DEBATE FORUM

Resolved: Day Care Is the Best Care For Children under Age Five 0/ WorkingAmericans

SERIES EDITOR: LENORE C. TERR, M.D.

Editor's Note: The issue of day care is receiving massiveprofessional and political attention today. How will publicday care policy be set? How young should children be whenthey enter day care? Are we better off supplementing familyincomes so that one parent is able to stay at home?

AFFIRMATIVE: LEON EISENBERG, M.D.

The question is not whether there should be day care forinfants and young children but how quality and accesscan beassured and how best to fit day care into a comprehensivefederal policy for child development. Calls for a return to the"traditional" Dick and Jane school reader pattern of at-homemotherhood mistake the fantasy portrayed in my first gradereader for yesteryear's reality.

Time was, according to that series, when the AmericanFamily consisted of Father and Mother and Dick and Janeand Spot. Father went off to work but always had time forDick and Jane; Mother stayed home, contentedly cookedwholesome meals, kept the house and garden immaculate,and loved Dick and Jane and Spot (and perhaps Father aswell; my reader was silent on the point). Life was so simplethat short sentences wereenough to describe it: "Mother cooksdinner. Jane helps Mother. Look, Jane! Watch Dick play ball.See Spot run."

Was there ever such a time? A time when all families werewhite-middle-class homeowners , when marital discord andseparation were unknown, and when out-of-wedlock birthssimply didn't happen? Not many Americans of my generationcould identify that family with their own; even fewer woulddo so today. Check the facts.

The United States has the dubious distinction of being firstamong industrialized countries in teenage birth rates (despitethe fact that it also heads the list in teenage abortion rates).In consequence of out-of-wedlock births and a tripling in thedivorce ratio over the past 15 years, one in every four of ournation's 62 million children under 18 lives with only oneparent , that parent the mother nine of ten times. Of children

Accepted September 30, 1988.Dr. Eisenberg is Professor and Chairman of the Department of

Social Medicine and ProfessorofPsychiatry. Harvard Medical School,Boston. Massachusetts. Dr. Provence is Professor Em erita of ChildDevelopment and Pediatrics, Yale University Child Study Center,New Haven, CT. Dr. Metcalf is Clinical Professor of Psychiatry atLangley Porter Psychiatric Institute, University of California. SanFrancisco. Dr. Westman is Professor of Psychiatry, University ofWisconsin, Madison, Wisconsin.

0890-8567/89/280 1-0000$02.00/0© 1989 by the American Acad­emy of Child and Adolescent Psychiatry.

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living in female-headed households, more than a third growup in poverty; if they are black, the proportion is twice ashigh. But the need for day care is not limited to single parentfamilies. Whether or not the family is intact, more than halfof all mothers with a child under age 3 are in the labor force.Some work outside the home because they prefer to; mostbecause they have to. Ifwe are to respond to the needs ofournation's children, we must begin with demographic reality(U.S. Bureau of the Census, 1987),which will not be changedby wishful thinking.

Some question whether day care for young infants can everbe developmentally appropriate. Their concern recalls thedoubts raised during World War II about the massive increasein day care for toddlers as women entered the labor force inlarge numbers to replace the men who had been drafted. Adecade of research identified fewdifferencesbetween childrenreared continuously at home and those who attended daynurseries (Stolz, 1960). That evidence was persuasive to mostprofessionals. It did not impress Richard Nixon when hevetoed the Comprehensive Child Development Bill of 1971on the grounds that it would commit the "vast moral (sic)authority of the national government to the side of communalapproaches to child rearing over against the family centeredapproach."

Agreed, the evidence on day care effects on toddlers doesnot establish the safety of day care for very young infants.That issue remains controversial; findings and the interpre­tations of the findings vary from study to study, in partbecause preoccupation with differences in day care has ob­scured attention to differences in the families to which theinfants return. It is likely that it is the interaction between thetwo that is decisive for developmental outcomes (McCartneyand Galanopoulos, 1988).

Having acknowledged the ambiguity in the data , how canI support infant day care when I cannot be sure it is withoutrisk? The answer should be self-evident: assuring access tocare based on the best standards we can design is the onlyeffective response in the real world of infant day care, whereinadequate staffing ratios, untrained workers, and unplannedprograms abound. Systematic longitudinal research is essen­tial to obtain the data that willenable us to improve outcomes.It is just about irrelevant to the question of whether day carewill continue to be used. That has already been decided inthe marketplace.

Quality can only be assured by specifying federal standardsfor care; access can only be assured by federal subsidy. Thecosts of day care amount to three-quarters or more of theaverage full-time pre-tax wage for women in their 20s. Whatis called for is a tuition subsidy for approved programs, one

DEBATE FORUM 131

indexed to family income . Access to day care of the bestquality is not enough by itself. Comprehensive national policymust include at least three other components: paid parentalleave after childbirth; protection of young families againstpoverty; and education for parenthood.

Federal legislation should mandate no fewer than 3 monthsand preferably up to 6 months of paid leave with guaranteedjob protection for either parent after the birth of an infant. Itshould shame us all that ours is the only Western industrialcountry without such provisions for the benefit of infants andparents. Effective parenting is not instinctive; it must belearned. Not all mothers or fathers will wish to use paid leave,but many will seize the option if it is available.

No less essential are measures to protect young mothersand their children against the destructive effects of poverty. Itis time for us to emulate the example of Sweden, wherepayments to single mothers provide a modest but decentstandard of living in conjunction with subsidized housing andmedical care. Swedish policy supports high female labor forceparticipation by continuing benefits at a generous level whenwomen return to work (Kamerman and Kahn, 1982). Familybenefits do not solve all the problems of single parents; theydo prevent the superimposition of penury on other socialstresses.

The final component is education for parenthood. Isolatednuclear families, reduction in family size, and sharp seques­tration of age groups in today's society combine to deprivechildren of the opportunity to learn parenting skills by mod­eling themselves on their own parents, grandparents, uncles,and aunts. They less often care for younger sibs becausecompleted families are smaller. Child development centershoused on junior high and high school campuses can enablemale and female adolescents to learn about child develop­ment, to enjoy younger children, and to prepare themselvesfor later parenthood. Courses in child development, combinedwith day care practicums, could be made intellectually stim­ulating. I am not suggesting a means to provide child care onthe cheap. The students will need to be closely supervised byqualified day care workers if the experience is to be fullyrewarding.

Taken together , these elements ofa comprehensive nationalpolicy on child development can make a significant contri­bution to the futures of our children. Some will object that ,in a time of resource constraints, we cannot afford new andcostly federal programs. There is no better response than thestatement by the Committee for Economic Development(1987) ; "If the nation defers the expense of preventive pro­grams during the formati ve years, it will incur much higherand more intractable costs for older children that have alreadyexperienced failure."

Perhaps you wonder what ever happened to the family inmy grade-school readers. All of them are much older now.Dick and Jane have their own homes. Although Dick's secondmarriage is better than his first, he and Carol have to workhard to meet the payments on their condo. Carol tries herbest when her husband's children visit, but she resents it whenthey are not nice to the new baby. Dick isn't much helpbecause he still feels guilty about the divorce. During theweek, little Di (they named her after the Princess) cries whenshe's dropped off at the only day-care center they can afford.

That worries them, but Carol does have to be at work ontime.

Jane grew up to be much like Mother. Homemaking wascareer enough for her. A fan of Phyllis Shatley's, she concen­trated on gourmet cooking and filmy lingerie to keep her manhappy. That's why it was such a shock when Bob ran off withanother woman and refused to pay child support for Jasonand Rebecca. With no work skills and no experience, Jane isreduced to living on AFDC as best she can. She remembersher childhood as happy. She always tried to do the right thing.She can't understand what happened to her. She feels likecrying all the time.

Of course, Dick and Jane are no more representative nowthan they were then. American families, as they always have,come in many sizes, colors, and accents. Throughout ourhistory, from native Americans to boat people, initially di­verse family structures have changed further in response tonew social demands. The one constant has been the need ourchildren have for affection, continuity, and stimulation fromthe adults who care for them . The goal of a national policyfor child development is to meet those needs by social inven­tions appropriate to the times (Eisenberg, 1987).

ReferencesCommittee for Economic Development (1987), Children in Need:

In vestment Strat egies fo r the Educationally Disadvantaged. NewYork: Committee for Economic Development.

Eisenberg, L. (1987), Preventi ve pediatrics: the promise and the peril.Pediatrics, 80:415-422.

Kamerman, S. S. & Kahn , A. J. (1982), Income transfers, work andthe economic well being of families with children. InternationalSocial Securit y R eview, 3:345- 382.

McCartney, K. & Galanopoulos, A. ( 1988), Child care and attach­ment: a new fronti er the second time around. Am. J. Orthopsychiat.58:16-24.

Stolz, L. M. (1960), Effects of maternal employment on children.Child Dev., 31:749-782.

U. S. Bureau of the Census , Current Population Reports, Series P­23, No. 150 (1987), Population Profile ofthe United Stat es: 1948­1985. Washington. DC: U. S. Government Printing Office.

AFFIRMA TIVE: SALLY PROVENCE, M.D.

The quest ion of the benefit or harm from day care is largelyan academic one because the need and demand for daytimeout-of-home care for children has grown to a staggering leveland continues upward. Nonetheless, it is important that men­tal health professionals continue to ask questions about theimpact of supplemental child care on child and parents. Theterm "crisis in child care" applied to the current situation inour country is not a fiction. More than half the mothers ofchildren under age 6 and half of the mothers of infants undera year are in the labor force, a new social phenomenon. Infantday care is currently the fastest growing day-care activity.Current efforts to gain parental leave for the care of newlyborn or adopted children reflect both the needs of familiesand the concern about the well-being of infants.

Mental health professionals and child development special­ists are justifiably concerned about what happens to infantsand young children whose care is far from "good enough."We see many who suffer from being neglected, physically oremotionally abused, or traumatized, or from living in less