Emptying the Nest: Does Day Care Work?
Hillary Clinton has well known positions on daycare. In this presidential political season, we can see where she’d take the country based on what she influenced the last time a Clinton held the national bully pulpit.
I spent eight years in getting the child-care bill passed in Congress,
and at its zenith, there was never a child-care movement in the country.
There was a coalition of child-advocacy groups, and a few large
international unions that put up hundreds of thousands of dollars,
and we created in the mind of the leadership of Congress
that there was a child-care movement — but there was nobody riding me.
And not one of my colleagues believed that their election turned on it for a moment.
There wasn’t a parents’ movement.
Congressman George Miller (D-CA) * Mother Jones * May/June 1991
I. THE CHILD CARE “CRISIS”
Daycare DataTo kick off the sixth year, and home stretch, of the Clinton Administration, in January 1998, the President and First Lady Hillary Rodham Clinton, a long-time children’s issues activist, announced an historic initiative: $20 billion in increased federal spending for child care over the next five years. This, they said, would address a silent child care crisis afflicting the nation.
Given the size of this initiative, we might do well to examine the underlying assumptions and common perceptions used to buttress such an expansion of federal involvement in day care. Is there a crisis in America today over child care? If so, is day care the answer?
To answer those questions adequately, the issue must be framed appropriately. Accepted as true is the modern myth that most families have two parents working today and are desperately struggling with day care.
This, it turns out, is not true.
Is there a child care crisis in this country? To answer, we need to know what parents really want, and most essentially, we must know what children need.
Continue reading at the jump.
Thank you (foot)notes:
Full Disclosure: Originally published by the Family Research Council in 1998.
II. WHAT DO PARENTS WANT?
To help determine what parents want in care for their children, Wirthlin Worldwide conducted
a nationwide poll during December 1997 on behalf of the Family Research Council. Surveying 1,004 adults in the United States, the poll asked respondents to rate
the desirability of various child care options.
Across the board, regardless of race, age, partisanship or income level, Americans rated
care by a child’s own mother as the single most desirable kind of care for children.
This decided preference for mother-care of children was underscored by a secondary
preference for care by a child’s grandmother, aunt, or other family member, followed by
split shifts for mother and father. Overall, when given a choice of nine different forms
of care, Americans chose differing forms of family care as the top three most desirable
choices. Moreover, in light of the Clinton child care proposal, it is imperative to note
that, of all the options presented to the respondents, commercial and government centers
were rated the least desirable.
These responses underscore what common sense tells us about what people prefer in
care for children. The results become even more significant when viewed as the latest
entry in a growing body of polling data that expresses this same desire for parental care
In May 1997, the Pew Research Center conducted a poll of 1,101 women and found
that 25 percent of the women employed full time preferred to stay home with their children.
Another 44 percent of women with children under 18 wanted to work part time
rather than full time. A startlingly mere 41 percent of the respondents felt that their
work and child care arrangements were good for their children.
In 1996, the Independent Women’s Forum commissioned a poll that included the question:
If you had enough money to live as comfortably as you’d like, would you prefer to
work full time, work part time, do volunteer work, or work at home caring for your
family? Of the women responding, 31 percent replied that they wanted to be at home
with their children if they could; and another 33 percent replied that they were interested
in working part time. A full 20 percent of the respondents expressed an interest in doing
volunteer work. Only 15 percent replied that they wanted to work full-time.
This same preference for a combination of mother-care and flexibility in work
arrangements showed up in a very large reader’s survey done by Parents magazine in
May 1996. After conducting a poll in which 18,000 women responded, the editors of
Parents concluded, “[E]motional conflict for mothers is epidemic.” They had discovered
a startling fact: Only 4 percent of the women who responded would choose full-time
employment if they could do “whatever they wished.” The majority of the respondents,
61 percent, wanted work flexibility in order to work part time and have more time for
their children. An additional 29 percent wanted to be at home with their children full
Similarly, in 1995, a Louis Harris poll found that only 15 percent of the women
respondents would work full time if they “had enough money to live as comfortably as
they would like.” An additional 33 percent of the women wanted to work only part time,
while, again, a full 20 percent wanted to do volunteer work.
The Silent Majority: Parents themselves don’t choose day care
What do parents want? This body of polling data about what parents say they want to
do is remarkably consistent with what the Census Bureau tells us that American parents
actually do choose.
Contrary to the media-driven perception that most children today are in some sort of
day care, the majority of American children are actually cared for by their own parents.
Furthermore, the vast majority of children are cared for by family members. Of the
19.7 million children under the age of five in America today, nearly half, 47.8 percent
are cared for by their own mother at home. An additional 3 percent of children are cared
for by their mothers at work. Another 9.6 percent are cared for by their fathers.1
This means that 60.3 percent of American children — 11.9 million kids — are cared for by
their moms and dads. For babies under a year old, this percentage rises to 67.4 percent.
One reason this is possible is that, contrary to popular belief, the overwhelming majority
of preschool children do not have mothers who work full-time. Of children under five,
66 percent have mothers who are either employed part time or not at all. This means that
only 34 percent of all preschoolers, or 6.7 million children, have mothers who are
employed full time.
When both parents do work, in keeping with the results from the Wirthlin poll, most
Americans turn to family members to help care for their children. Of the 10.2 million
preschoolers whose mothers are employed, 16 percent are cared for by their grandparents
and 8.9 percent are cared for by other relatives. This means that almost half, 49.1 percent
of preschoolers with employed moms, are cared for by relatives. For babies, this
total rises to 56 percent.
When all the family care is added up — moms, dads, grandparents, and other relatives
— the true story about American child care emerges: The vast majority of our preschoolers,
73.5 percent, are cared for by members of their families.
Commercial day care centers are chosen for only 21.6 percent of preschoolers with
employed moms — this amounts to only 2.2 million children, 11.2 percent of all
preschoolers in the nation. The number of children in day care centers is just barely
more than the number of children cared for by their fathers: 1.9 million children cared
for by their dads is a statistical dead heat with day care centers. (Grandparents are close
behind, watching 1.7 million kids.)
While parents today are working hard to care for their children personally, often at
great sacrifice and without much societal support, the media repeat over and over again
that the two-income family is today’s norm, leaving these parents to feel they are alone.
They are not alone. They are instead, the silent, unrecognized, majority.
But what about the families who cannot afford to have one parent forgo employment
income and stay home? The common perception is that the decision to have one parent
at home increasingly has become the province of the rich. Quite the converse is true:
The family income bracket with the largest number of at-home mothers is $20,000 to
$24,999.2 Currently, the median income of dual-income families is $57,637. This compares
to a median income of $38,835 for families with mothers at home.3
Furthermore, the number of children targeted by the Clinton child care plan,
preschoolers whose families are below the poverty line, is quite small. Of the preschoolers
whose mothers are employed, only 1.1 million are in poverty. Among these children,
more are cared for by their fathers than are put in day care centers. Of preschoolers
whose mothers are employed and below the poverty level, 17.6 percent are cared for by
their fathers. Another 34.7 percent are cared for by relatives. This means that more than
half, 52.3 percent, of these children below poverty level are being cared for by family.
Only 17.3 percent of these preschoolers are utilizing commercial day care. While they
may indeed have difficulties with employment-related expenses, child care help may not
be one of them. The majority of low-income families do not purchase child care. This
makes them beyond the reach of the federal subsidies in the Clinton plan.
This is clear evidence that such a narrowly targeted, but well-funded, federal benefit not
only discriminates against low- to middle-income American families who are struggling to
keep one parent at home with their children, but also reaches only the tiniest fraction of families
with children below the poverty line who need assistance.
III. THE IRREDUCIBLE NEEDS OF CHILDREN
The issue of child care in our country ostensibly reflects a growing concern over the
needs of children. Indeed, imagery revolving around children figures prominently in discussions
about and proposals for child care. Nevertheless, the bottom-line question
“What do children need?” is rarely asked, let alone answered. Instead, the issue of child
care is usually framed by assumptions about parental needs and desires.
What do children actually need for healthy development? The best summary answer
may have been given by psychologist Urie Bronfenbrenner, who says that what a child
needs for healthy development is “a strong, mutual, irrational, emotional attachment
[with someone] who is committed to the child’s well-being and development, preferably
for life.”4 Someone once commented that what that means is that someone must be
“crazy about the kid.”
As it turns out, the love and devotion given children do not merely guide and train
them, but our earliest interactions with them even become part of their hard-wiring. The
long-standing debate over nature vs. nurture took an amazing turn this last year when
researchers discovered new information about how a child’s brain develops. When devotion
to a child is teamed up with positive interaction, the actual physical structure of the
brain changes. As an infant’s brain is stimulated by interaction with a loving, attentive
caregiver, the synapses that fire as a result form the neuronal pathways that the child will
use for thinking, feeling and acting the rest of his life. Sadly, this process also works in
the negative; continuously stressful interactions with a caregiver can be harmful in the
process of brain development.
In April 1997, the White House convened a Conference on the Brain and Early
Development to review and discuss these new findings. Dr. Stanley Greenspan, clinical
professor of psychiatry and pediatrics at George Washington University Medical School,
has written that researchers have identified six stages of interaction that are the “essential
building blocks for a child’s healthy mind and brain.” These six building blocks are:
1) an ongoing, loving intimate relationship;
2) interactions tailored specifically to a baby’s unique nervous system;
3) “emotional dialogue” involving smiles and sounds;
4) wordless discussions and negotiations with gestures;
5) creative, pretend play; and
6) interactions to develop logic.5
Greenspan, who has won the American Psychiatric Association’s highest award for
child psychiatry research, concludes, “[M]ost out-of-home child care cannot provide a
number of [these] essential building blocks. …”6 This is because, even though many day
care providers are well-intentioned, most caregivers in day care centers aren’t able to
form long-term or in-depth relationships with the children in their care. As Greenspan
points out, this is a result of high staff turnover, the multiple children in their care, and
the fact that children change “classes” and “teachers” each year in day care centers.
In assessing a child’s needs, Greenspan has formulated a framework of “critical experiences”
that he believes form the foundational requirements of healthy child development.
These are, he says, “the irreducible needs of infants and children.” What do children
need? In short, they need: safety, security and protection; ongoing, intimate relationships;
emotional interactions geared to their developmental needs and levels; gearing
experiences to their nervous systems; limits and expectations; and neighborhood and cultural
In each of these categories, there are serious questions about the ability of centerbased
care to meet the needs of children. Greenspan believes that ignoring those questions
has brought us to “an evolutionary crossroads”:
[F]or the first time in history, there is a growing trend for more and
more middle- and upper-middle class parents to farm out the care of
their babies to others, often in settings not conducive to meeting children’s
irreducible needs. Impersonal child care may be only the most
obvious symptom of a society that is moving toward impersonal modes
of communication, education and health and mental health care. Major
societal changes are clearly necessary. Unfortunately, the consequences
of not making changes may not be immediately obvious. The impact
will likely be slow and insidious. People may gradually become more
self-centered and less concerned with others. Thinking may become
more polarized, all or nothing, rather than subtle and reflective.
Impulsive behavior, helplessness, and depression may increase. The
ability for self-awareness and problem-solving may decrease, as will
our capacity to live together and govern ourselves in cohesive communities.8
Greenspan concludes, in a rather stunning departure from the party-line in his field,
“[W]e need to gradually bring about social arrangements which maximize at home care
of young infants by their parents.”9 This is the enduring gold standard against which all
other child care arrangements are measured: care by a child’s own parents, usually his
When a baby is born, the mother-child relationship begins with a process researchers
have labeled “bonding.” This is such a special and unique relationship that studies have
found that mothers can pick out their own babies by smell within their first day of life;
after six days, a baby is able to pick out the smell of his own mother’s breast-milk.10 This
special relationship begins even before birth, as illustrated by an anecdote from
Argentina, recounted by Drs. Marshall Klaus and John Kennell, authors of renowned
works on parent-infant bonding. Two babies were mistakenly given to the wrong
mothers. The mistake was discovered while they were still in the hospital, but neither of
the angry mothers wanted to give up the babies they had been caring for and with whom
they had begun bonding. However, the neonatologist suggested that the two mothers and
two babies spend the night together in the same hospital room. Some time during the
night, the mothers noticed that each time one of them spoke, their biological baby
responded and turned toward her voice. It was clear that even while being held by the
other mother, each baby knew his own mother. The women quickly took back their own
The bonding between mother and child in normal situations develops into a relationship
that researchers call “attachment.” It is the quality of this first relationship in a
baby’s life that researchers now believe forms the foundation for healthy emotional
development. It is as if in this first intimate relationship we develop the template for all
relationships to follow.
But, like all relationships, healthy attachment takes effort and time to develop. And,
of course, not all mothers are good mothers. Child development researchers have developed
a system of four categories to describe the spectrum of mother-child attachment
relationships: secure attachment, anxious-avoidant, ambivalent or disorganized.
Children who are securely attached to their mothers rate more highly across the board on
behavioral measurements. These children display “more peer leadership, less social
withdrawal and hesitation, greater self-confidence and curiosity about new things, and
more sympathy to the distress of others…”12 On the other end of the scale, children who
are not securely attached to their mothers are more aggressive, more impulsive, less confident,
more dependent, have more behavior problems, and exhibit more antisocial
Attachment theory itself has become largely accepted among child development
experts. Its implications, however, remain very controversial. In particular, the strength
of the connection between insecure attachment and maternal employment is a matter of
The flash point of this debate was a review of the attachment research published in
1988 by Dr. Jay Belsky of Pennsylvania State University which found:
[C]hildren in any of a variety of child care arrangements, including
center care, family day care, and nanny care, for 20 or more hours per
week beginning in the first year of life, are at elevated risk of being
classified as insecure in their attachments to their mothers at 12 or 18
months of age and of being more disobedient and aggressive when they
are from 3 to 8 years of age.14
This conclusion outraged many in the child development community. They responded
to Belsky’s analysis by arguing that quality of care is the essential variable, regardless of
who gives it. Hence the increasing usage in the ensuing decade of the word “caregiver”
in the American vernacular.
Belsky published another review of the literature in 1990 in which he clarified his
concern with day care: “[E]xtensive infant day care as we know it and have it in this
country is a ‘risk factor,’” he explained. Later, in 1995, he explained that this does not
mean that “day care is inherently bad,” and he, too, calls for better “quality-care
Nevertheless, the risk factor concept is a helpful framework from which to analyze day
care, on both a personal and a political level. With a process as multi-faceted as child
rearing, it is difficult to ascribe praise or blame to any one factor involved. Not all children
who are cared for in day care centers turn out poorly, and not all children cared for
by their mothers turn out well, so there should be a modulated approach to this issue that
takes these disparate results into account.
Having made that caveat, the question remains: Just how much of a risk factor is day
care to a child’s development? This is a question that is never quantified directly in the
child development literature. Nevertheless, there are data from which an answer can be
In a review of the attachment literature done for the U.S. Department of Health and
Human Services, the author states categorically, “[M]ost babies with employed mothers
are securely attached to them.” As it turns out, “most” is quantified as 55 percent.16
This is an abysmally low percentage to use as a positive defense of day care. Still, the
real question should be how does this compare to mother-care? Of children whose
mothers are not employed full-time, 71 percent are classified as securely attached.17 This
means that infants whose mothers are employed full time during the baby’s first year have a
55 percent higher risk of being insecurely attached.
The attachment researchers, however, studiously avoid these kind of comparisons and
conclusions and currently are focusing instead on an “ecological” approach, looking for
how all the factors that influence a child’s development and attachment relationships
interrelate. Yes, the argument goes, the risk may be higher, but most children do fine in
day care. What is the difference between the secure and insecure ones? Belsky, in his
1990 review, writes that the research shows some evidence of a commonsense answer
that might prove troubling even for parents of children in day care with secure attachments:
[O]ne consequence of extensive non-parental care initiated in the first
year is that the influence parents would otherwise exert on their children
is “lost” to, or at least assumed by, nonparental caregivers.18
Belsky adds that, in addition, other research suggests that, when infants begin fulltime
nonparental care in the first year of life, “their later development is predicted by the
quality of their day care, but not by family factors and processes.” This conclusion may
need modification in light of the most recent research coming from the National Institute
of Child Health and Human Development, which found that a mother’s relationship with
her baby is unparalleled in its effect on the child’s well-being.
The NICHD Longitudinal Child Care Study
Largely in response to the controversy surrounding the Belsky review and the issues of
maternal employment and infant attachment, the National Institute of Child Health and
Human Development (NICHD) commissioned a study of early nonmaternal care and its
effects on infants. The national study of 1,153 infants, followed from birth through age seven, is the largest, most multi-faceted, longitudinal study done on infant attachment
and has generated considerable attention.
In April 1996, the researchers released their interim results to headlines around the
world: Mother-Child Bond Not Hurt by Day Care, Study Concludes!20 Indeed, the report
released at an International Conference on Infant Studies stated categorically: “Results
were clear and consistent: There were no significant differences in attachment classifications
related to child-care participation.”21
Unfortunately, the details included in the report showed a much murkier conclusion.
Their data delivered solid support to Belsky’s risk factor model. Child care in and of
itself was not an independent predictor of insecurity, but when combined with a mother
who was judged to be more insensitive to her child, problems arose. Specifically, when
an infant of an insensitive mother was in alternative care for more than 10 hours a week,
or in unstable, low-quality care, rates of insecure attachment increased significantly.22
Perhaps the most important, and most overlooked, finding from the study for public
policy analysis was the negation of the “compensatory” hypothesis. Child development
researchers have advanced the theory that children of insensitive mothers are better off in
day care where they can receive “well-trained, high-quality” care. The NICHD research
showed the opposite. Children of insensitive mothers were more likely to be securely
attached the less time they spent in nonmaternal care.23
This is the finding that should have been in the headlines — mothers, whether good or bad,
are the standard in care for children.
The study is not yet complete and so the jury is still out. However, in media interviews,
Belsky, who helped direct the study, commented that so far the findings do not
contradict his earlier research. “These new data don’t lead me to be sanguine, but they
don’t lead me to be alarmed either,” he told The Washington Post. However, in another
interview with Dr. Brenda Hunter, author and developmental psychologist, he commented,
“The study shows it’s drizzling now. It could be cloud cover or it could be the leading
edge of a storm. We just don’t know.”24
IV. DAY CARE CONCERNS
It is clear from the discussion surrounding the NICHD study and the White House
Conference on Child Care in 1997 that “quality” will be a major focal point of the coming
child care debate. Day care advocates believe that more federal subsidies will help
ensure quality care for children in child care centers. However, some of the concerns
over quality in day care are challenges that may be resistant to monetary solutions.
There is no doubt, and no disagreement, over the current level of quality among day care
centers. It is abysmal.
In 1995, a study from the University of Colorado reported that six out of seven day
care centers in America are “dismal.” The researchers wrote, “The level of quality at
most U.S. child care centers, especially in infant-toddler rooms, does not meet children’s
needs for health, safety, warm relationships, and learning.” Even worse, the study con
cluded that most child care is “sufficiently poor to interfere with children’s emotional
and intellectual development.”25
There is also consensus that high turnover is a huge challenge for the child care industry.
A study done in 1990 found that average teacher turnover in child care centers
nationwide was 50 percent. In for-profit chain day care centers, this average shot up to
Day care advocates insist that these are precisely the issues that provide the rationale
for governmental subsidies. More funding, they believe, will solve the quality problem.
Is quality of care a function of money? To a degree. But consider for a moment the
issue of staff-to-child ratios. In order to be accredited by the National Association for
the Education of Young Children (NAEYC), a center must have one caregiver for four
babies. For two-year-olds it’s one to six; for three-year-olds one to seven. Four babies.
Six two-year-olds. Seven three-year-olds. Anyone who has ever cared for children will
understand immediately why, with these ratios as the definition for high-quality care,
there is such a staff turnover problem in the industry.
Even that’s merely a description of what NAEYC believes should be happening.
Reality is something different. One study found that nationwide only 58 percent of centers
met these criteria for babies under 5 months old. Compliance for babies under
12 months old went up to only 65 percent. This rate went as low as 41 percent for
In fact, the report states that, when centers fail to meet the standards,
they have, on average, twice as many children as the required ratios.28
These staffing issues are especially troubling given the development factors enumerated
by Greenspan. It would be an unusual person who was able to provide that kind of
critical interaction for an infant when single-handedly responsible for four or more
babies, all day, every day. The same is true of two- and three-year-olds, perhaps even
With large numbers of children being cared for together, day care brings with it another
inherent problem — exposure to infections and disease. This is a particularly difficult
problem for the industry to address for two reasons. First, a child’s immune system is
not fully developed until he is at least five or six. A child of this age is more susceptible
to infections, making it more difficult to control the spread of illness once any child in
the center becomes sick. In addition to some of the more obvious reasons why children
more easily spread germs, research shows that some highly infectious children may be
asymptomatic, other infections are transmitted before the onset of symptoms, and small
children put their hands in their mouths every one to three minutes!29
Second, a child’s environment is an efficient transmitter of germs. The Centers for
Disease Control has recently issued a report titled the “ABC’s of Safe and Healthy Child
Care: A Handbook for Child Care Providers,” which addresses this issue. Their recommendation
is that infants and toddlers not be allowed to share toys unless they are
washed and disinfected between uses.30 The American Academy of Pediatrics recommends
washing and disinfecting toys handled by children on a daily basis.31
This, of course, is a pretty tall order to fill. Not surprisingly, then, children in day
care get sick. A lot. In fact, children in day care are 18 times more likely to become ill, and, at any one time, 16 percent of children attending a day care center are sick. Of
these sick children, 82 percent still attend their day care.32 Additionally, according to an
article published by the American Academy of Family Physicians, these illnesses soon
spread outside day care centers to the communities. “Children in day care … are responsible
for many community disease outbreaks,” writes a group of family physicians.33 For
example, 40 percent of community outbreaks of the serious infection hepatitis A can be
traced to day care centers. Among child care centers who admit children under the age
of two, 50 percent experience outbreaks of hepatitis A. This infection has a 28-day incubation
period and is often asymptomatic in young children.34
The health concern that is most prevalent in day care centers is otitis media, or ear infections.
This is one common problem that the medical literature clearly and convincingly
associates with increased day care attendance. One study of 244 children found that
21 percent of the children in day care had to be hospitalized for myringotomy and tube
placement as a result of ear infections compared to only 3 percent of the children cared
for at home.35 Another study analyzed the tympanograms of three-year-olds and found
that only 52 percent of children attending day care had normal tympanograms compared
to 74 percent of those cared for at home.
Although some dismiss ear infections as garden-variety childhood illnesses that are to
be expected, the increase in their occurrence associated with child care should not be
viewed too sanguinely. In keeping with a risk factor conception of day care, it appears
that repeated ear infections may be another factor that is detrimental to a child’s healthy
emotional development. A recent study of young children who suffered chronic ear
infections in the first year of life found that these youngsters “play more often alone and
have fewer positive and fewer negative verbal interactions with peers than nonchronic
children in day care.” Their nonverbal skills were not affected at all. The researchers
hypothesize that this effect comes from the moderate hearing loss associated with otitis
Additionally, researchers have become concerned with the apparent connection
between routine use of antibiotics to clear up ear infections and the rise of antibioticresistant
organisms. Use of antibiotics for ear infections has become routine: Physicians
prescribe antibiotics for 98 percent of children with acute ear infections.
Epidemiologists say this is a large and growing problem:
[E]scalated use of child-care facilities has had a marked effect on the
epidemiology of infectious diseases in young children. Children
attending child care are at high risk for respiratory and gastrointestinal
tract illnesses. The high prevalence of infectious diseases in the childcare
setting is accompanied by high usage of antibiotics, which in turn
has resulted in spread of antibiotic-resistant organisms.38
On the opposite end of the spectrum from the relatively benign otitis media is the
cytomegalovirus (CMV) infection, which is also closely, and dangerously, associated
with day care. Children attending day care are infected with CMV two to three times more often than children at home. In fact, one study reported in Pediatrics found that
half of the children in large day care centers have active CMV infections.40
Many adults have already developed immunity to CMV. But not everyone is resistant.
This is a serious problem because CMV is the leading cause of congenital infection
worldwide; approximately 10 percent of infants infected prenatally have significant
complications. Unfortunately, controlling the spread of the infection is very difficult
because children who contract the virus are asymptomatic 95 percent of the time. As a
result, in addition to the threat posed to child care workers, children can unwittingly
carry the virus home and spread it to their unborn siblings through their mothers.41
There is also some concern among researchers that increased usage of day care may be
contributing to the alarming rise in asthma cases in the last decade. According to the
National Institutes of Health, the number of American asthma sufferers grew 74 percent
between 1984 and 1994. So far, researchers do not know why. One particularly puzzling
fact is that the increase in the number of cases and the increase in the number of
deaths (which rose 59 percent) are disproportionately occurring among children, according
to the Centers for Disease Control.
Why the link with day care? Viral infections, to which children in day care have
greater exposure, are linked to 80 percent of hospitalizations among children with asthma.
There is also a correlation between high use of antibiotics and asthma among children.42
For most children in day care and their families, the seemingly ever-present case of the
sniffles that inevitably goes with group care is a minor annoyance and a part of childhood.
Some researchers argue that children must eventually develop immunities and
resistance to disease and that day care merely accelerates that natural process. And, of
course, siblings cared for at home spread germs among themselves. However, the literature
is clear that there is an elevated health risk for children associated with day care
attendance that also has implications for the larger community as children move between
group care and home. Additionally, as parents make risk management decisions for their
children, the increased risk must be viewed in the context of the infant or child’s higher
level of vulnerability. Children must be exposed to many germs eventually, but their susceptibility
to serious illness decreases with age. Pneumonia in a five-year-old is an
entirely different proposition from pneumonia in an infant. As a result, the health literature
does document some sad and troubling cases of transmission of tuberculosis, and
fatal cases of pneumonia and invasive group A streptococcus among infants directly
attributable to day care attendance.43
V. LEGISLATIVE HISTORY AND FEDERAL CHILD CARE
One of the main reasons for the controversy surrounding child care is the heavy federal
involvement in the issue. Because of large federal subsidies, child care is no longer a
private, family matter. Child care has not been a neglected issue at the federal level,
contrary to the Clintons’ implication. In fact, the federal Department of Health and
Human Services issued a press release in October 1997, in which it stated that child care had been a top priority for the Clinton Administration. “As a result of the President’s
efforts,” they stated, “federal child care funding has increased by 68 percent since
In fact, federal subsidies of the child care market have increased, in constant 1990 dollars,
from two million dollars in 1965 to roughly 11.7 billion dollars in 1995.44 The first
federal involvement in day care was “day nurseries” funded through the Works Progress
Administration (WPA) in 1933 during the Depression. By 1943, the WPA funds came to
an end. But by then Rosie the Riveter was headed into the work force to support the war
effort and the centers continued on under the auspices of the Lanham Act. In 1945, the
U.S. Children’s Bureau recorded that 1.6 million children were being cared for in these
federally-funded day care centers.45
The 1960s brought the Great Society and the inauguration of a federal preschool program
for low-income families, Head Start, in 1965. Then in 1969, President Nixon
brought bipartisan sanction to federal involvement in day care by calling for “a national
commitment” to give “all American children an opportunity for healthful and stimulating
development during the first five years of life.” This was followed by the 1970 White
House Conference on Children, which called for extensive federal involvement in child
care. Nixon did veto child care legislation passed in 1972, but then signed into law an
expansion of the dependent care deduction, which was later replaced by the child care
credit in 1976. Then, in 1975 Title XX of the Social Security Act was inaugurated, funds
from which now subsidize day care in 45 states.46
It was a decade later, in the mid-1980s, that a coalition came together to make a major
push for expanded federal involvement in child care. The result was the introduction of
H.R. 3, the Act for Better Child Care, or “ABC” bill. Although a four-year battle ended
in defeat on that specific bill for the child care advocates, federal spending on child care
continued to increase. In particular, the Family Support Act of 1988 specifically provided
funds for child care for welfare recipients and low-income families.
In 1990, the battle was rejoined. This time, the child care establishment won the day.
As part of the budget bill that year, the Child Care and Development Block Grant and
the At-Risk Child Care program were inaugurated, significantly expanding the federal
involvement in child care support.
The other major federal expenditures on child care are: The Child Care and
Development Block Grant, which spent $933 million in 1995; the Title XX social services
block grant for $448 million; child care for AFDC recipients, $633 million; at-risk
child care, $279 million; and transitional child care assistance, $192 million. Head Start,
which is a quasi-child care program, was funded at $3.4 billion in 1995 and another
$1.5 billion was spent on subsidizing food for child care centers through the school
lunch program. This last program is the single largest source of direct financial assistance
for child care.47
These are the largest federal programs that involve child care. Compiling an authoritative
list of federal projects in child care is more difficult because so many programs in
so many different federal departments and agencies have child care components. For
example, the General Accounting Office has identified 90 federal programs that are
involved in some way with early childhood, 34 of which are focused on child care.
Similarly, the Congressional Research Service has identified 46 federal child care programs,
although 32 of these are funded at less than $50 million annually.48
The largest elements of the Clinton child care proposal currently before Congress
would, over five years, expand the Child Care Block grant by $7.5 billion; expand the
child care tax credit by $5.2 billion; expand Head Start by $3.8 billion and establish an
entirely new program called the Early Learning Fund at $3 billion.
Having just embarked on the deconstruction of a welfare system that fostered a culture
of dependency and helped create a demoralized underclass, despite initial good intentions,
we would do well to approach the issue of child care with an eye to the Law of
Unintended Consequences. As the federal government continues increasing its subsidy
of nonparental care of infants and toddlers, what will happen? The data on day care
usage are already providing evidence that the child care market is responding predictably
with a shift toward the subsidized product. William Prosser, an analyst with the federal
Department of Health and Human Services, writes:
[I]f subsidies have increased over the years, then one could hypothesize
that the kinds of care more often subsidized — and thus, cheaper to parents
— would increase in prevalence. Since center care has traditionally
and increasingly been subsidized by both government and perhaps by
providers themselves, one would expect an increase in the use of center
care compared to the use of relative care. In fact, we do see an increase
in the use of center care and a decline in the use of relative care. …49
Federal intervention in child care for American children should be guided by what parents
want and what children need. At the very least, the government should be neutral
and avoid social engineering that skews the child care market by emphasizing and underwriting
commercial, institutional and bureaucratized solutions.
Parents all across this country have spoken both literally and figuratively by making
the sacrifices necessary to care for their own children by themselves or within their families.
What do parents want? They want to care for their own children. Yet our federal
policy underwrites only paid child care. What do children need? Children cannot speak
for themselves, but we know what they need. They need enduring relationships with
people who are crazy about them. Yet our federal policy prefers the care of hired
The Clinton federal child care initiative may be propelled by good intentions. But
what will be the unintended consequences? No one yet really knows. But common
sense, current research, and recent history indicate it won’t be good for our kids, or for
the future of the nation. The old welfare system is being dismantled largely because we
found that it was displacing the father from the family. Building a national child care
system on the foundations may end up doing the same thing to mothers.
Charmaine Crouse Yoest [Ph.D.] is the co-author of Mother in the Middle (HarperCollins / Zondervan, 1996), an
examination of the devaluing of motherhood, child care, and the work-family challenge for women. She is
also a Bradley Fellow at the University of Virginia. She is the mother of three [now five] children. [Currently Vice President of the Family Research Council.]
1 All statistics on child care arrangements of preschoolers
come from U.S. Census Bureau, “Who’s Minding Our
Preschoolers?” Fall 1994 (Update), P70-62. Internet
address is http: //www.census.gov/population/www/socdemo/
2 U.S. Census Bureau, Current Population Survey, P-60,
3 U.S. Bureau of the Census, Money Income in the United
State: 1996, Current Population Reports, P60-197,
pp. 19-23; as cited by Robert Rector, “Facts About
American Families and Day Care,” FYI, (Washington D.C.:
The Heritage Foundation), January 21, 1998, p. 2.
4 Urie Bronfenbrenner, “Discovering What Families Do,”
David Blankenhorn, Steven Bayme, Jean Bethke Elshtain,
eds., Rebuilding the Nest: A New Commitment to the
American Family (Milwaukee, Wisconsin: Family Service
America, 1990) p. 31.
5 Stanley I. Greenspan, “The Reasons Why We Need to
Rely Less on Day Care,” The Washington Post, October 19,
7 Stanley I. Greenspan, “The Irreducible Needs of Infants
and Children,” unpublished manuscript, based on his book
The Growth of the Mind and the Endangered Origins of
Intelligence, (Reading, MA: Addison Wesley Longman,
8 Ibid., pp. 7-8.
9 Greenspan, op. cit., C4.
10 M. Kaitz, P. Lapidot, R. Branner, and A. Eidelman,
“Mothers Can Recognize Their Infants by Touch,”
Developmental Psychology 28 (1992): 35-39; as cited by
Marshall Klaus, John H. Kennell, and Phyllis H. Klaus,
Bonding: Building the Foundations of Secure Attachment and
Independence (Reading, Massachusetts: Addison-Wesley,
1995), p. 85.
11 Klaus et al., op. cit., p. 68.
12 Jay Belsky, “Parental and Nonparental Child Care and
Children’s Socioemotional Development,” Journal of
Marriage and the Family (November 1990), p. 890.
13 Virginia L. Colin, Human Attachment: What We Know
Now, Literature Review on Infant Attachment prepared
under contract for the Office of the Assistant Secretary for
Planning and Evaluation, Department of Health and Human
Services, June 18, 1991, pp. 20-22.
14 Ibid., p. 895.
15 Jay Belsky, “A nation (still) at risk?” National Forum,
16 Colin, op. cit., p. 8.
17 Since this percentage is never acknowledged in the
research literature, it must be derived. We know that the
percentage of all infants who are securely attached is
65 percent (Colin). We then can calculate what proportion
of all infants have mothers working full-time, 37.5 percent,
and not working full-time, 62.5 percent (1996 percentages).
Then, since we know that 55 percent of infants with mothers
working full-time are securely attached, the equation
can be completed with the datum that 71 percent of infants
with mothers not employed are securely attached.
18 Belsky, op. cit., p. 897.
19 Carollee Howes, “Can the age of entry and the quality
of infant child care predict adjustment in kindergarten?”
Developmental Psychology 26: 292-303, as cited by Belsky,
20 Barbara Vobejda, “Mother-Child Bond Not Hurt by Day
Care, Study Concludes,” The Washington Post, April 21,
21 Infant Child Care and Attachment Security: Results of the
NICHD Study of Early Child Care, April 20, 1996, p. 14.
22 Ibid., p. 11.
23 Ibid., p. 12.
24 Brenda Hunter, “Storm Clouds or a Drizzle? A Look at
a New Study on Child Care,” Insight, (Washington, DC:
Family Research Council, April, 1996).
25 Suzanne W. Helburn, ed., “Cost, Quality and Child
Outcomes in Child Care Centers,” University of Colorado
at Denver, the University of California at Los Angeles, The
University of North Carolina and Yale University (Denver:
Department of Economics, Center for Research on
Economic and Social Policy, University of Colorado at
26 E. E. Kisker, S. L. Hofferth, D. A. Phillips, and E.
Farquhar, A Profile of Child Care Settings, Early Education
and Care in 1990, Vol. 1 (Princeton: Mathematical Policy
Research, Inc., 1991), p. 146; as cited by Ellen Galinsky
and Dana F. Friedman, Education Before School: Investing in
Quality Child Care (New York, New York: Scholastic, Inc.,
1993), p. 50.
27 Kisker et al., p. 121; as cited by Galinsky, p. 54.
28 Galinsky, op. cit., p. 55.
29 S.B. Thacker, D.C. Addiss, R.A. Goodman, B.R.
Holloway, H.C. Spencer, “Infectious diseases and injuries in
child day care: Opportunities for healthier children,” The
Journal of the American Medical Association, 1992; 268:
1720-6; E.L. Ford-James, M.H. Kim, B.A. Yaffe, A.E.
Ford-Jones, W.H. Abelson, R.M. Issenman et al., “Infectious
diseases in day-care centers: minimizing the risk,”
Canadian Medical Association Journal, 1987; 137: 105-7; as
cited by Cynthia G. Olsen, Carmen P. Wong, Richard E.
Gordon, David J. Harper and Philip S. Whitecar, “The role
of the family physician in the day care setting,” American
Family Physician, September 15, 1996.
30 The ABC’s of Safe and Healthy Child Care: A Handbook
for Child Care Providers (Washington, DC: Government
Printing Office, 1997).
31 Red Book: Report of the Committee on Infectious
Diseases, American Academy of Pediatrics, 1994; as cited
by Michael Kelly, “The Battle of the Bugs: Kids Share
Diseases Despite Day Care’s Best Efforts,” The Commercial
Appeal, February 11, 1997, C1.
32 Olsen et al.
35 E.R. Wald, B. Dashefsky, C. Byers, N. Guerra, and F.
Taylor, “Frequency and Severity of Infections in Day Care,”
Journal of Pediatrics, April, 1988, pp. 540-6.
36 F.W. Henderson and G.S. Giebink, “Otitis media among
children in day care: epidemiology and pathogenesis,”
Review of Infectious Diseases, 1986; 8: 533-8; as cited in
37 L. Vernon-Feagans, E.E. Manlove, and B.L. Volling,
“Otitis media and the social behavior of day-care- attending
children,” Child Development, August 1996, pp. 1528-39.
38 S.J. Holmes, A.L. Morrow and L.K. Pickering, “Childcare
practices: effects of social change on the epidemiology
of infectious diseases and antibiotic resistance,”
Epidemiologic Reviews, 18 (1): pp. 10-28, 1996.
39 R.F. Pass, “Day care centers and transmission of
cytomegalovirus: new insight into an old problem,”
Seminar on Pediatric Infectious Diseases, 1990;1:245-51; as
cited by Olsen.
40 James G. Dobbins et al., “The Risks of
Cytomegalovirus Transmission in Child Day Care”
(Proceedings of the International Conference on Child Day
Care Health) Pediatrics (December 1994), p. 1016.
41 R.F. Pass and C. Hutto, “Group day care and
cytomegaloviral infections of mothers and children,” Review
of Infectious Disease, 1986; 8: 599-605; as cited by Olsen.
42 Sabin Russell, “Puzzling Rise in Asthma Deaths Cases:
Fatalities increase despite smog reductions,” The San
Francisco Chronicle, July 3, 1996.
43 M.M. Engelgau, C.H. Woernle, B. Schwartz, N.J. Vance
and J.M. Horan, “Invasive group A streptococcus carriage
in a child care centre after a fatal case,” Archives of Disease
in Childhood, October 1994, pp. 318-22; T. Cherian, M.C.
Steinhoff, L.H. Harrison, D. Rohn, L.K. McDougal and J.
Dick, “A cluster of invasive pneumococcal disease in young
children in child care,” The Journal of the American Medical
Association, March 2, 1994, pp. 695-7; and “Hemorrhage
and shock associated with invasive pneumococcal infection
in healthy infants and children,” The Journal of the American
Medical Association, January 25, 1995, pp. 280-2.
44 William R. Prosser and Sharon M. McGroder, “The
Supply and Demand for Child Care: Measurement and
Analytic Issues,” Alan Booth, ed., Child Care in the 1990s:
Trends and Consequences, (Hillsdale, New Jersey: Lawrence
Erlbaum Associates, 1992), p. 46.
45 Geraldine Youcha, Minding the Children: Child Care in
America from Colonial Times to the Present, (New York:
Scribner, 1995), p. 312.
46 1996 Green Book: Background Material and Data on
Programs Within the Jurisdiction of the Committee on Ways
and Means, Committee on Ways and Means, U.S. House of
Representatives, (Washington, DC: Government Printing
Office, 1996); and Heidi L. Brennan, “White House Child
Care Conference,” Welcome Home, December, 1997.
47 The Green Book, p. 643.
48 The Green Book, pp. 639-645.
49 Prosser, p. 47.
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