The Day-Care Dilemma
Too many children today live in conditions
that threaten their brain development.
What can we do?
By James Collins
Environment matters, for anyone wondering how the latest
brain research applies to the care of infants and toddlers, that is
the crucial finding. Yes, proper brain development is a matter of
genetics and nutrition and whether a mother-to-be drinks or smokes,
but it also depends on the stimuli, as the scientists call them, that
a baby receives. It depends on what the baby sees, hears and touches
and on the emotions he or she repeatedly experiences.
But if environment matters, we are faced with a question:
At a times when children suffer from perhaps the gravest social problems
of any group in the U.S., how do we ensure that they grow up in the
best environment possible?
In many ways, children are better off today than they
were in previous decades. They are healthier, their families have
a higher income, the level of their mother's education (the most important
determinant of a child's intelligence) has risen.
But 1 out of every 10 children three years old and younger
lives in "extreme poverty"- at or below 50% of the federal poverty
level. And the well-being of many others is threatened by such social
changes as the rise of single-parent households, the uneven quality
of day care, the decline of communities and, some would argue, the
push to reform the welfare system.
Social policy cannot ameliorate all these conditions.
A change in attitude toward parenting and marriage would do children
far more good than any government program. Over the past few years,
however, there has been a movement in Washington and the state capitals
to address the problems of children, from newborn to the age of three.
Now neuroscientists, by confirming much of what social scientists
had already surmised about early development, are giving that movement
The recent concern about infants and toddlers has been
inspired in part by Starting Points, a landmark report published
by the Carnegie Corporation in 1994, which identified a "quiet crisis"
in the lives of the youngest children. Hilary Clinton has begun to
speak out on the importance of a child's earliest years, and several
Governors have forcefully taken up the issue. The size of the programs
in place is quite modest. But to their advocates they hold out promise
not only of helping children fulfill their potential but also of saving
society the costs incurred when intellectually and socially impaired
children grow up to be intellectually and socially impaired adults.
Government policy in any number of areas-health care,
taxes, the economy, crime-touches children. But the initiative that
will have the most particular and powerful effect on them is welfare
reform. If, as some predict, the incomes of poor mothers are drastically
reduced as a result of the new system, children will be harmed. But
let's assume that the reforms work as intended and mothers get jobs
that pay them more than paupers' wages. What effect may the changes
have on childhood development?
There is some evidence that children benefit if their
mothers stay home with them until they are one year old, and the welfare
law allows states to exempt new mothers from work requirements for
a year. But so far, states do not seem to be taking advantage of the
provision. For example, in Wisconsin, which is a leader in welfare
reform, mothers must start looking for work when their baby is 12
weeks old. Those who favor these reforms say a mother who has a job
will be a prouder and more responsible parent, and some studies suggest
that children do benefit if their mother receives earned income rather
than a government check for the same amount.
If mothers are out working, however, the quality of
child care provided by others will largely determine how ell the children
fare under the states' new plans. To care for their children, many
mothers will rely on relatives and friends, some of whom will be loving
and attentive and some of whom will not. Also, the strain on the daycare
system is a matter of grave concern to child-development and childcare
A recent study found that 40% of daycare centers for
infants and toddlers gave less than the minimal standard of care.
Problems ranged from safety hazards to unresponsive caregivers to
a lack of toys. If a caregiver spoons food from one bowl into the
mouths of half a dozen toddlers lined up in high chairs, as has been
known to happen, not only is the health of the children at risk but
they are surely not receiving the kind of attention that promotes
healthy brain development.
"If you push more children into this system through
welfare reform," say Ellen Galinsky, co-president of the Families
and Work Institute, "and you are saying to these families, "Just get
any child care you can find and can pay for,' there's a real danger.
The challenge for the states is to regulate and subsidize
child care in such a way as to increase the likelihood of good outcomes
for children. This is true regardless of welfare reform, of course.
Bad day-care can harm the development of any child. Research has shown
that children benefit when caregivers are trained and the ratio of
staff to children is high. Several states license centers accordingly,
requiring a minimum amount of training and setting ratios for different
age groups. Welfare mothers themselves are not necessarily the best
caregivers, and it is possible that in some instances welfare reform
will actually improve the care of children. But high-quality care
is expensive and states do not have adequate budgets to subsidize
The Federal Government and the states do have programs
specifically aimed at helping the development of infants and toddlers,
although as social policy they are nowhere near as sweeping as an
overhaul of welfare. The most notable federal initiative is Early
Head Start, which was created in 1994 when Congress preauthorized
funding for Head Start, which was created in 1994 when Congress preauthorized
funding for Head Start, the 32-years old program that brings three,
four and five year-olds into classroom settings in part of prepare
them for school, Mary Jo Bane was working at the time at the Department
of Health and Human Services (she quit over welfare reform), and she
led a task force charged with finding ways to improve Head Start,
Child-development experts, she says, "pointed the group toward the
importance of interventions earlier than age four."
In 1996, the budget for Early Head Start was $146 million,
and HHS awarded grants to 143 sites. The money is used to provide
a variety of services to poor families with children under the age
of 4 and to poor pregnant women. How the funds are spent is determined
to some extent by the communities that receive them. Some communities
are experimenting with family interventions that include grandparents;
others are trying to address the special health needs of newborns
or to provide extra help to teen parents with a history of drug abuse.
Smart start, healthy start
North Carolina has instituted a flexible program called
Smart Start. Under it, parents, teachers, doctors and nurses, child-care
providers, ministers and businesspeople form partnerships at the county
level that set goals for the education and health care of children
under six. These partnerships then administer private and public funds
as they see fit. In one county, for example, administrators chose
to give subsidies to new parents so that mothers could stay home from
work during a baby's first year. More than half of North Carolina's
100 counties are participating in the program, at a cost to the state
of $68 million.
Governor James Hunt hopes that by adding hard science
to his arguments, he will strengthen his positon when battling for
increases in Smart Start funding. "This is revolutionary information,"
he says of studies demonstrating the sensitivity of babies' brains
in the first years of life. "Now that we can measure it and prove
it, and if it can be made known widely so people understand this,
then they'll understand why their schools aren't going to work for
them, their technical training isn't going to work, other things we
do later on aren't going to work fully unless we do this part right
and do this at the appropriate time.
Some states have found that a very simple but powerful
way to help parents is simply to coordinate the various services that
they already offer. In West Virginia, for example, single sites that
provide more than a dozen services have been established in seven
communities. "Parents typically get a runaround and may only get a
long list of phone numbers," says Kimberly Veraas, chairwoman of the
state's Early Childhood Implementation Commission, "If they're really
motivated, they can get information. But now we're rolling out the
red carpet to parents. They only have to tell their story once.
As developmental experts often point out, child rearing
is not an innate skill, and several states are trying to help educate
parents about parenting. Home visits by social workers or nurse are
among the most promising methods. In Oregon such visits occur under
a program called Healthy Start. Sandra Daus, 22, single mother of
an 18-month old girl, recalls the help she received from Millissa
Magill. "She encouraged me to read books, a lot of books," say Duas.
"I thought when Sydney got older, maybe two or three, we'd start reading.
Mellissa said no, start reading to her now. Sydney was a month old.
In Vermont someone from the state's Success of Six program
first visits a home within two weeks of the baby's birth. "That gets
us in the door at age zero instead of age five, so we can assess what
families need," Governor Howard Dean points out. Visits may continue
for up to three years. "It is so inexpensive," says Dean, "to take
care of children relative to the other things we do, such a build
jails and put up expensive social-service networks for run-away youth.
With the new scientific evidence to bolster it, the
logic for spending money on early-childhood development programs may
seem incontrovertible. But not everyone is convinced. The question
of what approaches have worked and will work has not been resolved.
Research supports the long-term benefits of older programs that are
used as models today, but those studies are criticized because they
look at very small sample of children who were given special attention
"We have seen over and over and over that even if you
can produce good results with small programs, when you expand to a
national level, the effect often disappears," says Ronald Haskins,
a top Republican staff member of the House Ways and Means Committee.
"That is the case with Head Start. We still do not have evidence that
Head Start produces any long-term effects.
Social science, however, is an imperfect discipline.
Referring to programs for young children, Isabel Sawhill, a scholar
at Urban Institute and former official in the Clinton Administration,
has written, "The evidence is always mixed. We simple do not know
whether they work. In these cases, one must weigh the risk of doing
something and having it not work against the risk of doing nothing
and missing an opportunity to improve lives. It can be just as costly
to not fund a potentially successful program as it is to fund a potentially
Right now, the total public expenditure on early-childhood
development is tiny. Given the potential rewards, how risky is a bigger
Melissa Ludtke/Cambridge, and
Lisa H. Towle/Raleigh
Other useful resources
Drew Bledsoe of the New England Patriots
has established the Drew Bledsoe Foundation Parenting
With Dignity program. Bledsoe says of his
success "my parents helped me the most to be what I
am today" and his goal is to help other parents give
their children the best possible start. For more information,