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Substitute Caregivers - Effects of Substitute Care on Child Outcomes

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Increases in the employment of mothers of young children have focused attention on the issue of substitute care (sometimes called nonmaternal care) of young children. In the United States, nearly 60 percent of all women with infants are in the paid labor force (Bachu and O'Connell 2000), and the majority of these children begin nonmaternal care prior to the age of four months for an average of thirty hours per week (NICHD Early Child Care Research Network 1997).

Who cares for these children while their mothers are at work? Substitute caregivers can be broadly grouped into two categories. Familial caregivers are related to the child. They include fathers—who in the United States are the primary care providers for about one-fifth of the children of employed mothers (Casper 1997)—grandparents, older siblings, aunts and uncles, and other relatives. Combined, almost half of all children of working mothers are cared for by some family member while the mother works (Smith 2000). Nonfamilial caregivers are those who are not related to the child, and include group arrangements (preschool, nurseries, day care centers), in-home care (nannies, who care for about 9% of the children of employed mothers), and family day homes. Family day home providers are persons who care for a small number of children (usually fewer than six) in the provider's home. The family day home provider is not necessarily related to the child; the term family day home comes from the assumption that care provided in a small-group arrangement in a private home more nearly approximates the type of care the child would receive in his/her own home. Family day homes are often not licensed or regulated by government agencies. Such arrangements account for about one-fifth of all caregiver arrangements.

Although most concern about substitute care has been focused on group arrangements, only about 30 percent of children of employed mothers are cared for in group centers, preschools, and nurseries. In the United States, group centers are generally licensed by state agencies, which set regulations concerning such matters as safety, sanitation, and caregiver/child ratios. Such centers vary greatly in quality, caregiver training, physical facilities, and use of developmental and educational programs.

There is an extensive literature examining the effects of early maternal employment and nonmaternal care on child cognitive outcomes. Results of these studies are mixed, but they generally suggest that there are no overall effects of maternal employment or nonmaternal care per se on child cognitive functioning (Greenstein 1995; NICHD Early Child Care Research Network 1997). However, the positive effects of early intervention programs on the cognitive functioning of economically disadvantaged children are well documented (Caughy et al. 1994).

Many researchers have studied the possible effects of substitute forms of child care on social development and behavioral problems (Clarke-Stewart 1989). It has been suggested that substitute care—particularly when these substitute forms are of low quality (Phillips et al. 1987; Howes 1990)—may be responsible for impairing social development or creating undesirable behavior such as aggression and noncompliance.

Research by social scientists in this area has centered on effects on emotional insecurity, sociability, and aggression. In particular, the emotional insecurity of children cared for in nonmaternal settings has been the focus of a hotly contested debate. Some researchers have found that infants of full-time employed mothers are more likely to be classified as insecurely attached than are infants of nonemployed mothers or mothers working part-time (see Belsky 1988 and Thompson 1991 for reviews; see Clarke-Stewart 1989 for a critique and meta-analysis). Jay Belsky (1988, p. 235), for example, has argued that "some nonmaternal care arrangements in the first year for more than 20 hours per week may be a risk factor in the emergence of developmental difficulties."

Many clinical studies suggest that children who had extensive nonmaternal care experiences as infants tend to be less compliant with their parents and more aggressive with their peers (Haskins 1985; Vaughn, Deane, and Waters 1985). However, Allison Clarke-Stewart (1989) suggests that these findings may simply reflect the fact that children in substitute care arrangements

. . . think for themselves and that they want their own way. They are not willing to comply with adults' arbitrary rules. . . . Children who have spent time in day care, then, may be more demanding and independent, more disobedient and more aggressive, more bossy and bratty than children who stay at home because they want their own way and do not have the skills to achieve it smoothly, rather than because they are maladjusted. (p. 269)

There have been a number of studies investigating this issue both in Europe and in North America. In a study of Swedish first-borns, Margarita Prodromidis and colleagues (1995) concluded that child care arrangements were not associated with aggression or noncompliance. Anne I. H. Borge and Edward C. Melhuish's (1995) study of Norwegian children suggested that, based on parental perceptions, day care center experience was associated with a lower level of behavior problems. In Switzerland, Blaise Pierrehumbert and her colleagues (1996) found that the effect of nonparental care on behavior problems was mediated by the pattern of attachment to the mother, and that behavior problems were minimized when the child had extensive nonparental care, or when the care was provided by other family members.

In the United States, there have been a number of large-scale studies of the effects of maternal employment during early childhood and substitute care experiences on child emotional and cognitive outcomes. Summarizing his analyses of one- to four-year-olds from the National Longitudinal Survey of Youth (NLSY), Frank Mott (1991, p. 147) concluded that "extensive use of infant nonmaternal care did not either substantially enhance or negatively influence subsequent scores" on the Memory for Location and Motor and Social Development instruments. His analyses of effects on the Peabody Picture Vocabulary Test, however, suggest that use of group care arrangements during infancy may enhance cognitive abilities, especially among healthy female infants. Male infants, on the other hand, do not exhibit effects of care arrangement on this cognitive dimension.

Nazli Baydar and Jeanne Brooks-Gunn (1991) studied cognitive and behavioral outcomes for children who were three to four years of age. Some of their analyses show a small but significant negative effect of maternal employment during infancy, and suggest that different types of substitute care may affect boys differently from the way they affect girls.

Jay Belsky and David Eggebeen's (1991) study of two- to six-year-old children suggests that children whose mothers were employed during infancy may be less compliant than other children. Theodore Greenstein (1993) summarized his study of 1,657 NLSY children by concluding that "early and extensive maternal employment does not seem to have generally adverse effects on the behavior of 4- and 5-year-old children" (p. 349). In the National Institute of Child Health and Human Development (NICHD) study, which looked at 1,300 children at ten research sites across the United States, extensive time spent in nonmaternal care was associated with heightened behavioral problems at fourteen and fifty-four months of age (NICHD Early Child Care Research Network 2000, 2001).

In general, it appears that nonmaternal or substitute care in early childhood probably does not have a large effect on child development. In those studies in which differences between children cared for at home by their mothers and children with extensive nonmaternal care experiences are observed, the differences tend to be small. The determining factor seems to be the quality of the care received by the child; children who receive high-quality care and high levels of emotional support are likely to be well-adjusted, regardless of who the caregiver is. Conversely, children who are neglected or receive little emotional support will probably demonstrate problems of emotional adjustment.


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Bachu, A., and O'Connell, M. (2000). Fertility of American Women: June 1998. Washington, DC: U.S. Census Bureau.

Baydar, N., and Brooks-Gunn, J. (1991). "Effects of Maternal Employment and Child-Care Arrangements on Preschoolers' Cognitive and Behavioral Outcomes: Evidence from the Children of the National Longitudinal Survey of Youth." Developmental Psychology 27:932–945.

Belsky, J. (1988). "The 'Effects' of Infant Day Care Reconsidered." Early Childhood Research Quarterly 3:235–272.

Belsky, J. (1992). "Developmental Risks Associated with Infant Day Care: Attachment Insecurity, Noncompliance, and Aggression?" In Psychosocial Issues In Day Care, ed. S. S. Chehrazi. Washington, DC: American Psychiatric Press.

Belsky, J., and Eggebeen, D. (1991). "Early and Extensive Maternal Employment and Young Children's Socioemotional Development: Children of the National Longitudinal Survey of Youth." Journal of Marriage and the Family 53:1083–1110.

Borge, A. I. H., and Melhuish, E. C. (1995). "A Longitudinal Study of Childhood Behaviour Problems, Maternal Employment, and Day Care in a Rural Norwegian Community." International Journal of Behavioral Development 18:23–42.

Casper, L. M. (1997). My Daddy Takes Care of Me! Fathers as Care Providers. Washington, DC: U.S. Census Bureau.

Caughy, M. O'B.; 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 65:457–471.

Clarke-Stewart, K. A. (1989). "Infant Day Care: Maligned or Malignant?" American Psychologist 44:266–273.

Desai, S.; Chase-Lansdale, P. L.; and Michael, R. T. (1989). "Mother or Market? Effects of Maternal Employment on the Intellectual Ability of 4-Year-Old Children." Demography 26:545–561.

Greenstein, T. N. (1993). "Maternal Employment and Child Behavioral Outcomes: A Household Economics Analysis." Journal of Family Issues 14:323–354.

Greenstein, T. N. (1995). "Are the 'Most-Advantaged' Children Truly Disadvantaged by Early Maternal Employment?" Journal of Family Issues 16:149–169.

Haskins, R. (1985). "Public School Aggression among Children with Varying Day-Care Experience." Child Development 56:689–703.

Howes, C. (1990). "Can the Age of Entry and the Quality of Infant Child Care Predict Behaviors in Kindergarten?" Developmental Psychology 26:292–303.

Mott, F. L. (1991). "Developmental Effects of Infant Care: the Mediating Role of Gender and Health." Journal of Social Issues 47:139–158.

NICHD Early Child Care Research Network. (1997). "Mother-Child Interaction and Cognitive Outcomes Associated with Early Child Care: Results of the NICHD Study." Paper presented at the biennial meeting of the Society for Research on Child Development, Washington, DC.

NICHD Early Child Care Research Network. (2000). "Childcare in the First Year of Life." Merrill-Palmer Quarterly 43:340–360.

NICHD Early Child Care Research Network. (2001). "Early Childcare and Children's Development Prior to School Entry." Paper presented at the biennial meeting of the Society for Research in Child Development, Minneapolis, MN.

Phillips, D.; McCartney, K.; Scarr, S.; and Howes, C. (1987). "Selective Review of Infant Day Care Research: a Cause for Concern!" Zero to Three 7:18–21.

Pierrehumbert, B.; Ramstein, T.; Karmaniola, A.; and Halfon, O. (1996). "Child Care in the Preschool Years: Attachment, Behavior Problems, and Cognitive Development." European Journal of Psychology of Education 11:201–214.

Prodromidis, M.; Lamb, M. E.; Sternberg, K. J.; Hwang, C. P.; and Broberg, A. G. (1995). "Aggression and Noncompliance among Swedish Children in Center-Based Care, Family Day-Care, and Home Care." International Journal of Behavioral Development 18:43–62.

Smith, K. (2000). Who's Minding the Kids? Child Care Arrangements, Fall 1995. Washington, DC: U.S. Census Bureau.

Thompson, R. A. (1991). "Infant Day Care: Concerns, Controversies, Choices." In Employed Mothers and Their Children, ed. J. V. Lerner and N. L. Galambos. New York: Garland.

Vaughn, B.; Deane, K.; and Waters, E. (1985). "The Impact of Out-Of-Home Care on Child-Mother Attachment Quality: Another Look at Some Enduring Questions." Monographs of the Society for Research in Child Development 50:(1–2, Serial No. 209).


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