Meeting Standards Improves Child Care

Abstract

Epidemiology| September 01 1999 Meeting Standards Improves Child Care AAP Grand Rounds (1999) 2 (3): 29. https://doi.org/10.1542/gr.2-3-29 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Meeting Standards Improves Child Care. AAP Grand Rounds September 1999; 2 (3): 29. https://doi.org/10.1542/gr.2-3-29 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: child care Source: NICHD Early Child Care Research Network. Child outcomes when child care center classes meet recommended standards for quality. Am J Public Health. 1999;89(7):1072–1077. Do child care settings that meet professional quality standards foster improved child development in 2-and 3-year-olds? A prospective cohort of 1,364 children from diverse social and ethnic backgrounds in 9 states was followed from birth. Child care centers were evaluated for child-staff ratio, observed group size, caregiver training and caregiver education and were compared with national standards set by the American Academy of Pediatrics (AAP) and the American Public Health Association (APHA). Compliance with these standards ranged from 10% at 6 months to 34% at 36 months of age. At 24 months of age, 24% of classes were not in compliance with their own state’s group size standard. Children enrolled in child care centers with complete data were assessed at 24 and 36 months of age for cognition, language and social behavior. Adjustment was made for confounding family and social variables. At 36 months, children whose classes met more standards had improved school readiness (p=0.01), better language comprehension (p=0.02) and fewer behavior problems (p<0.01). The number of standards met was associated linearly with child outcomes with no threshold effects: that is, with each additional standard met by the centers, child behavior, development and school readiness were incrementally better. Child-staff ratio at 24 months and caregiver training and education at 36 months were predictive of child outcomes. In 1992, the AAP and APHA published joint professional standards for child care.1 These include maximum group size and child-staff ratios by child age and minimum training levels for staff. Current state regulation of child care standards is quite variable. This multi-site study, coordinated by the National Institute of Child Health and Human Development (NICHD), provides important information on how poorly child care centers are performing in meeting these standards and on the impact of this performance on child developmental and social outcomes. Their findings are consistent with those of the NICHD Study of Early Child Care, showing an association of child care quality with child development.2 This new study suggests that centers meeting fewer standards will have children with below-average school readiness. Further study of this cohort when they reach school age will be of great interest. Finally, although this study was adjusted for social factors, there may have been other characteristics of parents who chose substandard child care centers that could confound the study’s findings. For example, parents who have developmental impairment might choose substandard child care centers and give birth to children who have lower than average school readiness. This potentially confounding issue requires further study to evaluate. Nonetheless, pediatricians should inform parents about established standards in selecting child care, and should advocate for more stringent policy and enforcement of child care regulations. You do not currently have access to this content.