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The quality of different types of child care at 10 and 18 months: A comparison between types and factors related to quality Penelope Leach

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The quality of care offered in four different types of non-parental child care to 307 infants at 10 months old and 331 infants at 18 months old was compared and factors associated with higher quality were identified. Observed quality was lowest in nurseries at each age point, except that at 18 months they offered more learning activities. There were few differences in the observed quality of care by child-minders, grandparents and nannies, although grandparents had somewhat lower safety and health scores and offered children fewer activities. Cost was largely unrelated to quality of care except in child-minding, where higher cost was associated with higher quality. Observed ratios of children to adults had a significant impact on quality of nursery care; the more infants or toddlers each adult had to care for, the lower the quality of the care she gave them. Mothers' overall satisfaction with their child's care was positively associated with its quality for home-based care but not for nursery settings.
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Early Child Development and Care
2006, 1–33, PrEview article
ISSN 0300-4430 (print)/ISSN 1476-8275 (online)/06/000001–33
© 2006 Taylor & Francis
DOI: 10.1080/03004430600722655
The quality of different types of child
care at 10 and 18 months: a comparison
between types and factors related
to quality
Penelope Leach
a,b
*, Jacqueline Barnes
a,b
, Lars-Erik
Malmberg
c
, Kathy Sylva
c
, Alan Stein
b,c
and the FCCC team
1
a
University of London, UK;
b
Tavistock and Portman NHS Trust, London, UK;
c
University of Oxford, UK
Taylor and Francis LtdGECD_A_172233.sgm10.1080/03004430600722655Early Childhood Development and Care0300-4430 (print)/1476-8275 (online)Original Article2006Taylor & Francis0000000002006PenelopeLeachpen.leach@btinternet.com
The quality of care offered in four different types of non-parental child care to 307 infants at 10
months old and 331 infants at 18 months old was compared and factors associated with higher
quality were identified. Observed quality was lowest in nurseries at each age point, except that at
18 months they offered more learning activities. There were few differences in the observed quality
of care by child-minders, grandparents and nannies, although grandparents had somewhat lower
safety and health scores and offered children fewer activities. Cost was largely unrelated to quality
of care except in child-minding, where higher cost was associated with higher quality. Observed
ratios of children to adults had a significant impact on quality of nursery care; the more infants or
toddlers each adult had to care for, the lower the quality of the care she gave them. Mothers’ overall
satisfaction with their child’s care was positively associated with its quality for home-based care but
not for nursery settings.
Keywords: Child care; Infancy; Nurseries; Child-minding; Maternal child care choice;
Satisfaction
The importance of child care quality
As research on the impact of child care on children’s development has progressed, the
overweening importance of the quality of care has become clear (Borge et al., 1996;
Petrogiannis & Melhuish, 1996; Lamb, 1998; Smith, 1998; National Institute of
*Corresponding author. Institute for the Study of Children, Families and Social Issues, Birkbeck,
University of London, London, UK. Email: pen.leach@btinternet.com
2 P. Leach et al.
Child Health and Human Development, Early Child Care Research Network
[NICHD], 2001a, b, 2002a, b; Melhuish, 2004). As Ramey (2005) commented:
… collectively this study [NICHD] unequivocally demonstrates that both the quality and
the quantity of nonparental care influence children’s development. Stated directly and
summatively, poor quality care is harmful. Conversely, high quality care can be somewhat
beneficial … (pp. 427–436)
Whatever the aims and parameters of studies of child care, quality is almost certain
to be a factor in the findings.
Quality of child care has an impact on many aspects of children’s development.
Most widespread have been studies showing relationships between quality and
various aspects of children’s social development and behaviour. For example, Howes
and Olenick (1986) studied centre care and compliance in a sample of American
infants at 18, 24 and 36 months at home, in day care and in a structured observation.
The best predictor of children’s overall non-compliance was quality of care, with
children from high-quality centres showing more compliance and cooperativeness
than children from low-quality centres. Howes (1990) in the USA and Beller et al.
(1996) in Germany reported positive correlations between quality of care and a range
of other aspects of social competence. Immediately before and after changes in
Florida child care regulations and consequent improvement in quality, Howes et al.
(1995) were able to show associations with improvements in peer interactions. Simi-
larly, a multi-site study in four American states found that, after controlling for family
background, higher quality of care was associated with better social competence
(Cost, Quality and Childcare Outcomes Study Team, 1995) as did the NIHCD study
(NICHD, 2001c). Phillips et al. (2001) and Volling and Feagans (1995) found that
centres with higher-quality care had children with better peer relations while in a
study of Israeli family day care Rosenthal (1990) found that aspects of the quality of
care were related to the frequency of aggressive interactions.
Recently studies have also shown links between child care quality and measures of
children’s cortisol. In full-time day care cortisol levels tend to rise throughout the day,
in contrast to the typical diurnal pattern, an endocrine response indicative of
increased stress. Increasing cortisol levels are more likely as the quality of day care
decreases. Some studies report associated increases in behaviour problems (Dettling
et al., 2000; Bruce et al., 2002).
Child care quality has also been shown to be positively related to cognitive and
language development. Vandell (2002), reporting on the NICHD sample at the age
of 54 months, found that children with child care in the highest tercile of quality
achieved significantly higher scores on ‘pre-academics’ and language than children in
child care in the lowest tercile. However the most powerful finding from that NICHD
study, further reported in NICHD (2005), concerned the quantity rather than the
quality of child care. More time in non-maternal care across the first four and a half
years of life predicted more problem behaviour, particularly antisocial and aggressive
behaviour, at four to five years of age. These effects were only partially mediated by
quality of child care. The effects and interaction of quantity and quality of child care
Differences in child care quality 3
vary in different populations. For example, while Waldfogel, Han and Brooks-Gunn
(2002) report that maternal employment in the first year of life is associated with
increased behaviour problems, a recent re-analysis suggests that this effect may
only be present where the quality of child care is below average (Brooks-Gunn et al.,
2002), while in an analysis of the NLSY data-set, a large-scale, representative, US
sample, Youngblade (2003) finds that maternal employment in the first year of life is
associated with behaviour problems for boys but not girls. In England, the Effective
Provision of Pre-school Education (EPPE) study of over 3000 children found that
early child care, particularly in the first two years, is associated with antisocial
behaviour at three and five years of age (Melhuish et al., 2001; Sammons et al., 2003).
Hours in non-parental care have also been shown to be associated with behaviour
problems in the results of a new longitudinal study of 17,000 children from 900
kindergartens in the USA (Early Childhood Longitudinal Study, ELLS-K) (Ritter &
Turner, 2003).
Defining child care quality
Child care quality has been described as a ‘slippery and multifaceted construct that
requires careful measurement and interpretation’ (Hwang et al., 1991, p. 117). It has
even been suggested (Moss & Pence, 1994 ) that quality is not an objective reality but
a relative value varying depending on the informant, who might be a parent, a child
care worker, a policy-maker or even a child. Confusing good quality with good
outcomes is a hazard in conceptualising quality of child care. While quality of child
care is positively related to many aspects of children’s ongoing development, it is also
positively related to children’s day to day happiness and security and to parents’ satis-
faction with child care. In the United Kingdom, efforts have been made to develop a
theoretical framework, and consequently methods of assessing quality, that can be
incorporated into good practice, inform care providers and establish ways to improve
services (Moss & Pence, 1994 ; Munton et al., 1995). This conceptualisation incor-
porates a ‘children’s rights’ approach: irrespective of differences in long-term
outcomes, young children have a right to the best quality day care that can be
provided. Even if this principle is accepted, however, the question of what is ‘best
quality’ remains to be answered. As in any other setting, ‘children in child care need
to be safe, healthy, responded to sensitively and appropriately, and encouraged to
develop their potential’ (Barnes, 2001, p. 4).
Child–caregiver relationships have been shown to be an important aspect of quality
of care. Scarr (1998), in a review, concluded that ‘quality child care is warm, support-
ive interactions with adults in a safe, healthy and stimulating environment, where
early education and trusting relationships combine to support individual children’s
physical, emotional, social and intellectual development’ (p. 100). A range of desir-
able practitioner qualities identified in the literature as fundamental to facilitating
good quality relationships between adults and children includes sensitivity, empathy
and attunement (for example, Post & Hohmann, 2000; Davis et al., 2002; Elfer et al.,
2003). Being cared for by adults possessing these qualities and attitudes can help
4 P. Leach et al.
infants and young children to feel confident in themselves, encourage them to
communicate and talk, to think and have ideas, and to learn and discover. The degree
to which trusted caregivers are available for individual children has recently been
shown to be a key feature of quality of care (Clasien de Schipper et al., 2004). These
carer qualities are closely linked with the concept of the key person in group child care
(Lindon, 2003). They are featured in the UK’s Key Elements of Effective Practice
(Department for Education & Skills; 2004) and the Common Core Skills and Knowl-
edge for the Children’s Workforce (Department for Education & Skills, 2005).
Children who experience greater caregiver stability while attending early years
settings have been found to have more secure relationships with their caregivers and
to show higher degrees of social competence (Howes & Hamilton, 1992b, 1993;
Raikes, 1993). Caregiver stability has been widely defined, including availability, the
amount of time a caregiver spends with individual children (Barnas & Cummings,
1994; Raikes, 1993), the frequency of changes in the primary caregiver (Howes &
Hamilton, 1992a, 1993), the rate of staff turnover (Clarke-Stewart et al., 1994;
Whitebrook et al., 2001) and the number of different arrangements experienced by
an individual child (NICHD, 1997a, b, 1998).
Structural—and regulatable—aspects of child care have also been found to be asso-
ciated with quality. Factors such as adult–child ratios, group sizes, children’s ages at
entry and hours in the facility, and caregivers’ qualifications have been found to be
predictive of sensitive, positive caregiving and of children’s early socio-emotional
development (Phillips, 1987; Clarke-Stewart et al., 1994; Vandell & Wolfe, 2000;
NICHD, 2005). Along with lower staff turnover rates, such factors are associated
with positive practitioner–child relationships and increased social competence and
social adjustment among the children (for example, Borge & Melhuish, 1995;
Richman & McGuire, 1988; Scarr et al., 1994).
Nevertheless, structural information, relatively easily garnered from administrative
sources, cannot be relied upon to infer quality of process. In a study of 120 American
centres, only one of six regulatable characteristics—the highest wage paid—was
significantly correlated with observed quality (Scarr et al., 1994). Another large study
in the USA (Howes et al., 1992) did find that process quality rose as the adult:child
ratio increased, but these were observed ratios, taken every 15 minutes over several
hours of observation. It is not enough to know the official ratios for a nursery as these
are not routinely met in practice (McGuire & Richman, 1989; Scarr et al., 1994).
Quality of different types of child care
At present it is as difficult to compare the quality of different types of child care as it
is to compare different views of the constituents of quality. Apart from inspection
data, presenting a strictly limited, structural view of available types of child care (for
example, OFSTED, 2005), most of the research showing the positive impact of high-
quality early years practice (NICHD, 1999; Sylva et al., 2004; Graham, 2005) and
the negative impact of poor quality of care, as well as too much care or care too early
in life (Gunnar et al., 1998; Melhuish, 2004), is more concerned with within-type
Differences in child care quality 5
than across-type differences in quality. Even when large-scale studies collect quality
data for a range of child care types, the range is usually collapsed to two or three cate-
gories so as to optimise numbers for analysis. An honourable exception is the EPPE
study of 3000 English children (Melhuish, 2001; Sammons et al., 2003) in which
types of child care were largely kept distinct and showed significant differences. For
example, child care in the first two years by a relative was associated with less antiso-
cial behaviour at three and five years, in contrast with very high levels of child care by
child-minders, or moderately high levels of care in nurseries or centres, which were
associated with more antisocial behaviour. Very similar results were also found in the
Effective Provision of Preschool Education Northern Ireland (EPPNI) study of 850
children in Northern Ireland (Melhuish et al., 2002). In the Families, Children and
Child Care study (Barnes et al., 2006; Leach et al., 2006), parental ideals, experiences
and levels of satisfaction were analysed separately for father care, grandparent/ rela-
tive care, nanny care, child-minder care and nursery/centre care. It is the observed
differences in the relative qualities of these care types at each of two age points that
are the subject of the present paper.
Quality and costs of care
Cost to the consumer is often assumed to be the most important determinant of the
type of care parents select, and the relative ‘affordability’ of one type of child care
compared with others is frequently mentioned by researchers, policy-makers and
parents. However, in their review of research into child care choices, Pungello and
Kurtz-Costes (1999) showed that relatively low price is only one of several extrinsic
characteristics of which parents take account—location, hours and reliability often
being equally important. Nevertheless, if cost is not the principal criterion for many
parents, it remains a significant factor as data from a recent qualitative study in
England show (Leach et al., 2006). Unfortunately the literature contains little
detailed information on the relative costs to parents of different types of child care
because it is both difficult to obtain and easily outdated by changes in the balance
between public and private provision and by subsidies and tax breaks. Even large-
scale research studies, such as the NICHD (2005, pp. 122–126) study, often eschew
price comparisons so most of the data available on the affordability of child care are
based on differences in parental (or maternal or familial) income rather than differ-
ences in outgoings by type of child care.
Cost matters, but its importance is not straightforward. Recent studies from the
USA and from Europe have put it into a wide context, exploring the complex rela-
tionships in women’s child care choices between external circumstances, including
different economic opportunities and labour market conditions, and personal atti-
tudes (Fagan, 2000; Pungello & Kurtz-Costes, 2000; Hakim, 2001), while a study
from the United Kingdom analysed the ‘choices’ recent government policies have
made available to mothers; the relationships in their child care decision-making
between external constraints and existing attitudes and preferences, and the policy
implications (Himmelweit & Sigala, 2003).
6 P. Leach et al.
Qualities looked for by mothers
While much of the literature suggests that extrinsic factors such as cost, geographical
locality and easy access dominate families’ choices of child care (Peyton et al., 2001;
Mortimer et al., 2003), there is also evidence that many mothers seeking child care
look for personal rather than practical or professional attributes. In a large study in
the USA, for example (Kontos et al., 1995), most mothers gave some attribute of the
caregiver as their first reason for choosing their care arrangement. In an English study
of 1200 families (Barnes et al., 2006), mothers who needed non-maternal infant care
often preferred it to be familial, many regarding care by a grandparent as ideal.
Throughout the first year mothers were more satisfied with the care given by individ-
uals—relatives, child-minders, nannies—than by more than one caregiver, in larger
groups such as nurseries. Not all parents have clear views about what they should look
for when choosing child care, however (Van Horn et al., 2001). Some cannot think
what qualities to list as desirable in a child care arrangement, while others list factors
that do not reliably match those that professionals use as indices of quality. Further-
more, despite its use in many studies as a paradigm for child care quality, parental
satisfaction with care is not an index of its actual quality. Parental reports of high
levels of satisfaction are normative even though their care arrangements vary widely
(Bogat & Gensheimer, 1986; Rassin et al., 1991). Parental satisfaction with care is
likely to be especially high when parent involvement is encouraged and the care
provider listens to the parent (Britner & Phillips, 1995; Barnes, et al., 2006). In the
USA it has been found that parents generally rate their children’s care more highly
than independent observers do (Cryer & Burchinal, 1997). It may be that parents’
ratings reflect their own positive relationship with the caregiver, or their hopes for
their children’s care, rather than a reality that may be difficult for them to observe or,
perhaps, to tolerate. As Munton et al. (1995) suggested, it should be possible to have
a universal framework within which different views can be compared. In the
meantime, parents’ reasons for choosing child care arrangements are important in
themselves. Peyton et al. (2001) found that parents who reported basing their child
care choice on quality indicators actually placed their children in higher-quality care
settings than parents who used practical criteria for care selection. The relationship
between the observed quality of different types of child care and the qualities looked
for by mothers is explored in the present study.
Measuring child care quality
Choice of methods and measures of child care quality, reviewed by Barnes (2001),
must take account of three main parameters. Firstly, the purposes inherent in differ-
ent observational measures of quality can be grouped broadly into two contrasting
approaches. One type of measure, principally from the USA, has been academic and
research oriented, developing methods that can be used to test ideas about the
relevance of quality for child outcomes. The second type of measure is designed to
meet the need to measure quality for licensing, regulation and, where necessary,
Differences in child care quality 7
improvement of child care offered to the general public. Both types of measure may
be needed, as in the present study (Cryer & Phillipsen, 1997).
Secondly, a choice must be made or, as here, a balance struck between recording
structure—perhaps from administrative records or interviews with child care staff—
and observing process in child care settings. The latter is more accurate and predic-
tive but also more demanding of research resources. Thirdly, a major methodological
concern, especially when observing child care in group settings, is how to reflect the
quality of each individual carer, the quality of each child’s experience with each of
several carers, and also arrive at a final estimate of the overall quality that represents
the centre or care home rather than one person’s experience. In the present study
several complementary assessments were used, but not entirely successfully.
Aims and hypotheses
The main aim of this paper is to compare the quality of child care offered to infants
and toddlers in different types of setting in England, and to identify which (if any)
structural factors are associated with higher-quality child care. In addition, the study
seeks to determine the nature of any relationships between the qualities mothers iden-
tify as important and the quality observed, the observed behaviour of mothers and
that of their caregivers, and their satisfaction with the child care they are using, and
its quality.
The research hypotheses are:
1. Observed quality of care will be higher in domestic settings with one caregiver
than in group settings with several caregivers.
2. Considering separately two dimensions of quality, those aspects of quality related
to cognitive stimulation will be higher in group care while those aspects of quality
reflecting sensitivity will be higher in single caregiver settings.
3. Structural and regulatable features of child care (e.g. cost, child/adult ratios) will
be associated with observed quality.
4. The qualities (characteristics) of child care preferred by mothers will not be asso-
ciated with the observed quality of their children’s care.
5. The observed quality of maternal behaviour will be associated with the observed
quality of their child’s care.
6. Mothers’ satisfaction with child care will be associated with its quality.
Methods
Procedures
Interviews with mothers. Face-to-face home interviews with mothers were conducted
when their infants were 3, 10 and 18 months old. Demographic information was
collected at the first interview. At each time point, mothers were asked about their
current type and amount of child care and its cost. At the 10 and 18 month
interviews, they were also asked in retrospect about the type and amount of any child
8 P. Leach et al.
care used between ages 4 and 9 months and between 11 and 17 months, respectively.
These responses were used to determine the dominant form of child care at each age
point; this was the child care setting observed if more than one type of care had been
used,
Observations of quality of child care. During the home interviews at 10 and 18
months, observations to determine the quality of maternal behaviour were also
conducted. Observations to determine the quality of children’s non-maternal care
were carried out in the child care settings at both the 10 and 18 month time
points, excluding those children cared for primarily by their fathers, the subject of
a separate study, and a small number of families using a friend to provide child
care.
Participants
At 10 months, 424 child carers were approached of whom 307 were observed (see
Table 1), comprising 84 grandparents, 33 nannies, 85 child-minders and 102 nurs-
eries. At 18 months, 422 child carers were approached—of whom 331 were observed
(see Table 1), comprising 81 grandparents, 38 nannies, 83 child-minders and 129
nurseries. A further 25 children in the FCCC sample whose dominant form of child
care was described as ‘friend’ were excluded from the study as this category of care
could not be defined so as to be compared with the others. Those observed were
compared with the total group (child sex, demographic characteristics, maternal age,
area deprivation) and they were comparable, except that those observed contained a
smaller proportion of non-white children, and the mothers of those observed had a
significantly higher average occupational status (see Table 1). The characteristics of
families using the four types of child care in question also differed in some ways both
at 10 months and at 18 months (see Tables 2 and 3). Those using grandparent care
at both age points were on average younger, with fewer educational qualifications,
lower social class and living in poorer neighbourhoods. In addition, fewer of those
using a grandparent for child care at 10 months were living with a partner. Those
using nannies at both 10 and 18 months had more children and were better off
financially (see Tables 2 and 3).
Measures
Family background. At both time points, mothers reported on background character-
istics of their children (age, gender, ethnic group), themselves (age, education, occu-
pation) and the family (living with partner, family income, adversity of living
conditions). Maternal educational qualifications were scaled on a six-point scale from
1 = vocational qualifications at 16 or below, to 6 = higher degree or above. Maternal
occupational status was defined according to the Computer Assisted Standard
Occupational Coding (Elias et al., 1993), using the three-group ordinal categorisation
Differences in child care quality 9
Table 1. Characteristics of participants in relation to the total number using child care at 10 and 18 months (standard deviations in brackets)
Total at 10
months (n = 424)
Participants 10
months (n = 307)
Significant
differences
Total at 18
months (n = 422)
Participants 18
months (n = 331)
Significant
differences
Child sex, female 48.8 47.9 50.9 52.0
Ethnic minority 21.0 13.7 χ
2
= 6.47 ** 21.1 14.8 χ
2
= 4.90*
Living with partner 92.0 93.5 90.5 91.8
Number of children in family 1.5 (0.7) 1.4 (0.7) 1.5 (0.7) 1.5 (0.7)
Maternal age 32.0 (4.9) 32.3 (4.7) 32.0 (4.8) 32.4 (4.5)
Mother’s education 4.6 (1.2) 4.7 (1.2) 4.6 (1.2) 4.8 (1.2)
Mother’s social class 2.5 (0.7) 2.6 (0.7) F = 2.49 *** 2.5 (0.8) 2.6 (0.7) F = 9.69 **
Family income 30,550 (15,964) 32,120 (13,200) 30,917 (16,670) 32,494 (16,983)
Environmental adversity 0.5 (0.8) 0.4 (0.8) F = 3.71 (*) 0.5 (1.0) 0.5 (0.9)
Area Child Poverty Index 27.5 (15.8) 26.0 (15.3) 27.8 (16.2) 26.6 (16.1)
10 P. Leach et al.
Table 2. Characteristics of participants in relation to the type of child care being used at 10 months
Total
(n = 307)
Grandparent
(n = 84)
Nanny
(n = 34)
Childminder
(n = 86)
Nursery
(n = 103) Significant effect of type of care
Child sex (female) 47.9 44.0 38.2 52.3 50.5 χ
2
= 2.72 n.s.
Ethnic minority 13.7 16.7 5.9 9.3 17.5 χ
2
= 5.04 n.s.
Living with partner 93.5 84.5 97.1 96.5 97.1 χ
2
= 15.28 **
Number of children in family 1.4 1.4 1.9 1.4 1.3 F = 6.69***, Na> G, C, Nu
Maternal age 32.3 29.4 33.8 33.2 33.5 F = 18.95***, Na, C, Nu>G
Mother’s education 4.7 4.0 5.2 4.8 5.1 F = 18.94***, Na, C, Nu>G
Mother’s social class 2.6 2.2 2.8 2.7 2.9 F = 22.29***, Na, C, Nu>G
Family income 32,120 23,000 47,049 29,556 36,772 F = 25.98***, Na, C, Nu>G,
Na> C, Nu, Nu>C
Environmental adversity 0.4 0.6 0.4 0.3 0.4 F = 1.26
Area Child Poverty Index 26.0 31.9 22.0 23.2 24.7 F = 6.35**, G > Na, C, Nu
Note: n.s., not significant; **, ; ***, ; Na = Nanny; G = Grandparent; C = Childminder; Nu = Nursery.
Differences in child care quality 11
Table 3. Characteristics of participants in relation to the type of child care being used at 18 months
Total
(n = 331)
Grandparent
(n = 81)
Nanny
(n = 38)
Childminder
(n = 83)
Nursery
(n = 129) Significant effect of type of care
Child sex (female) 52.0 50.6 55.3 48.2 54.3 χ
2
= 0.97 n.s.
Ethnic minority 14.8 21.0 10.5 8.4 16.3 χ
2
= 5.90*
Living with partner 91.8 90.1 92.1 94.0 91.5 χ
2
= 0.85 n.s.
Number of children in family 1.5 1.5 1.8 1.3 1.4 F = 5.49***, Na> G, C, Nu
Maternal age 32.4 30.0 34.1 32.6 33.1 F = 11.54***, Na, C, Nu>G
Mother’s education 4.8 4.0 5.4 4.9 5.0 F = 17.25***, Na, C, Nu>G
Mother’s social class 2.6 2.2 2.9 2.7 2.7 F = 12.26***, Na, C, Nu>G
Family income 32,494 25,530 44,459 31,656 33,881 F = 12.33***, Na> G, C, Nu, Nu>G
Environmental adversity 0.5 0.6 0.4 0.4 0.4 F = 0.85
Area Child Poverty Index 26.6 31.8 25.8 24.0 25.1 F = 4.08**, G>C, Nu
Note: n.s., not significant; *, ; **, ; ***, Na = Nanny; G = Grandparent; C = Childminder; Nu = Nursery.
12 P. Leach et al.
(1 = working class occupations, e.g. factory work or low-level job in service industries;
2 = intermediate occupations, e.g. secretary, data entry; and 3 = managerial and
professional, e.g. the professions, senior management jobs). The Child Poverty Index
from the Indices of Multiple Deprivation 2000 (Noble et al., 2000) was used as a
measure of area level deprivation. The Child Poverty Index is an aggregate measure
of the proportion of families with children 0–16 years old within an electoral ward
who receive means-tested benefits (income support, job seekers allowance, family
credit and disability working allowance), a higher value indicating more deprivation.
Two subscales from the HOME inventory (Bradley et al., 1989 )—Emotional and
Verbal Responsivity, and Avoidance of restriction and Punishment were also
completed during maternal interviews, at both time points.
Types of child care. Four types of non-parental child care are compared in this study:
care by a grandparent or other relative; care by a nanny in the child’s home; care by
a child-minder in her home; and group care in a nursery or centre. The dominant
(observed) form of non-maternal care at 10 months and at 18 months was decided
according to the following formula: if the child had only one type of care for 12 weekly
hours or more, this was the dominant form. If the child had two or more types of care
that together totalled 12 weekly hours or more, the one with the most hours was the
dominant form. If a child had an equal number of weekly hours in two or more types
of care, the type that was most different from maternal care was selected for observa-
tion (e.g. child-minder would be chosen over a grandparent as non-familial, and over
a nanny as taking place outside the child’s home; nursery care would be chosen over
all other types as it was non-familial, outside the home and using multiple carers in a
group setting).
Measures of quality and structure of child care
1. The Caregiver Interaction Scale (CIS) (Arnett, 1989) was completed across all
non-maternal child care settings. Three of the original four subscales were used,
excluding ‘Permissiveness’, with some reductions in items that were not appro-
priate for children of this age (details available on request). All items are rated on
four-point scales by the observers asking themselves ‘to what extent are each of
the following statements characteristic of this caregiver?’ (1 = not at all; 4 = very
much). ‘Positive Relationship’ (eight items) concerns the warmth, level of enthu-
siasm and developmental appropriateness of the caregiver’s interaction with chil-
dren (e.g. ‘Speaks warmly to babies and toddlers’). ‘Punitiveness’ (six items)
refers to hostile, threatening, and harshly critical behaviour toward children, (e.g.
‘Seems critical of babies and toddlers’). ‘Detachment’ (four items) indicates the
extent to which the caregiver was uninvolved with and uninterested in the chil-
dren (e.g. Seems distant or detached from the babies and toddlers’). Inter-rater
agreement was assessed as the agreement between a golden standard and four
raters of 20 child observations. The weighted mean kappa coefficient for each
rater with the gold standard rater ranged from 0.68 to 0.74.
Differences in child care quality 13
2. The Observational Record of the Caregiving Environment (ORCE) was
developed by the NICHD (1996) as a measure of quality of care that focuses on
a particular child’s experiences rather than on what happens in the group as a
whole. The scale assesses the nuances of the caregiver’s behaviour in relation to
the child. The FCCC shortened version (details available on request) includes
eight caregiver domains with items rated from 1 (not at all characteristic) to 4
(very characteristic). The separate scales are: sensitivity/responsiveness to
distress; sensitivity/responsiveness to non-distress; intrusiveness; detachment/
disengagement; stimulation of development; positive regard for child; negative
regard for child; and flatness of affect. These can be added together to obtain a
total item score (see NICHD, 1996; Clarke-Stewart, 1999). The inter-rater
agreement for the ORCE ranged from 0.62 to 0.74.
3. The infant (0–3) version of The Home Observation Measurement of the Envi-
ronment (HOME) (Bradley et al., 1989) was used to rate non-maternal caregiv-
ers. The HOME measures the extent to which the home environment supports
child development. All observation items are dichotomous (0 = no, 1 = yes). One
subscale out of the original six, Emotional and Verbal Responsiveness (11 items,
e.g. ‘spontaneously praises child at least twice’) was used at 10 months to assess
maternal and other caregiver sensitivity; although it was not designed for use in
nursery settings this scale was used as part of the interview with nursery carers so
that there would be a measure of sensitivity comparable across all settings. In
settings other than nurseries the ‘avoidance of restriction and punishment’
subscale (seven items) was also used. At 18 months the Responsiveness and
Avoidance of Restriction scale was included. The mean inter-rater agreement
between four independent raters and a gold-standard rater were kappa values
between 0.77 and 0.90.
4. Two additional measures of quality designed specifically for formal child care
settings were used: The Family Day Care Rating Scale (FDCRS) (Harms & Clif-
ford, 1984) for home-based child care (Child-minders) and the Infant and
Toddler Environment Rating Scale (ITERS) (Harms et al., 1990) for group care
in nurseries. In order to produce a measure that was comparable across these two
settings, items were compared and a common set of eight items constructed from
the Space and Furnishings subscale (four items), the Learning subscale (two
items) and the Language subscale (two items). This short-form combined scale
had internal consistency of alpha = 0.75 at 10 months and alpha = 0.61 at 18
months. The total measure was also completed in each setting so that a total
mean item score could be derived.
5. A reduced version of the Safety scale from the assessment profile for homes with
young children, research version (Abbott-Shim & Sibley, 1993), was used to
determine the level of safety in home settings. The original scale has 11 items
scored yes (1) or no (0) covering the safety of indoor physical space, but those
that could not be determined without questioning or more intrusive examination
(e.g. tap water 120°F or less, cleaning agents out of child’s reach) were excluded
and seven items were retained (e.g. heaters and fans are protected from child’s
14 P. Leach et al.
reach or not present). An equivalent list of items was used from the assessment
profile for early childhood programmes (Abbott-Shim & Sibley, 1987) so that
safety scores could be compared across all settings.
6. In nurseries, a record of the numbers of children and adults who were in the room
was made approximately every 10 minutes. At 10 months the average number of
observations was 10.4 (n = 95) and at 18 months was 11.2 (n = 123). These
observations were combined so that an average child:staff ratio could be
calculated for the relevant room in each nursery.
7. Interviews were conducted with nursery managers at 18 months to enquire about
the ages, qualifications and experience of their staff and data about staff qualifi-
cations, experience and age were aggregated at the nursery level.
8. Grandparents, nannies and child-minders were asked whether they took the child
on a list of seven possible types of outing (e.g. to a library, park or swimming
pool), and the sum of these dichotomous items (0 = no, 1 = yes) were added to
make a total score.
Maternal perceptions of child care. At 10 months, mothers using child care were asked
to indicate which three characteristics of child care out of a list of nine were the most
important to them when selecting child care: provide professional child care, provide
substitute for mother care, teach babies new things, provide adequate outdoor space
and toys, provide a safe physical environment, provide dependable care, provide
adequate indoor space and toys, provide a loving and understanding environment,
and provide worry-free child care.
At 10 and 18 months, mothers using non-parental care were asked to complete the
Parental Satisfaction with Child Care Scale (Harrell & Ridley, 1975), indicating their
level of satisfaction with 11 different aspects of their current child care—convenience,
dependability, price, competence of staff/caregivers, teaching new things, appropriate
discipline, providing love and understanding, nutritious food, worry-free child care,
baby’s satisfaction with care, and overall quality—on a five-point scale (1 = extremely
dissatisfied, 5 = extremely satisfied). Total satisfaction was the average of the
11 responses; alpha = 0.87) (Barnes et al., 2006). This measure was introduced after
the study started, and in consequence the sample size (n = 245, 247) is smaller than
those for the demographic and quality indicators.
Analysis
Analysis of variance tests were used to compare mean values of each aspect of quality
in the four types of child care with post hoc Sheffe tests. The frequency with which
mothers deemed each of the nine characteristics of child care important was calcu-
lated. Chi-square tests were used to determine whether or not each was chosen by a
similar proportion of mothers using the four types of non-maternal child care:
grandparent/relative, child-minder, nanny and nursery. Pearson correlations were
calculated to determine the relationship between structural and regulatable indicators
Differences in child care quality 15
of child care; the mother’s own behaviour and the observed quality of non-maternal
child care were calculated. Spearman’s rank-order correlation coefficients were calcu-
lated between each item ranked as one of the top three characteristics considered
important by mothers and the measures of observed quality. Pearson correlation coef-
ficients were calculated between maternal satisfaction with child care and observed
quality.
Results
Comparison of observed quality
When the children were 10 months old, the care observed in nursery settings was
significantly poorer than the observed care given by grandparents, nannies or child-
minders in all domains apart from punitive behaviour (see Table 4). Results from the
Caregiver Interaction Scales showed there was less positive behaviour and more
detachment by adults in nurseries, while results from the HOME indicated less
emotional responsiveness. Similarly, the ORCE total score indicated a lower overall
quality of carer–child interactions (see Table 4). The only significant differences
between the three types of home-based care was that grandparents had a lower level
of positive relationship compared with nannies and child-minders. The Profile safety
and health scale indicated higher levels of safety in child-minders’ homes than in
grandparents’ homes or nurseries. Comparing only the two ‘formal’ types of child
care, the quality of space and furnishings was better in nurseries while the level of
interaction and activity related to the development of language and reasoning was
higher for the child-minders (see Table 4). The overall total quality as indicated by
the common ITERS/FRCRS did not reveal a significant difference between these two
types of care. Comparing only the home-based care settings, the range of activities
offered was greatest by nannies, and least by grandparents.
At 18 months the picture was slightly more mixed (see Table 5). The highest level
of positive relationships (CIS) was seen when children were with nannies, higher than
between children and nursery staff and between children and grandparents. Positive
relationships with child-minders did not differ significantly from any of the other
types of care. As at 10 months, nursery staff were more detached than grandparents
and nannies, but again child-minders did not differ significantly from nursery staff or
from the other home-based carers. The overall level of interactional quality (ORCE)
was lower in nurseries than all the other types of care, and nursery staff were also
judged to be lower than other types in their emotional responsivity as measured by
the HOME. Punitiveness was, on average, lower among child-minders than grand-
parents, but mean levels in the other types of setting tended to vary more and neither
nannies nor nursery staff differed significantly from other types of carer (see Table 5).
Comparing only child-minders and nurseries, there were more learning activities in
the nurseries (see Table 5); however, the quality of the space and furnishings, and
language and reasoning activities, were now similar and the total ITERS/FDCCRS
score still did not differentiate between the types of setting. Comparing only the
16 P. Leach et al.
Table 4. Comparison of observed quality in four types of child care at 10 months (standard deviations in brackets)
Quality measure
Grandparent
(n = 84)
Nanny
(n = 34)
Childminder
(n = 86)
Nursery
(n = 103)
F and significant post hoc
comparisons
CIS Positive relationship (1–4) 3.41 (0.41) 3.61 (0.45) 3.58 (0.40) 3.33 (0.50) 6.64 ***, Na, C>Nu
CIS Punitiveness (1–4) 1.31 (0.31) 1.26 (0.45) 1.26 (0.40) 1.20 (0.29) 1.54 n.s.
CIS Detachment (1–4) 1.32 (0.36) 1.31 (0.51) 1.45 (0.53) 1.71 (0.59) 11.43 ***, Nu >G, Na, C
ORCE total (1–4) 3.62 (0.25) 3.69 (0.32) 3.58 (0.29) 3.35 (0.31) 20.47 ***, G, Na, C>Nu
HOME Emotional responsiveness (0–11) 9.48 (0.98) 9.62 (0.70) 9.38 (1.05) 8.54 (1.53) 14.85***, G, Na, C>Nu
HOME Avoidance of restriction and
punishment (0–8)
5.45 (0.81) 5.62 (0.55) 5.67 (0.66) n/a 2.15 n.s.
Profile Safety and Health (0–7) 5.71 (1.26) 6.03 (1.32) 6.56 (1.52) 5.75 (1.21) 7.75***, C >G, Nu
Activities (0–7) 1.81 (1.28) 3.55 (1.50) 2.77 (1.65) n/a 18.67***, Na > G, C, C > G
ITERS/FDCRS common items t-test
Space and furnishing (1–7) n/a n/a 3.22 (0.96) 3.60 (1.10) 2.26*
Language and reasoning (1–7) n/a n/a 4.71 (1.35) 3.65 (1.47) 4.68 ***
Learning activities (1–7) n/a n/a 3.66 (0.97) 3.73 (1.11) 0.41 n.s.
Total ITERS/FDCRS (1–7) n/a n/a 3.67 (0.92) 3.65 (1.01) 0.12 n.s.
Total ITERS or FDCRS (1–7) n/a n/a 3.63 (0.73) 3.57 (0.87)
Note: n/a, not available; n.s., not significant; *, ; ***, ; Na = Nanny; G = Grandparent; C = Childminder; Nu = Nursery.
Differences in child care quality 17
Table 5. Comparison of observed quality in four types of child care at 18 months (standard deviations in brackets)
Quality measure
Grandparent
(n = 81)
Nanny
(n = 38)
Childminder
(n = 83)
Nursery
(n = 129)
F and significant post hoc
comparisons
CIS Positive relationship (1–4) 3.38 (0.46) 3.70 (0.31) 3.49 (0.41) 3.34 (0.43) 7.91***, Na > G, Nu
CIS Punitiveness (1–4) 1.35 (0.36) 1.18 (0.40) 1.18 (0.23) 1.32 (0.40) 4.99**, G>C
CIS Detachment (1–4) 1.36 (0.38) 1.32 (0.49) 1.49 (0.40) 1.57 (0.46) 5.56**, Nu >G, Na
ORCE total (1–4) 3.59 (0.29) 3.73 (0.24) 3.59 (0.27) 3.39 (0.37) 15.74***, G, Na, C>Nu
HOME Emotional
responsiveness (0–11)
9.41 (0.98) 9.61 (0.75) 9.35 (0.88) 8.63 (1.53) 12.15***, G, Na, C>Nu
Profile Safety and Health (0–7) 3.84 (0.84) 4.00 (0.90) 4.24 (0.89) 6.53 (0.84) 224.49***, N > G, Na, C, C > G
Total activities (0–7) 2.18 (1.24) 3.29 (1.16) 2.84 (1.48) n/a 10.24***, Na, C>G
ITERS/FDCRS common items T test
Space and furnishing (1–7) n/a n/a 3.30 (0.97) 3.43 (0.95) 0.92 n.s.
Language and reasoning (1–7) n/a n/a 5.11 (1.47) 4.92 (1.48) 0.91 n.s.
Learning activities (1–7) n/a n/a 3.50 (0.94) 3.89 (0.99) 2.83**
Total ITERS/FDCRS (1–7) n/a n/a 3.77 (0.85) 3.91 (0.81) 1.23 n.s.
Total ITERS or FDCRS (1–7) n/a n/a 3.72 (0.76) 3.88 (0.75)
Note: n/a, not available; n.s., not significant; **, ; ***, Na = Nanny; G = Grandparent; C = Childminder; Nu = Nursery; CIS = Caregiver Interaction Scale; ORCE
= The Observational Record of the Caregiving Environment; HOME = Home Observation Measurement of the Environment; FDCRS = The Family Day Care
Rating Scale; ITERS = Infant and Toddler Environment Rating Scale; Profile Safety and Health = Assessment Profile for homes with young children; Assessment
Profile for early childhood programmes.
18 P. Leach et al.
home-based care types, a smaller range of activities was still offered by grandparents
than by nannies or child-minders (see Table 5).
Associations between structural features and quality of care
At 10 months the cost of child care was largely unrelated to the quality observed,
taking all types of care together, and only one association was significant when each
type was considered separately. That one significant association was between higher
costs in nursery settings and less emotional responsivity (HOME) (see Table 6). At
18 months, higher cost in the total sample was associated with less punitive behaviour
(CIS) and more safety overall (see Table 6). Taking each child care type separately,
there was a marginal association for nannies between higher cost and more positive
interactions (CIS). For child-minders, higher cost was associated with marginally
more positive interactions, less punitive behaviour (CIS) and better overall interac-
tions (ORCE).
The average child:adult ratio was clearly associated with nursery staff behaviour
(see Table 6). When there were more children to each adult, staff were less positive,
more punitive and more detached at both 10 and at 18 months, as indicated by the
CIS. In addition, at 18 months the quality of the overall interactions (ORCE) was
lower when there were more children to each adult, and carers were less emotionally
responsive (HOME).
Few significant associations emerge between the ages, qualifications and experi-
ence of nursery staff and aspects of the care they offer; however, those few significant
ones are all in the expected direction. Nurseries with older staff scored significantly
lower on detachment (0.27, p < 0.05) and higher on the quality of their overall inter-
actions with children (0.38, p < 0.01). Mothers who scored more highly on avoidance
of punishment were significantly more likely to use nurseries with better qualified
(0.27, p < 0.05) and more experienced (0.26, p < 0.05) staff.
Qualities important to mothers, type of care used and relationship to quality
In Table 7 the three qualities of child care judged most desirable by all the mothers
are presented in rank-order. The most frequently selected quality was ‘providing a
loving and caring environment’ (80.9%), followed by ‘providing a safe physical
environment’ (67.8%) and ‘providing worry free child care’ (48.4%). Some of the
characteristics mothers considered most desirable varied according to the type of care
used. Mothers using grandparents or other relatives as caregivers tended more often
to say that ‘providing a safe physical environment’ was an important quality of child
care (p < 0.10). Fewer mothers using other types of care, in particular fewer using
nannies (51.5%), thought this an important quality. More mothers using child-
minders or nannies as caregivers thought serving as a ‘substitute for the mother’ was
an important quality, compared with those using other types or the total group (p <
0.05; see Table 7) while these mothers were the least likely to say that ‘teaching the
baby new things’ was an important feature of child care (p < 0.10).
Differences in child care quality 19
Table 6. Associations (Pearson correlation coefficients) between cost of child care, child to adult ratio (nurseries only) and observed quality of
care, at 10 months and at 18 months
10 months 18 months
CIS positive
relationship
CIS
punitive
CIS
detachment ORCE
HOME
responsivity
Safety
and
health
CIS positive
relationship CIS
punitive
CIS
detachment ORCE
HOME
responsivity
Safety and
health
Cost of care
Total group
(n = 256, 307)
0.04 0.11 0.02 0.08 0.03 0.03 0.10 0.13* 0.01 0.04 0.03 0.25***
Grandparent
(n = 27, 71)
0.13 –0.29 0.21 0.04 0.11 0.05 0.05 0.04 0.09 0.05 0.01 0.10
Nanny
(n = 32,36)
0.03 0.21 0.01 0.01 0.06 0.24 0.28(*) 0.27 0.26 0.26 0.17 0.22
Childminder
(n = 83, 79)
0.06 0.13 0.06 .07 0.08 0.25* 0.20(*) 0.27* 0.04 0.27** 0.12 0.07
Nursery
(n = 102, 121)
0.04 .06 0.10 0.10 0.21* 0.09 0.04 0.02 0.07 0.03 0.05 0.08
Child:adult
ratio
Nursery
(n = 95, 122)
0.21* 0.20* 0.21* 0.17 0.03 0.02 0.28** 0.22* 0.23** 0.22* 0.27** 0.03
Note: n.s., not significant; *, ; **, ; ***, ; Na = Nanny; G = Grandparent; C = Childminder; Nu = Nursery; CIS = Caregiver Interaction Scale; ORCE = The Observational
Record of the Caregiving Environment; HOME = Home Observation Measurement of the Environment; FDCRS = The Family Day Care Rating Scale; ITERS = Infant and
Toddler Environment Rating Scale; Profile Safety and Health = Assessment Profile for homes with young children; Assessment Profile for early childhood programmes.
20 P. Leach et al.
Table 7. Numbers of mothers selecting each child care quality as one of their top three qualities looked for by the type of child care used at 10
months (percentages in brackets)
Looked for quality
Total
(n = 304)
Grandparent
(n = 84)
Nanny
(n = 33)
Childminder
(n = 85)
Nursery
(n = 102) χ
2
Provide a loving and understanding
environment
246 (80.9) 68 (81.0) 31 (93.9) 67 (78.8) 80 (78.4) n.s.
Provide a safe physical environment 206 (67.8) 63 (75.0) 17 (51.5) 56 (65.9) 70 (68.6) 6.18, p < 0.10
Provide worry-free child care 147 (48.4) 40 (47.6) 18 (54.5) 43 (50.6) 46 (45.1) n.s.
Provide dependable care 95 (31.3) 21 (25.0) 14 (42.4) 27 (31.8) 33 (32.4) n.s.
Provide professional child care 71 (23.4) 15 (17.9) 7 (21.2) 18 (21.2) 31 (30.4) n.s.
Teach babies new things 58 (19.1) 22 (26.2) 5 (15.2) 10 (11.8) 21 (20.6) 6.18, p < 0.10
Provide substitute for mother care 51 (16.8) 11 (13.1) 7 (21.2) 22 (25.9) 11 (10.8) 8.95, p < 0.05
Provide adequate indoor space and toys 28 (9.2) 9 (10.7) 0 9 (10.6) 10 (9.8) n.s.
Provide adequate outdoor space and toys 8 (2.6) 3 (3.6) 0 3 (3.5) 2 (2.0) n.s.
Note: n.s., not significant.
Differences in child care quality 21
Taking all those using child care together (n = 304), there were few significant
relationships between the characteristics perceived as important and observed
quality.
Maternal behaviour and observed child care quality
At 10 months there were few (7 out of 48) significant associations between behav-
iours observed in mothers and that observed in their child’s carer. When mothers
were observed to be more emotionally and verbally responsive (HOME), grand-
parents were also observed to be higher on this scale (r = 0.33, p < 0.01), and
nursery care was likely to be marginally safer (r = 0.21, p < 0.05). When mothers
were more likely to avoid punitive and restrictive behaviour (HOME), grandpar-
ents and nannies were rated as less punitive (CIS, grandparents r = 0.29, nannies
r = 0.60, p < 0.001), the overall quality of interactions with grandparents was
higher (ORCE, r = 0.23, p < 0.05), nannies were less detached (CIS, r = 0.33, p
< 0.05) and the environment (the child’s own home) was likely to be safer (r =
0.41, p < 0.05).
At 18 months there were more significant associations (10 out of 48), although
again these were mainly with care by grandparents or nannies. When mothers were
observed as more responsive (HOME), grandparents were likely to have more
positive interactions (r = 0.29, p < 0.01), less detachment (CIS, r = 0.34, p < 0.01)
and better interactions overall (ORCE, r = 0.27, p < 0.05). Nannies were also higher
on this scale (r = 0.33, p < 0.05). When mothers were more responsive, child-minders
were likely to be less detached (CIS, r = 0.25, p < 0.05).
Mothers more likely to avoid restriction and punishment had nannies who were less
punitive (CIS, r = 0.47, p < 0.01) and more positive (CIS, r = 0.33, p < 0.05) with
better interactions (ORCE, r = 0.39, p < 0.05). Avoidance of restriction by mothers
was also associated in nurseries at 18 months with better interactions measured by the
ORCE (r = 0.26, p < 0.01), and marginally more positive interactions (CIS, r = 0.20,
p < 0.05).
Associations between maternal satisfaction and the quality of care
At both 10 and 18 months, mothers reported satisfaction with their child care was
significantly associated with less observed detachment and better quality interactions
as indicated by the ORCE, and with more responsivity as indicated by the HOME
(see Table 8). However, these associations based on the total sample mask interest-
ing differences between the child care types. Satisfaction was most closely associated
with observed quality for grandparent care at both 10 and 18 months, and with
observed quality of child-minders at 18 months. Maternal satisfaction was less
strongly associated with quality of care by nannies, although associations are in the
same direction as for grandparents and child-minders and the group sizes are small.
However, maternal satisfaction is entirely unrelated to observed quality in nursery
settings.
22 P. Leach et al.
Table 8. Associations (Pearson correlation coefficients) between maternal satisfaction with child care and its observed quality
at 10 and 18 months
10 months 18 months
CIS positive
relationship
CIS
punitive
CIS
detachment ORCE
HOME
responsivity
Safety and
health
CIS positive
relationship
CIS
punitive
CIS
detachment ORCE
HOME
responsivity
Safety and
health
Total group (n = 245, 247) 0.13* 0.03 0.20** 0.29*** 0.27*** 0.01 0.12* 0.03 0.25*** 0.23*** 0.21*** 0.27***
Grandparent (n = 73, 67) 0.36** 0.05 0.27* 0.43*** 0.29** 0.17 0.26* 0.04 0.34** 0.25* 0.19 0.24*
Nanny (n = 27, 27) 0.15 0.12 0.21 0.18 0.15 0.03 0.08 0.07 0.27 0.29 0.22 0.02
Childminder (n = 63, 58) 0.05 0.16 0.21(*) 0.07 0.09 0.08 0.32** 0.02 0.27* 0.26* 0.32** 0.19
Nursery (n = 82, 95) 0.02 0.22* 0.07 0.02 0.14 0.08 0.02 0.08 0.06 0.02 0.00 0.06
Note: *, ; **, ; ***, CIS = Caregiver Interaction Scale; ORCE = The Observational Record of the Caregiving Environment; HOME = Home Observation Measurement of the Environment; FDCRS =
The Family Day Care Rating Scale; ITERS = Infant and Toddler Environment Rating Scale; Profile Safety and Health = Assessment Profile for homes with young children; Assessment Profile for early
childhood programmes.
Differences in child care quality 23
Discussion
Many previous large-scale studies of child care quality have concentrated on quality-
within-type, as the Cost Quality and Outcomes Study Team (1995) concentrated
exclusively on centre care. Where studies have considered quality across types, nota-
bly the NICHD study of early child care, they have usually collapsed care categories
for their final analyses so that conclusions about relative quality can only be drawn
for, say, centre care versus all other types. It was a main aim of this study to compare
the quality of child care offered to infants and toddlers in a range of different types of
non-parental arrangement and setting. A four-type classification, covering familial
home-based care (grandparent or other relative), non-familial home-based care
(nanny) in the child’s own home, non-familial home-based care in another home
(child-minder) and nursery/centre care, and the use of a battery of assessments of
quality, most of which are comparable across all settings, has produced some inter-
esting findings. These should be interpreted in the context of the different character-
istics of the users of each type of care; in particular, the relative scarcity of both human
and financial capital among those using grandparent care.
The first research hypothesis—that quality of care would be higher in domestic-
scale settings with one caregiver than in group settings with several caregivers—is
confirmed. Nursery care was rated as significantly lower than any of the other three
at both age points on all measures of the quality of interpersonal interactions except
for Punitiveness, which showed no significant discrimination among the four types at
10 months and only one at 18 months. Even comparable items from the home-based
and centre care measure of safety and health, which might have been expected to
favour the most highly regulated and inspected type of care, produced significantly
lower scores for nurseries at 10 months than for child-minders or grandparents. The
relatively low quality of care for very young children in nurseries is consistent with our
previously reported finding (Barnes et al., 2006) that mothers of 10-month-old
infants are less satisfied with nursery care than with any other type.
Comparisons were made between nurseries and the other type of ‘formal’ care,
child-minding (family day care) alone. Neither total scores for the separate ITERS
and FDCRS, nor a measure consisting of common items from them, discriminated
between the two types of care, but there were significant differences between some
individual scales. At 10 months the quality of the physical environment (space and
furnishings) was better in nurseries than in child-minders’ homes but the level of
stimulating adult–child activities, which could be related to the development of
language and reasoning, was lower in nurseries and higher in child-minders’ homes.
At 18 months, however, neither of these two measures discriminated between the two
settings but there were more activities that might promote cognitive development in
the nurseries. Our second hypothesis is therefore confirmed as far as it relates to
aspects of quality reflecting caregiver sensitivity being higher in single caregiver
settings, but only weakly confirmed as it relates to aspects of quality relating to cogni-
tive stimulation being higher in group care. In the light of earlier studies, including
English data (see Melhuish, 2004), nurseries might have been expected to score
24 P. Leach et al.
significantly more highly than child-minders (family day care settings) on activities
related to language and reasoning and to learning activities at both ages. Since nurs-
eries did provide significantly more learning activities at 18 months, although not
earlier, it may be that their predicted lead in the provision of all aspects of cognitive
stimulation is age dependent and will become apparent in the findings from follow-
up when these children are older.
Within the higher overall sensitivity of adults in single-caregiver settings there were
some interesting differences between the three types. Grandparents, often considered
by parents to be the ideal caregivers for such young children (Barnes et al., 2006),
were observed to have lower levels of positive relationships with children than nannies
and child-minders at both age points, and at 18 months they were more punitive, to
a small but significant extent, than child-minders. Furthermore, at 10 months their
homes were judged to be less safe than those of child-minders and at 18 months they
offered children a smaller range of outings and activities than either child-minders or
nannies. Mothers using grandparent care sometimes express concern about grand-
parents’ motivation and energy for daily child care (Leach et al., 2006); however, the
mothers who were using child care by grandparents were the least privileged in the
study. There are few, if any, non-narrative studies of nannies’ behaviour or quality of
care as this form of child care is often assumed to be confined to a very small minority
of atypically wealthy families, and therefore not part of mainstream child care.
However, daily, and sometimes shared, nanny care is increasingly used by highly paid
working mothers. Nannies fared relatively well in these quality assessments, having
high levels of positive relationships—higher than all other caregivers at 18 months—
and offering a significantly high level of activities to their charges at both 10 and 18
months.
The contribution made by information on structural and regulatable features of
child care to assessments of quality is still open to debate. Costs of care and the rela-
tive affordability of different types in different locations is an important factor in
parental choice of care (Leach et al., 2006), but its relationship to the quality of that
care is complex and less understood, partly because the cost data in the literature are
often indirect, recording the types of care used by higher-earning and lower-earning
parents, for example, rather than the actual costs of child care places. In this study
the actual monetary costs to the mother of the care used at each time point was estab-
lished, and shown to be largely unrelated to the observed quality of care, especially in
nurseries. Taking the group as a whole, mothers of 10-month-old babies who paid
more did not get higher-quality child care. Looking at each type of care in turn for
this age group, there are only two significant associations between price and quality.
The first is for child-minders and relates higher cost to higher scores on safety and
health. The second is for nurseries and suggests an unexpected relationship between
higher price paid by mothers and somewhat less responsive care received by their
infants. At 18 months for the group as a whole, higher cost goes with somewhat less
punitiveness and very significantly higher scores on safety and health. Taking each
type of care individually, however, there is no relationship between the cost of nurs-
eries and their quality, and only a marginal association between the cost of nannies
Differences in child care quality 25
and more positive relationships with their charges. For child-minders, however,
higher costs are clearly associated with measures of higher-quality relationships with
children, including less punitiveness. These findings may reflect practical realities of
English child care, in which the demand for privately provided nursery places still
outstrips demand, while child-minding seeks recognition as a professional alternative.
Structural features that have been most consistently found to be related to quality
are caregivers’ qualifications, their pay and the ratios of caregivers to children, rather
than those that are primarily organisational, such as group and room sizes and
outdoor play-space (see Scarr et al., 1994), and as predicted in our third hypothesis,
that is the case here. Observed child–carer ratios in the nurseries were significantly
related to most of the measures of observed quality of care at 10 months and almost
all at 18 months. The higher the number of 10-month-old infants sharing one carer,
the less positive and the more punitive and detached was her relationship with them.
In addition, at 18 months, when carers had more toddlers to care for, the quality of
their interaction with them was significantly lower and they were less emotionally
responsive to them. The only measure of observed quality in nurseries that was not
significantly related to the ratio of adults to children at 18 months was the safety and
health scale. The importance of this finding is that it relates to actual ratios rather
than those described in centre brochures or on official inspection forms. Group child
care settings are prone to high staff turn-over and staff absence, with low levels of
training, highly intensive work and poor remuneration. Clearly, close attention
should be paid not only to who should be caring for infants and toddlers, but to who
actually is from day to day.
It is suggested in the literature that parents may not know how to judge quality of
child care (Van Horn et al., 2001), are inclined to be more satisfied with their child
care than its observed quality merits (Cryer & Burchinal, 1997) and are particularly
likely to be highly satisfied when the carer relates well to themselves as well as to
their child (Barnes et al., 2006). However, it has also been shown that parents’
reasons for choosing particular child care arrangements are important in that choice
made according to quality criteria is related to higher quality care than choice made
according to structural or practical considerations (Peyton et al., 2001). While this
study collected no data concerning the reasoning behind actual choices of child care
made by mothers (but see Leach et al., 2006), it did collect an indication of the
characteristics of child care they considered most important. Asked to select their
top three of nine important characteristics of child care, less than 10% of mothers
put structural characteristics (e.g. more space and play equipment) in their top
three, although safety was considered important. Instead they focused on relational
characteristics such as the provision of love and understanding. The rank ordering
of these qualities varied surprisingly little according to the type of care used except
that mothers using grandparent care were more likely to include ‘providing a safe
physical environment’ in their top three, while mothers using child-minders or
nannies were most likely to rank ‘providing substitute for mother care’ and least
likely to rank ‘teach baby new things’. Possibly mothers paying individual caregivers
(who tended to be among the most highly educated) considered that the prime role
26 P. Leach et al.
of the caregiver was to compensate for their own absence during working hours and
that they (and their partners) could provide all the teaching that was required. We
predicted that the selection of qualities mothers considered important would not be
associated with the observed quality of care; however, a few significant associations
were identified. It would be interesting to extend the choice of items offered to
include structural qualities thought to be of importance, such as cost.
An assessment of the quality of mothers’ behaviour towards their infants was made
at 10 and 18 months. Quality of maternal care was expected to relate to the observed
quality of her child carer but this fifth hypothesis was not confirmed. At 10 months,
only seven—and at 18 months, only 10—out of a possible 48 associations between
mothers’ and carers’ behaviour were significant. It is interesting, however, that almost
all of these related to grandparent or nanny care. In particular, the behaviour of moth-
ers and grandparents was similar. If mothers were observed to be emotionally and
verbally responsive and to avoid restrictive and punitive behaviour, so did the grand-
parents (and nannies) who were caring for their children. It seems probable that these
were modes of interaction with children taught to, or modelled for, mothers by their
own mothers, and insisted upon with nannies. At 18 months responsive mothers also
had child-minders who were less detached, and avoidance of restriction and punish-
ment at home was associated with better and more positive interaction in nursery. It
is possible that a mother’s views about punishment may be more relevant when select-
ing child care than her own sensitivity and responsiveness.
Confirming our sixth hypothesis, and in contrast to the relative lack of relationship
between maternal behaviour and child care quality, the overall relationships between
mothers’ satisfaction with care and its quality were positive for four out of six associ-
ations at 10 months and for five out of six at 18 months. On first inspection these find-
ings suggest that whatever their reasons for choosing the care they used, mothers
recognised, and were significantly more satisfied with, higher-quality care at both age
points. Significances were especially high at 18 months between mothers’ satisfaction
and caregivers’ better-quality interactions, higher responsivity, lesser detachment and
higher safety and health scores. When each care type is taken separately, however,
some interesting differences emerge—notably the lack of any association between
maternal satisfaction and the observed quality of nursery care. In this study, at 10
months the ‘whole-group’ association between mothers’ satisfaction and care quality
is carried by the observed quality of grandparent care, and at 18 months it is carried
by the observed quality of child-minding, with the association with care by nannies
running in the same direction, although much less strongly. Association between
maternal satisfaction with care by nurseries and observed quality is non-existent.
As previously reported (Barnes et al., 2006), these mothers were significantly less
satisfied with nursery care of 10-month-old babies than individual care, both formal
and informal, with the highest satisfaction for grandparent care. So the fact that satis-
faction with, and quality of care by, nurseries are unrelated suggests that nurseries are
somehow outside the mothers’ range of judgement. This may be because mothers
have little opportunity to see what goes on inside nurseries, and only a brief drop-off
and collection period in which to form any view of the relationships between carers
Differences in child care quality 27
and their child. On the other hand, it may be that mothers are less inclined to look for
opportunities to judge nurseries than other forms of care because they see them as
scarce and desirable professional establishments where all the staff are trained and
high standards of care can be taken for granted, a view somewhat encouraged by UK
Government policy and investment (see Leach et al., 2006). Further research is
needed both to discover the reasons for the disassociation between maternal satisfac-
tion and quality of nursery care and to explore ways in which it could be reversed.
Future research will explore the relationship between quality observations and chil-
dren’s developmental outcomes. It will be important to build on the findings of this
study and compensate for some of its limitations. Firstly, although the overall study
sample for the Families, Children and Childcare study is large (1201 children), and
retention has been good (Malmberg et al., 2005), it is a fact of English life that many
infants and young toddlers do not receive any non-maternal care (see Sylva et al., in
press ). In consequence, the number of mothers using each type of care at each of the
two age points is not large enough for all group comparisons to be robust (e.g.
nannies) and it precludes consideration of further subgroups (e.g. quality by type and
by gender). Secondly, the intended matching of quality of observed care in nurseries
with reported structural qualities proved unexpectedly difficult to achieve. Nursery
managers were often reluctant to give the time necessary for sifting through personnel
records, while some individuals who were serving in managerial roles did not have the
authority to do so. A further difficulty was that, on one site in particular, several study
children attended the same nurseries during the four years of data collection;
although managers understood that a separate observation and interview was neces-
sary for each child, some were reluctant to grant a second such visit within a few
weeks. Thirdly, part of the difficulty of measuring quality of child care is that there
are few measures that can be reliably used in all types of child care setting. In this
study every effort was made to include some such instruments (e.g. CIS, HOME),
and we also constructed a subset of equivalent items from the ITERS and FDCRS so
as to compare the two ‘formal’ types of care—nurseries and child-minders. Neither
the original scales nor this new construction found many differences between nurser-
ies and home-based care; more methodological developments are needed.
Conclusions
The observed quality of non-parental child care available to infants and young
toddlers in England varies according to child care type. It is important to consider
types of care separately as well as within the whole group as this revealed some inter-
esting and even unexpected relationships. Quality is lower in nurseries than in any or
all of the home-based types studied at both time points, except that at 18 months, and
in comparison only with child-minding, nurseries offer more learning activities. There
are few differences in observed quality between the three types of home-based care,
which suggests that purchased care, such as that provided by registered child-minders
or by a nanny, can be considered as good as (or in some cases better than) care by a
relative—sometimes seen by parents as the only type of care they will countenance.
28 P. Leach et al.
Indeed grandparents had somewhat lower levels of positive relationships with children
and lower safety and health scores than either child-minders or nannies. It is impor-
tant to note that mothers using grandparent care were the most disadvantaged.
At 10 months the cost of care was largely unrelated to its observed quality overall.
Taking each type separately, more expensive nurseries were less emotionally respon-
sive. At 18 months higher cost overall went with less punitiveness and greater safety,
while type-by-type comparisons showed that paying more for child-minding went
with several aspects of higher quality. At both ages the structural characteristic with
the highest impact on the quality of nursery care was the ratio of children to adults:
the more children each adult had to care for, the lower the quality of that care. The
qualities of care judged important by mothers did not differ according to the type of
care being used, and the observed quality of mother’s behaviour at 10 months was not
richly associated with the observed quality of her child’s care except that there was a
positive association over two generations such that mothers sensitivity or responsive-
ness tended to match that of the child’s grandparent. Mothers’ overall satisfaction
with their child care was positively associated with almost every child care quality
variable at both 10 and 18 months. However, type-by-type data show that there was
no such significant relationship for nurseries.
There is considerable evidence in the literature and in this study of relatively poor-
quality care for infants and toddlers in nurseries, and of large variations in quality
between one nursery and another (e.g. Cost Quality and Outcomes Study Team,
1995), which uncritical acceptance by parents will do nothing to reverse. Public
education—perhaps including dissemination of data from official inspections—is
needed to help make parents aware of what can and should be expected of nurseries
caring for very young children, and to encourage parents to take an equally confident
and critical approach to all types of available child care: nurseries as well as relatives,
nannies and child-minders.
Acknowledgements
The authors gratefully acknowledge the contributions of families and project staff.
The project is funded by the Tedworth Charitable Trust and the Glass-House Trust.
Note
1. The Families, Children and Child Care project team is Beverley Davies, Jenny Godlieb,
Lindsay Hague, Denise Jennings, Michelle Nichols, Bina Ram, Angela Triner and Jo Walker.
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... Households with lower incomes have been found to be more likely to use grandparental care [17]. Mothers using grandparental childcare tended to be the most disadvantaged groups [26]. ...
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... For instance, Sollars (2020) found that parents cited airy environments and cleanliness of the facilities as the structural factors they were most concerned about. Leach et al. (2008) found that infants' mothers considered the caring environment, the safety of the physical environment, and worry-free childcare quality as essential factors in their program selection. Furthermore, Rentzou (2013) found that infants' and toddlers' parents considered space and furnishings to be important factors. ...
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... Thus, the daycare runs daylong as long as the office time practiced in a country. (Leach et al. (2008) pointed out service provided by someone outside of the legal guardians. He explained daycare centre as the care of a child for the day by someone aside from the child's legal guardians, typically executed by a person external to the child's instantaneous family. ...
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... Ett socialt, emotionellt och kognitivt stödjande klimat där barnen får öva och pröva, misslyckas och lyckas, ger barn förutsättningar att utvecklas socialt, emotionellt och kognitivt (Carl, 2007;Leach et al., 2008;LoCasale-Crouch et al., 2007). Ett sådant klimat inkluderar barns egna initiativ och idéer, vilket har starka positiva effekter på såväl barns framtida sociala förmågor som deras lärande (Curby et al., 2009;Persson, 2015). ...
... Ett socialt, emotionellt och kognitivt stödjande klimat där barnen får öva och pröva, misslyckas och lyckas, ger barn förutsättningar att utvecklas socialt, emotionellt och kognitivt (Carl, 2007;Leach et al., 2008;LoCasale-Crouch et al., 2007). Ett sådant klimat inkluderar barns egna initiativ och idéer, vilket har starka positiva effekter på såväl barns framtida sociala förmågor som deras lärande (Curby et al., 2009;Persson, 2015). ...
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Book synopsis: Throughout the world the number of working mothers with young children has continued to grow. This has important consequences for social policy decisions, particularly in the fields of parental leave, childcare and pre-school services provision. Some countries are far more successful at combining high quality early childhood services with high percentages of mothers in employment, whereas others continue to struggle. This edited volume examines the ways in which different countries across the world are tackling early childhood services and how these services affect young children’s experiences and development, for better and worse. Some of the recurring questions of childcare provision are tackled, including: Is pre-school childcare detrimental to children? Does the quality of childcare matter? Why are some countries succeeding in providing quality childcare services, and others are not? How can we best organise parental leave, employment regulations and childcare provision?
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Examined the relations among adrenocortical stress reactivity, infant emotional or proneness-to-distress temperament, and quality of attachment in 66 infants tested at 9 and at 13 months. Performed the Louisville Temperament Assessment at 9 months and conducted the Strange Situation at 13 months. Adrenocortical activity was not associated with attachment classifications. Emotional temperament at 9 months was strongly correlated with emotional temperament at 13 months. There was also evidence that at both ages infants who were more prone to distress experienced greater increases in adrenocortical activity during the laboratory tests. Significantly, however, although both the Louisville Temperament Assessment and the Strange Situation involve maternal separation (a potent stimulant of the adrenocortical system in nonhuman primate infants), we noted only small elevations in cortisol, and these elevations were significant only at 9 months.
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A structured interview schedule was administered to mothers from 89 families in Pennsylvania whose children were either enrolled in day care centers or were on a day care waiting list. Evidence from these interviews indicated that satisfaction with substitute child care was positively related with maternal work satisfaction, but not with the quality of mother child interaction. Work satisfaction and quality of mother child interaction, however, were previously correlated to one another. The constructs of role dominance and shifting role dominance were used to conceptualize the problem and interpret the findings.
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