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Babes in Day Care
The controversy over whether nonmaternal care harms infants

by Ellen Ruppel Shell

FOR many of us, the very notion of infant day care conjures up unpleasant, Dickensian images. Subjecting a baby to daily care by a surrogate so that its mother can work seems to go against the American grain. This may in part explain the explosive public reaction to reports of a review paper, "The 'Effects' of Infant Day Care Reconsidered," written by Jay Belsky, a developmental psychologist at Pennsylvania State University, for Early Childhood Research Quarterly. The paper reported that Belsky's research group, that of the psychiatrist Dr. Peter Barglow, of the University of Chicago Medical School, and others had shown that infants of twelve to thirteen months who have been subjected to more than twenty hours a week of nonmaternal care are at risk for future psychological and behavioral difficulties. Nonmaternal care includes day-care centers, family day care, and care in the infant's home by a babysitter or a relative.

Newspaper reports about this finding sent shudders of guilt through millions of parents. The headlines have long since subsided, but what remains is the misguided impression that Belsky scientifically established what many of us secretly fear to be true: that mothers of infants who do not devote at least most of their time to child-rearing risk compromising their children.

The impression given by the report is quietly echoed by a handful of child-development experts. Dr. Eleanor Galenson, a prominent New York City child psychiatrist, told me that she has long considered full time child care to be bad for infants and that Belsky's report simply confirmed what she saw in her practice every day -- children whose psyches are seriously damaged in part because of a dearth of maternal attention. "Putting infants into full-time day care is a dangerous practice," she says. "Psychiatrists have been afraid to come out and tell the public this, but many of us certainly know it to be true." Another extremely influential authority on child care told me privately that despite public pronouncements to the contrary, he feels "in my guts" that infants are better off at home with their mothers.
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Many psychologists and psychiatrists who specialize in the study of child-care issues, however, respond quite differently to Belsky's review. Many are outraged not only that Belsky would publish such a report but also that he would tout it on talk shows even before it was published. The announcement was particularly surprising coming from Belsky, who was well known for another review paper he wrote on infant care in a university-based day-care center in the late 1970s which concluded that "the total body of evidence ... offers little support for the claim that day care disrupts the child's tie to his mother." Some accused Belsky of harboring a personal bias (his wife quit a professional position to raise their children) and of being publicity-hungry. Belsky dismisses such attacks as vulgar and inappropriate, but they illustrate the deeply felt nature of the debate. Probably no adult and surely no parent can claim to be completely unbiased when it comes to the question of how and with whom infants should spend their days. However, while it is not possible to settle the question, given the relative paucity of data on the effects of infant care, a closer examination of Belsky's arguments and the base on which he builds them does shed some light.

BELSKY and others who study the effects of child care on children rely for their infant data mainly on the Strange Situation Test, which is simpler to perform than it is to interpret. The test was designed in 1964 by the child psychologist Mary Ainsworth, then at Johns Hopkins University, to measure a one year-old's-attachment to its mother. It involves seven-three minute episodes in which the child is left alone with its mother, then left with its mother and a stranger, and then left successively with the stranger, with the mother, alone, and with the stranger, until, finally, the mother returns for good. Observers judge how readily the baby can be calmed by its mother when stressed, and whether it avoids or resists her. Insecurely attached babies either avoid or actually push away their mothers, while securely attached babies seek their mothers out. Research that relied on the results of this test has demonstrated that infants raised at home who are insecurely attached to their mothers are at higher risk for future psychological problems than are securely attached infants.

In his review paper Belsky reported that his research group's study and three others all demonstrate that infants subjected routinely to more than twenty hours a week of nonmaternal care are more likely to show insecure attachment when tested. This insecure attachment is associated with "heightened aggressiveness, noncompliance, and withdrawal in the preschool and early school years." He concluded from this that extensive day care in the first year of life is itself a psychological risk factor. (Day care after a child's first year is not in contention here, and little is known about its effects.)

As Belsky himself concedes, however, the Strange Situation Test may well not be the best method for comparing children who experience day care with those who do not. The test was designed to measure infant attachment at a time when most children were raised at home. Belsky's critics point out that children in day care are subjected to what is in some respects a strange situation every day, when their mother or father leaves them in the care of someone else. Over weeks or months these children may very well get used to spending time with people other than their parents. Several psychologists have argued that infants in day care might simply have a precocious independence from their mother -- an independence that most normal children acquire over the next several years -- and would not show stress if given the test. Belsky is troubled by this argument.

"I don't want to suggest that the Strange Situation Test is definitive -- far from it," he says. "I have no qualms with the argument that we need new measures. But early research showed that day-care kids show the same level of stress due to separation as non-day-care kids [hence they are equally suitable to be tested for insecure attachment], and my critics completely ignore this data." Belsky's critics counter that such data as exist to support the notion that day-care and non-day-care infants experience equal stress in the Strange Situation Test is at best inconclusive. Moreover, most of the research done in early-infant day care does not control for the quality of care an infant receives. And other than making an attempt at defining the economic class of an infant's parents, researchers barely consider its home environment. Yet parents who regularly use child care may differ in any number of ways from parents who keep their children at home, and these differences might be crucial to the interpretation of test results.

"The decision to place children in day care is correlated with many other variables, and this is absolutely the issue," says John Richters, a developmental psychologist and staff fellow at the National Institute of Mental Health, who wrote, with Carolyn Zahn-Waxler, a developmental psychologist at the NIMH, a rebuttal for Early Childhood Research Quarterly of Belsky's report. For example, parents who use full-time infant care may, on average, be under more financial strain than other parents; they may put more emphasis on their careers, or be less interested in domestic activities. "We have no idea what's involved here," Richters says. "Parents who use more than twenty hours of child care each week might share one or more other traits thatwould cause their infants to show a less secure attachment to Mother." Belsky acknowledges that studies have not yet taken these other variables into consideration, and says that doing so is "the current research agenda."

This methodological problem aside, the difference in maternal attachment Belsky reported between infants in day care and in home care, while significant, is not overwhelming. In the four studies Belsky reviewed, a total of 464 infants were tested. Of these, 41.5 percent of the infants in day care and 25.7 percent of infants cared for at home were insecurely attached. Alison Clarke-Stewart, a psychologist at the University of California at Irvine, who wrote a review of sixteen studies of infant care, found the differences to be somewhat smaller, with about 36 percent of infants in day care and 29 percent of infants cared for at home insecurely attached. (Studies in Europe, Israel, and Asia using the Strange Situation Test find about 35 percent of all infants in home care to be insecurely attached. ) In all studies the majority of infants remained securely attached to their mothers regardless of their exposure to day care. There is no ignoring the question of why so many children in both groups test insecurely attached; so far there are no answers.

At any rate, Clarke-Stewart points out, even infants in day care who appear from test results to be insecurely attached are not necessarily at high risk of suffering from future psychological problems. "Belsky contends that childcare infants doubt Mom's availability and responsiveness, and that they develop a coping style to mask their anger," she says. "But this is an interpretation for which we have no empirical support. Children in infant day care have been observed to be normal. They are not emotionally disturbed." As for the implication of longitudinal studies showing later psychological problems for children raised at home who were categorized as insecurely attached on the Strange Situation Test, Clarke-Stewart and others say that day-care infants are by definition brought up differently from homecare infants, and that this difference in upbringing might well make it inappropriate to compare them directly.

"Comparing infants in child care with infants raised exclusively at home may not be very useful," says Kathleen McCartney, a psychologist at the University of New Hampshire who specializes in day-care issues. "We have no idea whether their differences, if any, are related to their day-care experience, their home experience, or other factors. Is child care a risk factor for infants? Well, it depends. What kind of child care are we talking about? What are the parents' motivations for using child care? What is the infant's personality? We do know that children in high-quality day-care centers do better than those in low-quality centers. We know that young children do better in small groups than in large ones. We know that children do better if their caretakers don't change frequently and are available, empathetic, and sensitive to the child's needs. But beyond that, there's not much that we can say that's backed by research."

BELSKY is dismayed by what he considers to be the misconstruction of his findings by political conservatives in anti-child-care arguments. "All I've said is that it's a risk factor," he says. "My purpose was not to castigate the very institution -- just the institution as it exists today in this country."

In an as yet unpublished book chapter titled "Motherhood and Child Care," Kathleen McCartney and Deborah Philips, who is a psychologist at the University of Virginia, discuss the evolution of American child care in this country. They point out that our notion of motherhood is a romanticized social construct peculiar to contemporary Western culture, and they argue that American society's almost obsessive ambivalence about who should care for young children "reflects concerns that child care poses a threat to motherhood and the sanctity of the family." Child-care services, they write, "are rarely portrayed as supportive and complementary to the family, unless accompanied by paternalistic motives to rectify the effects of deprivation." It follows that the debate over whether children are slightly more or less attached to their mothers owing to early exposure to child care overlooks a much more fundamental conflict: the underlying uneasiness we as a nation feel with the very idea of infant care.

Legislators and educators, who continue to question the role of infant care too, seem to put aside the reality that half of all infants today are regularly cared for by someone other than their parents, three quarters of them for more than twenty hours a week, and that that proportion is growing steadily. Research into the effects of infant day care clearly must proceed, and its implications may be great for parents and employers. But that research should not distract us from the undisputed fact that bad care is never good for any child and good day care is all too hard to find.

Copyright © 1988 by Ellen Ruppel Shell. All rights reserved.
The Atlantic Monthly; August, 1988; Babes In Day Care; Volume 262, No. 2; pages 73-74

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