Small comfort

As debate continues about whether child care hurts children, Karen Kissane looks through the latest research and finds a mix of good and bad news. Part two of our special report: Who is looking after our children?
ARE CHILD care centres the gulags of the ’90s, dumping grounds where vulnerable children are abandoned day after day to survive as best they might? Or are they warm, creative places where children are kept safe and happy while their parents work?
Twenty years after mothers of young children began returning to the workforce in numbers, the child-care debate is alive and angry. Age cartoonist Michael Leunig inflamed it further in July with his “Thoughts of a baby lying in a child-care centre”, in which a small, weeping bundle defended its mother against accusations of being a “cruel, ignorant, selfish bitch”, and blamed
itself for failing to win her love.

Many people feel passionately that it must be a cruelty for small children to endure long separations from the person they love most in the world. Many parents who have used child care feel grieved and defensive that an experience they have found so positive for their children could be so maligned.

Who is right? As with most complex questions, the answer is “it depends”.

Studies suggest that each case depends on a combination of factors including the age at which the child began care, the number of hours per week, the quality of the child-care centre and how well-loved and secure the child felt at home. The child’s own temperament is important, too; children are not merely passive recipients of influences.

Yet the voices of children are strikingly absent from the huge body of research; no one seems to have asked older kids in child care whether or not they like it, and whether they would still rather be at home with mum or dad.

These are questions that may remain unanswered. The Australian researcher Gay Ochiltree says she wanted to do such a study, in which children would be both observed and talked to, but was refused funding on the basis that it would be unethical to question small children.

In general, Australian and international studies consistently find that the toddler and child who is well looked after at home and at day care thrives. If it’s a good centre or family day care home and the child’s relationship with the parents is sound, there is no evidence that pre-school care will cause harm either at the time or later in life.

Professor Margot Prior, the director of psychology at the Royal Children’s Hospital, says: “Quality day care has no damaging effects providing the child has a good relationship with the parents. Of course, they can experience grief, but if their attachment (to the parents) is secure, they cope with the separation. The security of that attachment does not depend on the hours spent together. If grief does occur, it should be temporary.”
Prior says it is normal for a child to cry and feel lost and uncertain at first in a new environment. Skilled caregivers will be good at distracting them into activities; gradually they feel safe and begin to enjoy themselves, and they realise that they are not abandoned when they find that their mother always comes back for them. “If a child continues to grieve over weeks or months, there’s an issue there that’s got to be dealt with,” she says. “It may or may not be to do with day care.” The educational psychologist Maurice Balson, author of the book Becoming Better Parents, agrees. “If the child’s got a good relationship with the parents at home, child care doesn’t bother me. Long term, it doesn’t matter what the child is experiencing; what matters is how the parents relate to it and what it makes of those experiences, how it interprets them . . .”
But the reassurance is not a blanket one. In her book Effects of Child Care on Young Children, Ochiltree reviews international studies done over the past 40 years. Some American research indicates that babies who have 20 or more hours of care in the first year of life tend, as older children, to be less close to their mothers and more aggressive than their peers (see box). Some United States studies found that disadvantaged children were better off in child care than at home with struggling families; Nordic studies, however, indicate that even in high- quality centres where most do well, children with emotional difficulties tend not to get the extra help they need.

Other findings are even more contradictory. There are indications that child care might make children more socially skilled, independent and intellectually able, but this seems to depend largely on whether the care was of high quality. IT IS the findings about quality that help explain why parents’ views about child care can vary so dramatically. Clearly, the quality gap can be dramatic, particularly in countries where child care is poorly regulated. (Australia has an accreditation process.) Ochiltree’s book quotes a national study of 64 centres in the US in 1979 that found big differences: “Small groups, especially those supervised by lead caregivers with preparation relevant to young children, are marked by activity and harmony.

Caregivers are warm and stimulating. Children are actively engaged in learning and get along with others . . .

“Larger groups, especially those supervised by caregivers without education or training specifically oriented toward young children, present a contrasting picture. Caregivers monitoring the activities of many children at once, without active intervention. In such an environment, some children `get lost’. Apathy and conflict are somewhat more frequent . . .” Recent New Zealand research into day care for the under-twos has made the alarming discovery that many parents did not know how to pick a quality centre. Some idealised arrangements that their babies and toddlers found miserable.

“Parents know more about how to choose a car than a child- care centre,” says the head of the research project, Professor Anne Smith, of the Children’s Issues Centre at the University of Otago. “We found that most parents are incredibly happy with
their child care, no matter what the quality was. The parents would say things like, `My child is perfectly happy, the staff are warm and caring’, about centres that we regarded as mediocre or poor.

“Some centres that we went to were distressing to the researchers.

(The children suffered from) boredom, wandering listlessly from one activity to another; there was more crying . . .
Overall, we found no relationship between parent satisfaction and the quality of care.”
Eighty per cent of parents had settled for the first centre they looked at, with less than 4 per cent knowledgeable enough to shop around and examine such issues as staff/child ratios and staff qualifications.

In good centres, the children were happy: “It’s not realistic to expect kids to be happy 100 per cent of the time, especially the under-twos. But in a good-quality centre, there shouldn’t be any more ups and downs than there are at home,” Smith says.

The most important component of quality was the warmth, responsiveness and consistency of the staff, she says. She believes the under-twos should have a ratio of one carer to every three children, with each child assigned an adult to be their special friend. And the centre’s staff should be stable, so that children do not get attached to caregivers only to lose them. Smith found that the caregivers’ level of wages per hour was the most important predictor of overall quality.

Ochiltree, now a lecturer in family studies in the Institute of Early Childhood Education at Macquarie University, advises parents to choose carefully and remain watchful. If there are aspects of the care that make you or the child unhappy, talk to the staff. If it doesn’t improve, move the child.

She is disturbed by the tone of the public child-care debate.

“What I object to most is the idea that mother has disappeared from the lives of children in child care. Of course, she hasn’t.

As much as children at home, they have mothers who are concerned about them and their parents remain the continuous figures in their lives throughout childhood.

“It’s also made to sound like they enter child care and stay there until they enter school. It’s not so. Many mothers are in and out of the workforce, often doing part-time work . . . And grandparents are actually the biggest providers of (non-parental) child care.”
Official statistics challenge the idea of parental deprivation.

When he analysed Australian Bureau of Statistics surveys on how people spent their time, the researcher Michael Bittman found that both mothers and fathers are spending more time with their children now than they did eight years ago. Women are cutting back on laundry and cooking, not on the kids.

Bittman, of the Social Policy Research Centre at the University of New South Wales, speculates that the concern about children being deprived of their mothers could be a form of “moral panic”. The term was coined by the sociologist Stan Cohen to describe the way a vague sense of unease becomes a public question of “Where will it all end?” It arises when there is discomfort about a big social change in this case, women re-entering the workforce. After public exaggeration, pronouncements by experts and stereotyping of the people being discussed, the discomfort becomes alarm. Ultimately, whatever is at issue comes to be seen as a threat to society’s values and interests.

Says Bittman, “One possible explanation (for this) is rising expectations. If over the years, mothers . . . are expected to do many more things for their children than an earlier generation of mothers, then it follows that the actual increase in time devoted to child care falls behind expectations that rise at a more rapid rate.”
What of Leunig’s tiny weeping bundle? Australia has few small babies in formal care, says Ochiltree, and maybe most of them wouldn’t be there if we had better parental leave.

In Sweden, which has what might be the world’s best and most widely used child-care system, few babies under nine months are in care because parents are entitled to 18 months paid leave after a birth, and they mostly choose to use it.

Three degrees of separation.

To study the effects odf child care on babies’ relationships with their mothers, researchers have used the `strange situation’ technique.

Gay Ochiltree explains in Effects of Child Care on Young Children that the child is put in a strange room with its mother and is observed during a series of events, including the mother leaving, a stranger entering and the mother returning.

Babies considered to be “securely attached” to their mothers protest or cry on separation but greet her with pleasure when she returns and are fairly easy to comfort. Those who are insecure-avoidant appear to be independent but reject mother when she returns, while those who are insecure-resistant are clingy and seek mother when she returns but resist her efforts at comfort. It has been argued that insecure attachment could be linked with later social and emotional problems. In America, it is estimated that about 30 per cent of babies of at-home mothers are insecurely attached.

American researcher Jay Belsky, reviewing studies involving 491 infants, found that those who had more than 20 hours a week of non-maternal care in the first year of life were 1.

6 times more likely to be insecurely attached, with boys more affected than girls. But other factors must also be at work, Belsky said, as many of those exposed to the “risk factor” of long day care as babies had not been affected.

But attachment research has been questioned regarding its suitability for children in day care. It has also been criticised for its focus on the child’s attachment to the mother.

First published in The Age.

Selecting sex is more than a simple choice

“A GIRL for you, a boy for me,” they sang in the ’20s. Soon it won’t be a topic for day-dreaming over a cup of tea but a matter for clinicians in laboratory coats. Within five years, predicts a senior fertility specialist, a new sperm-sorting technique will allow any couple to choose their baby’s sex.

What’s more, Professor Robert Jansen, the chairman of the infertility committee of the Royal Australian College of Obstetricians and Gynaecologists, believes couples should be free to use the technique as they see fit.

“Ultimately I think the decision has to be made by the people who have to live with the consequences of the decision, not individuals who have nothing to do with the couple concerned, ” he says. “But the world is full of people who want to make decisions for other people.” Is it as simple as that?
Choosing babies’ sex has become a hot topic since last week’s news that a team at Monash IVF implanted female embryos into a woman who carried a male-linked genetic disease. The woman’s first baby died and two other pregnancies were terminated because of X-linked hydrocephalus, an untreatable form of fluid on the brain that causes death within hours of birth.

Any male child the woman conceived would have a 50 per cent chance of carrying the defect.

This is a case where there were clear medical grounds for sex-selection. This was not about valuing one sex over the other but about offering a healthy child to a couple who had already lost three much-wanted babies.

Nevertheless, the procedure raises ethical questions. The director of embryology at Monash, Dr Leeanda Wilton, says it is no longer considered experimental given the healthy babies it has produced overseas. A somewhat more cautious Professor Jansen says: “It’s still pretty new.” There are questions about what should be done with embryos of the at-risk sex created in the process (in this case, Epworth Hospital’s ethics committee insisted that the male embryos be frozen).

And there are questions about who should be offered the procedure. If there is only a 50-50 chance of a defect being passed on, should couples be required to try naturally first? If so, how many times? What of couples who do not carry a gene for a defect, but merely a gene that would predispose a child to a particular disease later in life? The child may or may not get it, and if it does appear it might not be in a disabling form; would this justify fiddling with human life in Petri dishes?
Tougher questions are looming. Scientists expect to discover soon the genes that contribute to height, IQ, skin color and personality traits such as shyness. If Westerners were able to choose superficial qualities commonly valued, the result could be hordes of thin, blond, blue-eyed, hetero conformists with high IQs who can play piano. If this seems fanciful, consider the poll finding that 11 per cent of Americans would abort a child predisposed to obesity.

The sperm-sorting technique Professor Jansen describes, which was discussed at the IVF world congress in Vienna early this year, is already being used for sex selection in animals.

He suspects that in the West couples would be more likely to opt for girls, as has happened in European sex selection clinics. But it is clear that worldwide, the technique would only exacerbate the dearth of women.

India is renowned for its abortions of female foetuses (of 8000 abortions at one Bombay clinic, 7999 were of females, according to an Indian Government report), and a Melbourne researcher, Dr Lynette Dumble, says India now has twice as many boys as girls. In one Chinese province, infanticide has left men of marriageable age outnumbering women by 10 to one.

One study suggested that even in America, sex selection would result in a 9.5 per cent surplus of males.

The Economist magazine has rather naively argued that imbalances of women would result in them becoming more highly valued.

As possessions, maybe. In the Third World, it’s more likely to further decrease their economic and social power and feed evils such as the trafficking of women.

In the West, couples might choose a boy and a girl. That would maintain the social balance but might change the nature of the relationship between parent and child. What happens to unconditional love when one introduces conditions? What would it be like for a child to know that a clinic had been sued because he or she had disappointed parents by turning out to be the “wrong” sex?
As it is, the unrealistic fantasies of would-be parents can make it hard for them to deal with the reality of a new baby. And, as the medical ethicist Nick Tonti-Filippini points out, in seeking the baby of our dreams we might lose sight of the fact that even the sweetest children become grotty adolescents.

We have moved a long way from the Judaeo-Christian ethic that every child is a gift from God. Our community largely accepts the ending of embryonic life that is physically or mentally defective. We rightly leave it to parents to decide whether to accept the suffering that would be imposed on them, their other children, and the child concerned.

This principle holds for the use of embryo biopsy to avoid serious genetic defect. It does not hold for the selection of sex or other normal characteristics. Ultimately, the danger is that in any search to produce humans who are ever more perfect – or worse, fit a desired cultural norm – we would lose touch with the very qualities that make us human.

First published in The Age.