The video In Our Hands focuses attention on the harmful effects of poor quality child care on infants and identifies critically important steps our society needs to take to improve infant care. This summary provides background information for the video. It describes recent major research findings on the quality of infant care and explains recommendations made in the video on how to prevent infants from being damaged.

What does research say about care for infants?

Today, there are 5 million infants and toddlers in child care in the United States. Recent research indicates that the quality of care experienced by most of these young children is inadequate and often harmful. In the Cost, Quality & Child Outcomes Study (1995) of 50 non-profit and 50 for-profit randomly chosen centers in four states, it was found that 92 percent of U.S. centers provided inadequate care to infants. These centers did not meet "children’s needs for health, safety, warm relationships, and learning" (p. 2). In addition, it was reported that 2 in 5 centers were rated less than minimal. The researchers stated that infants in poor quality settings "are more vulnerable to illness because basic sanitary conditions are not met for diapering and feeding; are endangered because of safety problems that exist in the room; miss warm, supportive relationships with adults; and lose out on learning because they lack the books and toys required for physical and intellectual growth" (p. 2).

Conditions for infants in family child care settings have been found to be similar to those described above for centers. In a study of family-based care in California, North Carolina, and Texas, Galinsky, Howes, Kontos, and Shinn (1994) rated only 9 percent of 226 settings as good quality, and 35 percent "as inadequate (growth-harming)" (p. 4). Only half of the children were rated as securely attached to their child care providers. It is noteworthy that 65 percent of the parents in the study believed they had no alternative to the family child care setting they were using. Children from low-income homes were found to be in lower quality family child care than those from higher-income homes. In contrast, child care centers for infants from low-income homes, which are regulated and subsidized, have been found to be equal or better than centers for infants from higher-income homes.

Galinsky et al. (1994) reported that several factors affected family child care quality. Quality appeared to be higher in settings in which the providers were trained. Another factor is that an extremely high percentage of settings (81 percent) were not regulated and operating illegally. These researchers also identified intentionality as an important factor. Intentionality referred to the group of family child care providers in the sample "who are committed to caring for children, who seek out opportunities to learn more about child care and education, and who seek out the company of other providers to learn from them" (p. 5). As compared to other child care providers, intentional providers were found to offer higher-quality, warmer, and more attentive care. This type of responsive care helps infants feel secure and supports healthy development.

What can be done about inadequate, damaging care?

Recommendations that stem from the research on infant care quality include the following:

• Training based on child development knowledge and practice is critical in any effort to prevent damage to infants and support their healthy development. Federal, state, and local agencies must work together to create training systems that reach all infant/toddler caregivers, including family child care providers.
  
  
• The regulation of infant care is essential. Regulations should ensure that care settings meet infants’ fundamental needs for: 1) close, caring relationships; 2) health and safety; 3) connection to family; and 4) knowledgeable, responsive caregivers.
  
  
• Attention must be paid to the selection of infant/toddler caregivers. Not just anyone is appropriate to care for infants. Individuals who are committed to providing good care will take advantage of opportunities to learn about child care and education, and are likely to be warm, responsive caregivers.

Training

The effort to train infant/toddler caregivers must be comprehensive, with a dual focus on content and delivery strategies. In order for the content of training to be sound, it should be based on current knowledge of child development research and practice. The training curriculum should help caregivers understand:

• the social-emotional foundation of early development,
• the infant’s inborn motivation to learn and explore,
• the impact of the child’s language and culture,
• the critical role of the child’s family, and
• the child’s individuality and special needs.

To be comprehensive, training should include information on:

• setting up group care environments,
• individualizing child care routines, and
• structuring care to promote the development of close caregiver-infant relationships.

The impact of a good training curriculum depends on how it is made available to caregivers. Training delivery strategies range from ensuring that there is an adequate number of trainers to the establishment of training strategies that reach out to caregivers, especially those working outside the child care regulation system. Increasingly, state agencies, resource and referral networks, community colleges, and organizations dedicated to the development of training content are collaborating to create training opportunities for infant/toddler caregivers. Examples of states where such efforts are currently underway include California, Minnesota, North Dakota, and Illinois.

Regulation

Because consistent, trusting relationships are essential for infants’ healthy development, the regulation of infant/toddler care should center on program policies that promote caregiver-child relationships. Close, caring relationships are made possible by the policies of primary care, continuity of care, and small groups. Primary care involves the assignment of caregivers to specific infants in a group setting. The primary caregiver is the person who is mainly responsible for the child, builds a relationship with the child’s family, and most often carries out day-to-day routines with the child. The relationship is not exclusive—another caregiver or two may also care for the child—but it is a special one. With primary care, programs are structured so that the infants know that someone who understands them well is emotionally available for comfort and nurturance.

Once a primary care relationship is established for an infant, the policy of continuity of care ensures that programs will attempt to keep caregivers and children together throughout the three years of the infancy period. This policy prevents the child from repeatedly grieving the loss of a caregiver that results from being switched from one caregiver to another. An additional benefit of continuity is that the children develop strong friendships with each other. There are a number of ways that continuity of care can be provided in group care, either through same-age or mixed-age grouping of children. Regulations can support continuity both by making it a guideline for child care programs and by allowing programs enough flexibility to organize care in a way that keeps a small group of infants and their caregiver together for an extended period of time.

Group size influences the quality of infants’ experience in child care in numerous ways. In a small group there are fewer distractions, and the children’s activities are focused. It is easy for children to be heard and understood. Infants are better able to develop a strong relationship with their primary caregiver, and the caregiver has the flexibility to manage the needs of all the children. Moreover, the younger the infant, the more crucial having only a few people to relate to becomes. For young infants, a small group provides a feeling of protection that encourages exploration. It is not surprising that every major research study on the quality of care for infants and toddlers has shown that small group size is a key factor.

In order to prevent damage to infants and toddlers, how small does a group have to be? How many infants should be assigned to a caregiver? The following recommendations are advocated by the Program for Infant/Toddler Caregivers (1994) and Zero To Three: National Center for Infants, Toddlers and Families (1995). The recommendations are broken down by whether the group is a same-age or mixed-age group. The guidelines for young, mobile, and older infant same-age groups are as follows:

Many settings, particularly family child care programs, have mixed-age groups of children. Because of the combination of ages of children in the group, the group size and caregiver-to-children ratio guidelines differ from those specified for same-age groups. The mixed-age guidelines are as follows:

*Of the four infants assigned to a caregiver, only two should be under 24 months of age.

Head Start (1996) recommends a ratio of one adult to four children for the entire infancy period. This formula makes it quite easy for programs to meet the goal of continuity. Group size does not change as children grow older. Both the guidelines cited above and the following Head Start guidelines appropriately emphasize a small total group size and a low ratio.

Regulations that keep groups of infants small and provide for primary care and continuity of care go a long way toward ensuring that infants’ fundamental needs for close, caring relationships; health and safety; connection to family; and knowledgeable, responsive caregivers are adequately met. To prevent damage to infants, states should take a comprehensive approach to working on each of these components of care.

Caregiver Selection

The selection and preparation of caregivers is as important as standards and regulation. As policymakers consider infant/toddler caregiving as a work option for people, attention should be paid to making sure that individuals who become caregivers are committed to the work. Caring for infants in groups is a challenging profession that requires an inclination to learn about infants and a genuine interest in forming warm, responsive relationships with them. Finding and supporting the development of competent caregivers is an essential part of efforts to keep infants in child care from harm.

References

Administration on Children, Youth and Families. (Nov. 1996). Head Start Program Performance Standards. Washington D.C.: Federal Register Vol. 61, No. 215.

Galinsky, E., Howes, C., Kontos, S., & Shinn, M. (1994). The Study of Children in Family Child Care and Relative Care. New York, NY: Families and Work Institute.

Cost, Quality & Child Outcomes Study Team. (1995). Cost, Quality, and Child Outcomes in Child Care Centers, Executive Summary, second edition. Denver: Economics Department, University of Colorado at Denver.

Lally, J.R., Mangione, P. & Signer, S. (1994). Together in Care: Meeting the Intimacy Needs of Infants and Toddlers in Groups. The Program for Infant Toddler Caregivers. Sacramento, CA: California Department of Education.

Lally, J.R., Griffin, A., Fenichel, E., Segal, M., Szanton, E. & Weissbourd, B. (1995). Caring for Infants in Groups: Developmentally Appropriate Practice. Washington, DC: Zero To Three: National Center for Infants, Toddlers and Families.

¹ The video In Our Hands was developed by WestEd, Center for Child & Family Studies and the California Department of Education, Child Development Division. For information on how to obtain the video, contact Carole Foster, WestEd, Telephone Number: (415) 331-5277.