers were rated as more sociable through kindergarten and as having fewer problem behaviors through second grade than children whose relationships with their day-care providers were not close. Also, children who had more positive classroom climates in day care were found to have better relationships with their peers in second grade. The NICHD study similarly found that care quality was associated with children's social development. However, they also noted that family characteristics, especially mother's sensitivity, were more strongly associated with children's behavior than their day-care experience (e.g., age of entry into care and care type).

One specific concern that the NICHD study addressed was whether using nonmaternal care affects the emotional attachment formed between infants and their mothers. The study found that the use of day care was not in and of itself associated with the quality of the attachment relationship. However, if mothers were low in sensitivity and the infants were either in poor quality care, in day care for more than ten hours per week, or experienced multiple settings before age fifteen months, then the infants were more likely to be insecurely attached to their mothers. Thus, the results suggest that the quality of mother-infant attachment is related to a combination of day care and home characteristics.

In conclusion, day care is an important issue in the United States given the increasing numbers of working mothers. Given the low prevalence of high quality care and the potential effects of low quality care, an important task for workers in early childhood is to increase the availability of high quality care. In addition, parents who choose to use day care must carefully search for and select high quality care for their children.