Nurseries are safe and secure - but are they bad for your baby?
(Filed: 12/06/2003)
Evidence suggests they are. Rebecca Abrams explores the conspiracy of silence that means this message isn't getting across to parents
It was an eye-opening experience. Or perhaps I should say an eye-shutting one, for it it didn't make pleasant viewing.
In the centre of the room, a five-month-old baby was crying with frustration. Stranded on his back, he couldn't yet turn over by himself. In the corner, a little girl of about seven months sat and stared into the middle distance. She made no demands for attention and got none.
The Thomas Coram Early Childhood Centre in London, a 'shining example of how nurseries should be'
Then there was the boy of nearly one, picked up like a sack of Pampers and carted off to be changed. Clothes removed, bottom wiped, new nappy put on in three minutes flat. All this was done with exemplary efficiency - all done without a single word or smile from the young woman doing the changing, the entire operation carried out as impersonally as if she'd been loading the dishwasher.
This was no Romanian orphanage, but the baby room of a brand new, beautifully appointed private nursery in an affluent suburb in the south of England, charmingly located amid majestic chestnut trees. Highly educated adults fight for places here. To stand a chance of getting in, they put their child's name down long before the birth.
The quotidian neglect I witnessed may not be typical of all nurseries, but certainly isn't exceptional either. Researchers on one recent British-based study were so distressed by their observations of some baby rooms in day nurseries they needed debriefing sessions afterwards. As a senior and highly respected government adviser puts it, somewhat laconically: "There are undoubtedly some very poor nurseries around."
For the whole of this month, events will be taking place up and down the country to celebrate Sure Start, the Government's national childcare and early-years strategy.
Sure Start has been responsible for many wonderful initiatives in the past five years. It has also shown considerable enthusiasm for nurseries. It has pledged £600 million to spending on childcare over the next two years, well more than half of it for nurseries. There's a promise of childcare places for two million children by 2006 and a nursery place for every three- and four-year-old by 2004.
Nursery places for three- and four-year-olds are all very well. But the Government's nursery strategy extends to children of all ages, from the age of four months upwards. Why should this be a cause of concern? There is a rapidly growing body of research that suggests that nurseries may well be the least desirable choice of childcare for children under two, especially for babies.
Baroness Ashton, the minister responsible for Sure Start, doesn't seem terribly keen to dwell on this point. "We're very responsive to research," she says, "but I want to use research not to rule things out, but to get quality as high as possible in all the schemes we're supporting."
So how concerned is the minister by the latest findings on babies and nurseries? "The jury's still out," she says. "Our job is not to dictate to families that this is good or that's bad, but to maximise the choices parents have."
But what if the evidence were conclusive? "It's a big if," she says. "I'd want to look at what the evidence actually says."
What the evidence actually says, according to the most recent, ambitious and - as it happens - government-funded research, is that while children show intellectual and social benefits from being in nurseries from the age of three, there are clear negative effects for children who had been in nurseries from their first year of life.
The press release sent out by the Department for Education and Skills in the wake of these findings made much of the good news, declaring excitedly: "This research shows that good-quality pre-school experiences support children's social and educational development." It made no mention of its findings on babies.
Even the full report is pretty coy - and that's the polite way of putting it. Assuming you're interested enough to go to the trouble of excavating the paper from the Kafkaesque depths of the Sure Start website, you'll still have to wade through 45 paragraphs before you get to this: "High levels of group care before the age of three (and particularly before the age of two) were associated with higher levels of anti-social behaviour at age three.
"The effect was largely restricted to children attending local authority and private day nurseries, where substantial numbers attended from infancy onwards."
"I don't think we're being coy," says Baroness Ashton. "One of our objectives is to get families out of poverty. We know the effects of poverty and we know the best solution is getting parents into work. We're trying to make sure all families can find childcare if they want it."
There's a real danger in this policy of prescribing for all what's only appropriate for some. Many mothers who now use nurseries for their babies are not those whose children stand to benefit.
Liz Jenkins, a 38-year-old solicitor and the mother of Leo, now four, is a case in point. She chose a nursery for her son, then six months old, for the security, the reliability and the interaction with other children.
"I didn't want a childminder or nanny because I wanted to be sure that whoever was looking after my baby wasn't doing so unobserved," she says. "I also liked all the toys and books, and the idea that he'd be with other children."
Liz visited eight nurseries before finding one she was happy with and was shocked by some of the things she saw. "The more expensive places were often the worst," she says. "One child was left dangling in a baby-bouncer in blazing sunshine for 20 minutes before anyone came to move her."
In the past decade, despite the horror stories, nurseries have become the childcare of choice for many parents. According to one recent study, nearly 50 per cent of first-time parents returning to work now consider nurseries preferable to either nannies or childminders. Over the past 10 years, the former ugly duckling of the childcare world has grown into a £2.15 billion business, the fastest growing sector of the childcare market.
It's not as if this is a cheap option. A full-time place in a local authority nursery costs about £500 a month. A private nursery in the smarter parts of London will set you back up to £1,300 a month, although for that "the service extends to putting your child to bed if you're held up at the office or can't quite make it home between work and the theatre".
Like Liz, many mothers think it's worth paying. Given the climate of intense anxiety about the dangers of child abuse, ranging from covert abusers at one end of the spectrum to fully-fledged paedophiles at the other, this is hardly surprising.
"A significant number of mothers start out wanting the professionalism and physical safety of nurseries," says Dr Penelope Leach, a childcare expert and the co-director of the Families, Children and Childcare Study.
But, as it turns out, only to begin with. Next month, Dr Leach and her colleagues release their latest findings, which show that by 18 months mothers using nurseries were the least satisfied with their childcare arrangements.
Instead, childminders had become most working parents' first choice. Parents using childminders were also the most satisfied with their children's care.
Dr Leach believes that many women returning to work simply can't bear to think too hard about the quality of emotional care their child will receive. Instead, they focus on more concrete things, such as physical safety and the activities on offer. Only once the adjustment to work has been made can mothers start to think more calmly about what's on offer and, in some cases, revisit their earlier decisions.
Whatever parents' or the Government's reasons for liking nurseries may be, these results strongly suggest that what parents say they want in terms of childcare, especially before they've tried it, is not the best basis for expanding or promoting nursery places for babies.
A still louder warning bell sounds from the United States where, according to one study, 82 per cent of babies are now in regular day care. Five independent studies have shown negative effects of early non-maternal childcare, especially for boys. Next month, the largest of these, the NICHD study, will publish its latest figures, showing that long hours in childcare centres from infancy carry long-term developmental risks.
"We're not talking axe murderers," says Professor Jay Belsky of Birkbeck College, London, "but there is ever more evidence to raise concerns, especially in the first year of life, especially long hours and especially in centre-based care."
Professor Belsky is entitled to feel a little smug about these findings. In 1986, when he first published research showing negative effects of day care in infancy, he was widely vilified and accused of scaremongering. "As someone who wrote about this in good faith and got skewered for it, these new findings are satisfying," he says. "But as someone who's concerned about the well-being of children, they're not at all."
Yet none of these findings should really surprise us. Most of us know, from common sense if not direct experience, that babies and three-year-olds are at very different stages of their development and need correspondingly different kinds of care. Nor should any of this be difficult to talk about openly. But it is.
In the course of writing this article, I spoke to many academics, civil servants and politicians working in this field who were more than happy to agree that nurseries are not the best place for children under 12 months - but only off the record.
On the record was a different matter. Again and again, an extraordinary wariness came over people; more than reluctance, something much closer to anxiety.
No one wants to risk appearing to be saying anything against working mothers. No one wants to think they're doing wrong by their own child. Absolutely no one wants to criticise another woman's choice of childcare. Not to her face, anyway.
On any given weekday in Britain, more than 400,000 children now attend day-care nurseries, a growing number of them babies. It's difficult to talk openly about it or address its implications, not because our children don't matter to us, but because they matter so much.
As Dr Leach says: "What parent could bear to think of their child holding up his arms and no one responding?" Add to this ambivalence about going back to work in the first place and often intensely mixed feelings about our child forming close bonds with someone else.
But one-to-one care is not just nice for babies, it's essential. "Babies are very resilient," says Dr Peter Hobson of the Tavistock Clinic in London and the author of The Cradle of Thought. "But what happens between an infant and her care-givers is vitally important, not only for the way the infant will come to relate to herself and others but also for her developing capacity to think."
Within an hour of birth, babies are responding to the way they're handled, looked at and talked to. "Still face" experiments with 10-week-old babies, in which mothers don't react in any way, show that babies are highly sensitive and quickly become distressed when a response is absent or inappropriate.
The delicate, finely tuned responsiveness that occurs naturally between most mothers and their babies is not only moving to behold, it affects in fundamental ways how babies' brains develop. Unlike three- and four-year-olds, babies don't need socialising and stimulating; they need to be sensitively loved by the people caring for them. Lack of eye contact, lack of baby talk, lack of gentle, playful touch: all have long-term consequences.
Not all nurseries are dire, of course and you won't find much better than Thomas Coram Early Childhood Centre, in the heart of central London, a shining example of how all nurseries should be, so nice, in fact, I wanted to be a baby there myself.
It's two in the afternoon when 10-month-old Hannah wakes from her sleep. This is only her third week and she's a bit disorientated and tearful. Wendy takes her on her lap and cradles her gently. When Hannah starts to look around, Wendy offers her a bottle of milk, snuggling her into the crook of her arm while Hannah drinks.
Twelve-month-old Max wanders sleepily through from the quiet room and settles himself on the sofa beside them. Wendy chats to him quietly over Hannah's head. When Max starts to pat the gemstone on Wendy's engagement ring, she asks if he likes it and offers him a toy with buttons he can press and twist. When Hannah finishes her bottle and burps, Wendy pauses in answering a question I've just asked to give Hannah's tummy a gentle rub.
An hour later, all six children are awake and playing. The atmosphere is still remarkably calm and peaceful. There are never less than three staff in the room. They fill each other in on what each child's been up to during the morning. It's like being with a group of mothers, not paid professionals.
For nurseries to be good enough for babies (and that means pretty near excellent), we need to be looking not at the locks on the doors and the pictures on the walls, but at how seriously the staff take the emotional needs of their charges.
"There's still a fear in some nurseries that making close relationships with the children will somehow hold them back, as if children have a fixed amount of love to go round," says Peter Elfer, a senior lecturer in early childhood studies at the Roehampton Institute and the co-author of a forthcoming book on nurseries.
"Actually, it's the other way around. For a baby, having one person in the nursery who knows them well, keeps them in mind and has a real relationship with them is really important."
Qualified staff and high child-adult ratios are the only way to ensure this kind of quality in nurseries. The trouble is it's expensive. At the Thomas Coram centre, a full-time nursery costs the borough of Camden twice what it costs the parents. No wonder so many nurseries employ staff with no or few qualifications, then pay them the minimum wage.
The Government's dilemma is how to reconcile different policies heading in different directions. Committed as it is to tackling child poverty by getting mothers into work, it doesn't want to make too much of research findings that call into question exactly how it's doing this. "There's no room for cracks in the childcare/working family package" was how one senior spokesperson put it - off the record, naturally.
But all childcare is not equal and we shouldn't fool ourselves otherwise or put up with being fooled. One of the most interesting findings from the government-funded EPEE research, a finding not in general circulation, is that while more than 20 hours in a nursery in the first year of life is linked to negative behaviour in school-aged children, a child looked after by a childminder needs to have clocked up more than 40 hours before showing signs of negative effects. The implications of this, for parents and policy-makers alike, should be clear enough.
Childminding, however, suffers from an outdated and unflattering reputation that's proving hard to shift. "A lot of people still think we're nice ladies around the corner looking after children for a bit of pin money," says Gil Haynes, the director of the National Childminding Association. "In fact, there are more hurdles to becoming a childminder these days than to becoming a secondary school teacher."
Not only do all 70,000 of the registered childminders in this country have to complete a compulsory training course and hold an up-to-date first aid certificate but they are also police- and health-checked, along with any other adults living in their house, and regularly inspected by Ofsted.
A well-organised, highly regulated profession, childminding is still unfairly haunted by the spectre of Louise Woodward and her ilk. In the past 10 years, only two children have died in childminder care, compared with one a week in its own home.
What childminding can offer far more easily than nurseries is the kind of personalised care that very young children need. Eileen Matthews, 52, has been a childminder in Durham for more than 20 years. She currently looks after eight-month-old Yash full-time and two three-year olds part-time.
"I think the care Yash gets with me is very close to what he'd get at home," she says. "I spend a lot of time talking to his parents about what they want and expect." Many of the children Eileen has minded over the years are now virtually grown up, but they still keep in touch.
"One girl I looked after will be 18 this Christmas," she says. "She's been emailing me recently to ask advice about what dress to wear to her first ball."
With the numbers of childminders falling fast, the Government is at last doing something to promote a profession it should long have been championing. The Home Child Carers Scheme, set up in April, enables registered childminders to work from parents' homes.
Later this month, it will be launching Quality First, an initiative to ensure standards and reassure parents. It's also putting £11.25 million into Childminding Networks, which provide minders with a supportive framework of colleagues and give parents a fall-back on days when a childminder can't work for any reason.
Meanwhile, the nursery business continues to boom and the responsibility for making good choices still lies chiefly in the hands of parents themselves. It's time to be honest with ourselves and face facts - at least those we can get our hands on.
Being treated like a pack of Pampers is not just unfortunate, as any researcher worth his or her salt will admit. The true emotional and psychological effects of neglectful or insensitive care in infancy may not show up at four or five, but 20 or 30 years down the line, in our relationships with our children, friends, husbands and wives.
What we're talking about is how highly we value the capacity to think, to empathise, to love. What we're talking about is the kind of society we're creating for the future.
To make good decisions in difficult circumstances (and most mothers find leaving their baby with someone else difficult), parents need easy access to unbiased information. An effective taboo on talking and thinking about children's needs, especially in the first year of life, is not what any of us need.
On this issue at least, the time has surely come for speaking on the record.