Effects of Day Care

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The effect of day care on children's development is related to the quality of the care the children receive. The Cost, Quality, and Outcomes Study of Child Care (CQO) investigated this issue and identified three levels of quality: low, mediocre, and high. Table 1 provides characteristics of each level. Higher quality was related to higher caregiver wages, higher caregiver education and training, and lower adult to child ratios.

This study examined the prevalence of each quality level. For preschool-aged children, only 24 percent of the day-care center classrooms were of high quality, 66 percent were mediocre quality, and 10 percent were low quality. For infants and toddlers, only 8 percent of the classrooms were of high quality, 52 percent were mediocre quality, and a full 40 percent were low quality. In a separate study of family day cares, only 9 percent provided good quality care, and a full 35 percent provided care that was potentially harmful to children's development.

Health and Safety

The effects of day care on children's health and safety vary by the quality of the setting and the attention paid to these issues. Because their immune systems are not yet fully functional, infants and toddlers are more susceptible to illnesses than older children. Infectious diseases (mainly upper respiratory and gastrointestinal) are higher among children in family day care and day-care centers than among children cared for in their own homes. However, scrupulous attention to hand washing and hygiene can cut the rate of infectious disease transmission substantially. Children in day-care centers may also be prone to injuries if the playground equipment is unsafe. This risk can be reduced by paying attention to the height of playground structures and the resilience of the surface under the equipment. The American Association of Public Health and the American Academy of Pediatrics developed a document entitled ''Caring for Our Children'' that provides comprehensive health and safety guidelines for day-care facilities.

Cognitive Development

The effects of day care on cognitive development are also related to the quality of the setting. The CQO study found that children in higher quality day care demonstrated more advanced cognitive skills than children in lower quality care. Specifically, their language development was more advanced, and they had better premath skills. In addition, compared to children who received low quality care, children who received high quality care in their preschool years continued to show heightened cognitive skills into the early school years.

The NICHD study researched this issue further by examining both day care quality and family characteristics. This study also found care quality to be related to language development as well as school readiness. However, family characteristics (such as family income, mother's vocabulary, and the home environment) were more strongly associated with children's cognitive development than day-care experience. This study also compared children who were and were not in day care and found that when family

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