Help! What are the pros and cons of sending my multiples to childcare?

In this episode, I answer a listener's question about whether she should send her multiples to childcare and how you know when your children are ready. 

First, I highlight that for many parents childcare is a necessity, not a choice, and that for the majority of multiple-birth parents, childcare is not affordable. 

Then, I speak about the debate in the literature about whether childcare is harmful or beneficial for children's development. I cover what aspects of the childcare facility and your children's needs should be taken into account when making a decision that suits your family. 

I emphasise the importance of balancing parental well-being with your children's needs when making a decision about childcare. 

Thanks for listening! If you are a soon-to-be or current parent of multiples, be sure to head over to my website http://www.fiercekindmama.com to get my FREE resources designed specifically for you!

Be sure to follow me on Instagram and Facebook too.

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Transcript

Dr Cristina Cavezza

Welcome to the Fierce Kind Mama of Multiples podcast. This podcast is for anyone raising multiples, twins, triplets or more. I speak to inspiring parents of multiples who have healed from unexpected pregnancies and birthing experiences and who candidly share the highs and lows of raising multiples.

I also speak to the professionals that work with multiple birth families.

Together we cover the practicalities of raising more than one baby at a time, as well as enhancing the emotional wellbeing of caregivers and children alike.

Come join us as we laugh, cry and share our personal and professional wisdom on all things multiples. I'm your host Dr Cristina Cavezza, and I am a Fierce Kind Mama of Multiples.
 
 Welcome to the show. Today, I will be answering a listener’s question about the pros and cons of sending your multiples to childcare but before we get started, I wanted to let you know about a new free resource I have available for those of you who are pregnant with multiples. 

If you want to learn more about how to be fully prepared for your multiple birth journey, then this guide is for you. In this guide, I take a holistic approach to help you prepare physically, financially, and emotionally. 

And if you know anyone else who is pregnant with multiples, please tell them to head over to my website: www.fiercekindmama.com 

And click on the free resources tab. 

The link is also available in the podcast show notes.

So, as I said the inspiration for today’s episode comes from a listener who wrote to me and asked me to discuss the pros and cons of sending your multiples to childcare.

She writes that she is very tired with full time parenting. For context, her twins are toddlers now.  However, she says her children are in a terribly clingy stage and she is unsure whether it would be harmful to send them to daycare now. She said that they are strongly attached to her, and she is worried it might disrupt their natural connection to her, their sense of safety and lead to a feeling of abandonment. She also writes that it is hard to get unbiased information about the pros and cons of childcare because if you ask other mothers or parents, she believes that they provide reasons that simply justify their own decisions about whether to send their kids to childcare or not. 

So, this is a great question because I think it is really hard sometimes to make personal decisions about what is right for your family when you are seeking information from other parents. As the listener said, she feels like other parents are simply trying to justify their own decisions which I think is a fair point. The other thing to point out here is that obviously for some families sending their children to childcare is a necessity. For those of you who are solo parenting or if you are in a partnership, but you need or want to work and you don’t have any other options, then access to childcare is super important. 

I also want to emphasise how incredibly difficult it can be for parents of multiples to access childcare when they want or need it. The statistics show that the majority of parents of multiples find childcare unaffordable. For working parents this can mean that, if they are in a partnership, one parent will need to stay at home part-time or full-time taking a significant period off of paid work, and this can have some negative consequences for the stay-at-home parent in terms of career progression and retirement savings. For those families that end up sending their kids to childcare, the costs can often be a significant chunk of their earnings and it can sometimes feel like what’s the point of continuing in paid employment when my take-home pay ends up being so little. The other thing to consider is it can be really hard to find a spot in a childcare local to you when you need it and if you have two or more children of the same age needing a spot in your local childcare, it becomes even more difficult. Many parents will have to put their children on a waiting list very early and this can sometimes mean that parents have limited choices because good-quality childcares will often be harder to get into. This is one of the many ways in which parents of multiples are disadvantaged because having choices is often associated with greater wellbeing. I’d like you to take a moment to think about this. If there has been in a time in your life where you felt like you didn’t have a choice – maybe there was something you wanted but you weren’t given the opportunity or you were somehow blocked from having the thing you wanted – or someone told you that you had to do something and there was no room or way you could say no – how did that make you feel? You probably felt angry, frustrated, or resentful because you weren’t given the freedom to choose. And so I see this as being an important part of the discussion when we talk about accessing childcare in the context of raising multiples. Regardless of whether you want to send your children to childcare or not, if you don’t have a choice this is often when we see more problems. 

But when we do have a choice, we often have to make uncomfortable decisions and we can spend a lot of time worrying about whether we are making the “right” decision. And it can be really overwhelming when we use other families as the benchmark for making decisions about what we should we do with our own children. 

I will say that as someone who has training in psychology, my job is to remain as impartial as possible and to evaluate research from an objective perspective. And I don’t take this responsibility lightly. I want to thank you for having enough trust in me to answer this question objectively. You are putting your trust in me, and my knowledge and I take that responsibility very seriously. 

However, I also want to highlight that I am a parent myself as you would know if you’ve been listening to my podcast, and I’ve had to make my own decisions about childcare. So, I undoubtedly will have biases based on my own circumstances that I want to acknowledge at the outset. Because as much as I aim to be objective, I am also human with my own life story and experiences. What I can say is because I am not in your exact situation, I can help as an outsider looking in. As an outsider who has her own struggles when it came to childcare but also as a professional who can critically examine research in the field and summarise it for you so that you are in a better position to decide about what is right for your family. 

I also want to highlight here that the information I can provide in this podcast is obviously general and may not fit your situation exactly. But my hope is that you will find something useful out of today’s episode that can help you make a decision about when you might like to access childcare if at all. 

Alright, within that context then, let’s take a closer look at this question of the pros and cons of childcare. 

The first thing to say here is that most of the data I have access to and will be summarising here comes from Western industrialised countries. It’s important I think to acknowledge this bias in the research from the outset because depending on where you live in the world, your situation may be entirely different. For those of you living in a predominantly English-speaking country like Australia, Canada, the US, the UK, then the research I summarise here will be much more relevant but again there may be differences even within these individual countries, particularly when it comes to government policies on the regulation, funding, and provision of childcare services. 

While rates vary across countries, in most Western industrialised nations, over 50% of preschool children attend daycare. In other words, the majority of kids in most of the English-speaking countries I mentioned earlier attend childcare at some point before the age of five years. 

But there has been a longstanding debate in the literature about whether childcare is harmful for children’s mental health. There are essentially two extremes. On one side, you’ve got people saying that attending childcare comes with risks, such as it can interfere with the child developing a secure attachment and children who attend childcare can be at greater risk of social maladjustment. While on the other side of the debate, you have people saying that childcare promotes healthy social and cognitive development. 

Now one thing we know is that if we have elevated levels of cortisol in our bodies, that is often associated with stress. Cortisol is a hormone and we believe that chronic exposure to elevated levels of cortisol may predispose an individual to certain mental health problems like depression and anxiety. The short-term spike in cortisol in response to something stressful is considered normal and adaptive but when we are speaking about the development of mental health problems like depression and anxiety we are talking about high levels of cortisol to stressful stimuli for a prolonged period of time. There is a general association between behavioural problems in children and atypical cortisol levels. We see higher cortisol levels in children with more behavioural problems. 

So, it makes sense that if we want to examine whether childcare has a negative effect on children’s mental wellbeing, that we measure the cortisol levels of children attending daycare and compare them to children not attending daycare. There have been several studies that have looked at this issue, but the findings are largely inconsistent, and this could be because differences in the quality of daycare and the age of the children may be associated with variations in stress levels. In other words, we might find differences of the effects of childcare on children less than two years old vs those older than two, for example. Similarly, we might find differences between daycares that are considered to have poor quality care vs daycares that provide better quality care. 

I am going to describe a review that aimed to examine this question by comparing the results of different studies that measured cortisol levels in children. The review that I will summarise was published in 2006. 

In order to be included in the review’s analysis, studies had to be published in a peer-reviewed journal, include children younger than 12 years of age who attended daycare on a regular basis, and cortisol had to be collected at daycare and also at home to allow a comparison between the two environments.  There were 11 studies that met these criteria and were included in the 2006 analysis. 

The researchers looked at studies comparing the children’s cortisol levels at home and at daycare; they looked at the cortisol levels of children attending low quality vs high quality daycares; and they looked at the cortisol levels of children of different ages and temperaments. 

And based on what they found, they drew four main, broad conclusions about the relationship between daycare, stress, and mental health. 

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First, the results clearly showed that there were differences in cortisol levels when children were at daycare as opposed to when they were at home. Cortisol levels were higher during the day while at daycare and lower when the children stayed at home. However, there was a lot of variability among the studies which suggested that other factors, such as the quality of the daycare, may explain this association. 

And that leads me on to the second broad conclusion. The results showed that higher levels of cortisol were found in children who attended low-quality daycares whereas children attending high-quality childcare had lower levels of cortisol. Now you might be wondering what is meant here by low-quality vs high-quality childcare so let me take a moment to explain the distinction as outlined in this 2006 review. Daycare quality here is being defined by two related components: process quality and structure quality. Process quality refers to how well the daycare staff interact with the children in attendance and adhere to health and safety protocols as well as the quality of educational play delivered. Structure quality refers to things like the caregiver-to-child ratio, the number of children in one room or program, and the amount of training the daycare staff receive. Lower quality daycares will score less well than higher quality daycares on these variables. For example, a lower-quality daycare may have staff that might give a distressed child a toy to play with rather than spend time interacting with the child until they settle. A lower quality childcare might have poorer adherence to health and safety protocols, they may have large numbers of kids in the program with fewer adults supervising and they may have staff who receive less training overall. And as I said before, a child attending such a centre may show higher levels of cortisol. 

The third finding was that cortisol levels were the highest amongst preschoolers and less in infants and school-aged children. Infants seemed less physiologically affected by daycare than preschoolers and this may be because infants and preschoolers differ in how they play with their peers. Infants tend to play less with their peers than older children and so perhaps they find daycare less socially taxing, if you like, which might explain why their cortisol levels remained stable. School-aged children also had relatively lower levels of cortisol when compared to preschoolers. This might be because school-aged children tend to have more advanced social skills, they tend to understand social rules better, and overall, they generally have more capacity for self-control. So, the difference we see in cortisol levels between preschoolers vs infants and older children who attend daycare might be a reflection of variations in social competencies.

However, it is important to note here that the studies that made up this analysis were measuring children of different ages at one point in time, so it is difficult to determine if the differences found were a reflection of age or social experience in childcare settings. What we would need to better understand the association between age and cortisol levels is a longitudinal study where the same children are tested over several years.  To my knowledge there are very few studies that have done this. A couple that I have come across have tested the same children repeatedly over the course of a year. Children’s saliva was collected in the morning and afternoon at childcare and then again in the evening at home by parents. They found that evening cortisol levels increased significantly throughout the year. This is the when the kids were at home after a day of childcare. This finding applied to both toddlers and preschoolers. So as the year proceeds children seem to get more activated at childcare in terms of a stress response and this spills over into the home environment. The implication of this is that it can be harder for these children to wind down in the evening. They may need more support from their caregivers and parents to regulate themselves and settle down for the night. 

In fact, many parents I speak with report that their children can be quite grumpy on the weekends or on the days they spend at home after doing two or more days at childcare. Some parents I’ve spoken with say that they like to send their kids one day on and one day off to avoid their kids getting overtired. So, maybe Monday they go to childcare and home on Tuesday and the next day back at childcare. But of course, your ability to do this will depend on whether you can get those days for your multiples at the childcare you are attending and if you work, you may not have the flexibility to break up your work days like this. 

Finally, the last broad conclusion that we can infer from the results of the 2006 analysis that I am summarising here is that temperament may also affect a child’s stress levels in a daycare setting. So, some children show cortisol increases at daycare more so than others. Some children find it harder to be separated from their caregivers or their primary caregiver more so than others and it is these children that tend to exhibit higher cortisol levels. If a child is rejected by their peers or seems to struggle socially, then these children are particularly prone to find childcare more physiologically challenging too. In other words, they are likely to exhibit higher cortisol levels. 

As with anything there are limitations to this research that need to be highlighted. The fact that children are not randomly assigned to lower-quality vs higher-quality daycare means that we don’t know if there is an influence of other factors at play here like the family’s characteristics, such as their income or the parent’s level of education, for example. We do know that children from a low socioeconomic background tend to have less access to high-quality daycares. We also know that children who are at-risk of abuse and neglect tend to show higher cortisol levels than children who are not at risk. In most of the studies included in this 2006 analysis, these factors were not carefully controlled making it harder to separate the effects of daycare versus these other social factors on children’s cortisol levels and stress. 

In fact, the home environment is worth highlighting here. Sometimes people assume that children who attend childcare will fare better than children who are cared for at home by their primary caregiver. This can be because people assume that the childcare environment will be more stimulating than what parents can offer at home. In the US there was a study done by the National Institute of Child Health and Human Development. They looked at the effects of childcare and the home environment on over 1,000 typically-developing children. They found that children who were cared for at home exclusively by their caregivers were no worse off than children who attended childcare. They also found that certain characteristics of the parents and families were strongly associated with children’s development than characteristics of childcare. In particular, children fared better when their parents were responsive, attentive, and sensitive to their needs. Also, families that had organised routines, provided books and play materials, as well as engaged in stimulating activities inside and outside of the home – so, this might be going to parks and libraries, for example – we saw better cognitive and social outcomes in children from these families. Regardless of whether children attend daycare or not, it’s the family and the parent’s interactions that tends to have the most impact on children’s development. 

Some people may also assume that it doesn’t matter which childcare you send your child to as most will be good enough but as we highlighted earlier there are differences in quality that should be taken into consideration when choosing to send your children to childcare. Ideally, your chosen childcare will have caregivers or teachers that show a positive attitude, who are responsive and encouraging towards the children, have appropriate physical contact with the children and discourage any negative interactions among the children. You will also want to know if the caregivers or teachers ask the children questions, show an interest in response to what the children say and respond to any vocalizations made by the children because these factors have been shown to be predictive of cognitive and language outcomes in children. 

Now I haven’t spoken much about family-run daycares but it’s important to point out here that when we speak about lower and higher-quality daycares, the study done by the National Institute of Child Health and Human Development in the US found that daycares that were not regulated or licensed, such as some home daycares, did not meet the standards of quality that regulated or licensed childcare centres did. So, it is really important that if you decide to use childcare that you consider whether the service you are using is regulated or licensed and provides a high standard of care. I think it matters less whether it’s a home daycare or family-run daycare versus a childcare centre. What matters more I think is how well the daycare adheres to established guidelines and the quality of the caregiving by the staff that work there. Remembering that children who attend high quality childcare tend to have better outcomes in terms of cognitive, language, and social development than children who attend low quality childcare services. 

It is probably worth mentioning at this point that many multiples will have additional needs. Sadly, we see the rates of certain difficulties like speech and language problems and certain disorders as being more prevalent in multiples, particularly those born prematurely. So, the question that you might be wondering now is what the outcomes for children with additional needs are. Is it better to enroll children with additional needs in childcare or not? Should we enrol them early or for more hours so that they get greater benefit? A couple of researchers named Booth and Kelly did a study with 156 young children. The children either had developmental disabilities or were at-risk of developmental disabilities. They compared children with developmental disabilities who attended childcare with those who didn’t, and they found no differences. Children with developmental disabilities who attended childcare did not show any special benefit when compared to those that didn’t. Again, the quality of the caregiving at home seemed to have the greatest influence on children’s outcomes. So, for children with additional needs, childcare is not necessarily more advantageous or harmful, and whether or not a child with additional needs attends childcare, the home environment appears to be the most important factor to consider. When it comes to whether these children should be enrolled from a very young age or for more hours, Booth and Kelly found that children with additional needs who started after 12 months of age seemed to do better than younger children. They also found that more hours in childcare did not result in better outcomes for children with additional needs. The amount of time spent in childcare didn’t seem to have an influence on the developmental outcomes of children with additional needs. 

So, where does all of this leave you?  How do you know whether to send your children to daycare or not and if you decide to, when is it the right time?

I think if you are listening to this, assuming you have a choice about whether you need to access childcare, you need to ask yourself the first question which is: do you want to?

If like the listener said you are tired of full-time parenting and you want a break, then maybe you need to consider if some form of childcare could be a good way for you to look after yourself. Remembering here, that you don’t necessarily need to send your kids to a centre for a full day, 5 times a week. I know that in some countries there are places that offer occasional childcare where you might drop your kids off for a few hours rather than a full day. In some places, there are fitness and recreation centres or gyms where you can book in an hour or 90-minute session, for example, so that you can use the facilities to train or do a class with your kids being cared for on-site. I remember I saw one recreation centre that allowed you to use the creche, the childcare facilities, and you didn’t have to use the gym. You could go off-site and do your shopping or run errands as long as you were contactable. And again, it was only for a couple of hours or so. 

So, I think when deciding whether your kids are ready or not, you need to first ask yourself, am I ready? Am I ready for them to be cared for by someone else? And if you don’t quite feel ready but part of you does want a break, remember there are other ways of achieving that like the occasional childcare examples I just highlighted but even hiring a nanny or babysitter for a couple of hours – that could be another good way of finding that time to yourself. 

If you are concerned about whether your kids are ready, like you worry about whether they will cope with being separated from you, I think this is going to depend a lot on your children’s temperament. And this can become even more complex because when you have multiples, you might find that there are differences in your individual children despite them being the same age.  As I highlighted earlier, some children find it harder to separate from their parents or primary caregiver and this might lead to them experiencing a stress response. The research I spoke about earlier showed that pattern of higher cortisol levels in these children. So, again if you have a choice and you don’t need to send your children to childcare, then you might not want to send your children if you are worried about the effects of separation anxiety. I think the good news is that you can provide a stimulating, enriching environment at home. In fact, I have already pointed out that the family environment has a greater impact on children’s development. 

But I also know that many parents find full-time caregiving hard. We need to balance your wellbeing as the primary caregiver with the wellbeing of your children. If you know that staying at home with your kids full-time is affecting your emotional wellbeing, then that’s a sign that it might be time to try some level of childcare even if you are worried about your children’s distress. Because if you choose a childcare service that is of a high standard and you are happy with the caregivers and how they interact with your children, particularly if they are really good at soothing your children if they are distressed and tuning into their needs, being attentive and all of that, then most likely childcare will not be detrimental to your children. In fact, it may be beneficial because you will get that break you need which means when you are looking after your kids again, you are in a better position to be sensitive and attuned to them. 

I think another thing to point out here is that it doesn’t have to be all or nothing and doesn’t have to be forever. I’ve already highlighted that you don’t have to send your children to a childcare centre for five, full days or even one full day. There are options for in home care or for brief periods of care. As well, if you do enrol your children in a childcare centre, you don’t have to send them for the full day and you also have permission to change your mind. If it’s not working out for you or your kids, you aren’t locked in to sending them. 

And I think that’s the beauty of having choices – you can be flexible, and you can give yourself permission to choose what’s best for you and your family given your unique needs and your children’s. What I will say is if you notice any feelings of guilt attached to the options – like if you think about sending your kids to childcare but then you feel guilty – I invite you to get curious about that and check in with yourself. Do you feel guilty because you think you should be caring for them – that you are a “bad” parent for wanting a break? If you answered yes to this question, then I’d be wondering if you are putting some unnecessary pressure on yourself. If this is something you are grappling with then you might like to check out my online program called Be Fierce Be Kind where I help parents of multiples look at how to let go of some these common, negative parental beliefs. You can find that program on my website fiercekindmama.com and click on the services tab. 

Or maybe you don’t want to send your kids to childcare, but you feel guilty because everyone else you know sends their kids to childcare and you are now worried that you might be doing something wrong? If you answered yes to this question, then I hope you can be reassured after the discussion today that a stimulating home environment can be as beneficial as a high quality daycare. 

Now, I am aware of the time, and I haven’t even touched on some of the issues that can come up around health and safety like if I send my kids to childcare, will they be sick most of the time and how do I manage that? Some of you listening to this might also be wondering about extended family – like are there any pros and cons if you have grandparents or other relatives caring for your children? These are all questions that I think we could dive into more detail so perhaps I will save those for future episodes.

For now, I want to thank you for joining me in today’s discussion and if you have any questions or feedback for me, please feel free to contact me at hello@fiercekindmama.com