Child-care wars: The latest round

Working mothers have been getting a bad rap for years in some quarters, accused of warping children's development by keeping the kid in day care while Mom pursues her career.

No matter that so-called welfare reform is predicated on the notion that mothers who work are better for children than mothers who depend on welfare, or that 59% of mothers with children under 6 years old work outside the home and necessarily have their children cared for by others. Despite the protests of working parents, the barrage of criticism just doesn't let up.

From time to time, scientific studies of the effects of child care have brought objectivity to the controversy:

• A multi-university study published in 1995 and updated two years later shows that children in high-quality day care, first, have higher scores on measures of their social and cognitive development and, second, are doing well in school by the time they reach second grade. Working parents took comfort—although the study also showed that most child care in the United States was not of high quality.

• Results from a longitudinal study conducted by the National Institute of Child Health and Development (NICHD) issued in 1996 showed that babies in day care had no more or greater attachment problems than babies cared for by mothers at home. Working mothers breathed a sigh of relief.

• Two years ago, data gleaned from the ongoing NICHD study showed that children who spent more than 30 hours a week in child care were more demanding, more noncompliant, and more aggressive than children who spent relatively less time in care. And, although the study showed that sensitive mothering and high-quality day care mitigated those effects, headlines trumpeted proof that bad things happen when a working mother leaves her child in day care. Many mothers were, naturally enough, outraged.

Last month, another blow fell as the NICHD released findings on how day-care children are doing as they get ready to enter kindergarten. The new data corroborate earlier findings that children who spend "lots of time" in day care are more likely to have behavior problems (Child Development 2003;74[4]). Several caveats:

• Only a small percentage of children who spend a lot of time in day care develop a serious problem

• Sensitive mothering and high-quality care blunt these social and emotional effects

• The duration of day care that produces these effects can't be quantified—there is no cut-off point, although the effect is dose-responsive, so to speak.

To make things still more guilt-inducing, a second study published in the same issue of Child Development found, on average, a higher cortisol level (a measure of stress) in children who spent more time in child care than others who spend relatively less time there.

So what are mothers (and fathers) to do? Economic realities and the quality of most day care being what they are, parents face hard choices. Luckier ones, notes Stanley Greenspan, MD, in a commentary in Child Development that accompanies these studies, might consider sharing work days and child care so that one parent is at home at least half of every day to provide nurturing care for infants and young children. Parents who are more economically pressed (the great majority) will have to wait until public policy on quality child care catches up with children's needs. They may have a long wait.