Quality early childhood education for under-two-year-olds: What should it look like? A literature review

Publication Details

Recent years have seen increasing participation of under-two-year-olds in early childhood education. This literature review draws together relevant research evidence to better understand what quality early childhood education for children under-two-years of age should look like.

Author(s): Carmen Dalli, E. Jayne White, Jean Rockel, Iris Duhn with Emma Buchanan, Susan Davidson, Sarah Ganly, Larissa Kus, and Bo Wang, Victoria University of Wellington.

Date Published: March 2011

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Chapter 5: Quality Outcomes for Under-two-year-olds: Updating the data on structural dimensions of quality


This chapter is organised around a set of questions that provide an easy entry point for considering the impact of different structural factors on the quality of centre-based early childhood services. The factors considered are: adult-child ratios; group sizes; quantity of care; teacher qualifications, education and experience; aspects of the physical environment such as noise levels and nutritional food. It is noted that these elements do not function independently. As discussed elsewhere in this report, research now recognises that quality is a multi-dimensional construct rather than a list of ingredients. The chapter concludes with summary points on: structural indicators of quality, factors that are recognised as barriers to positive outcomes for under-two-year-olds in early childhood provision, and what is known about the effects of ECE on under-two-year-olds.

This chapter addresses the broad question: "what is new knowledge about the links between regulable elements of early childhood education and care programmes and outcomes for under-two-year-olds?" This is to support the material provided in Chapter 4 in answering question 1 of this review:

What does research evidence suggest about what quality early childhood education for under-two-year-olds should 'look like'? What are the features or dimensions of quality? How should these vary according to the age of the child and other key factors?

Regulable elements are understood to mean structural elements of early childhood provisions and settings such as adult:child ratios, group sizes, teacher/educator characteristics like qualifications, education, and specialised training, and the physical environment of early childhood education and care settings. It bears noting that, as discussed in Chapter 2, structural characteristics are only one dimension of the equation of quality; ecological understandings of quality (e.g., Goelman et al., 2006) emphasise that structural characteristics work in conjunction with process characteristics (e.g., warmth of interaction; joint attention etc., as discussed in Chapter 4). Process characteristics ought to be considered as interacting with other contextual factors, such as philosophical beliefs within the local context, attitudes of staff, auspices of the centre, as well as organisational structure.

Goelman et al. (2006) have suggested that an alternative way of describing quality factors is to see them as elements on a continuum that ranges from proximal to distal factors. In Goelman's continuum of quality, proximal factors have a direct influence on the quality of teacher-child interaction at any given time and include teacher attitudes to their workplace and colleagues, adult:child ratios, and number of staff. Distal factors, such as government regulations, funding levels and practices like teacher registration requirements, influence quality in a less immediate way by creating "the parameters and possibilities that either facilitate or frustrate the delivery of quality child care" (p. 293). In between proximal and distal factors there are intermediate factors like staff wages, parent fees, and subsidies. Goelman et al. explained that these intermediate financial factors are not set by regulation but are decided at the level of the centre administration and organisation, and "help to define the possibilities and limitations of the actual classroom experiences of the children and staff. These three factors will logically lead to higher levels of staff satisfaction, better adult:child ratios, and the ability to put more paid staff into the classrooms" (p. 292).

This chapter deals with what is understood about the links between the elements of quality that are susceptible to regulatory or direct policy action; this covers some of what Goelman et al. (2006) have called proximal factors (i.e., adult:child ratios, but not staff attitudes) as well as distal factors like requirements about qualifications. Factors at the intermediate level of Goelman et al.'s continuum are also discussed when they are implicated in findings related to regulable elements of early childhood education and care.

Chapter 2 noted that much of what is understood about the links between structural elements of early childcare programmes originated in the findings of "second wave" childcare research published in the 1980s and 1990s. That research remains in citation in policy and pedagogical documents of various state jurisdictions (Arkansas Framework for Infant and Toddler Care Work Group, 2002; David, Goouch, Powell & Abbott, 2003; Kentucky State Department of Education, 2009; Marshall et al., 2004), in recommended standards by professional bodies like the American National Association for the Education of Young Children (NAEYC, 2008) and in manuals of quality assessment tools such as the ITERS and the more recent Classroom Assessment Scoring System or CLASS (Pianta, Le Paro, & Hamre, 2008). An extensive review of research on ratios, group size and staff qualifications and training compiled by researchers at the Thomas Coram Research Unit of the Institute of Education at the University of London (Munton et al., 2002) included a comprehensive update of that literature to the end of the 1990s.

Most recently, the National Institute for Child Health and Development (NICHD) longitudinal Study of Early Child Care (NICHD Early Child Care Research Network, 2005) has provided regular reports on its findings about "how the different aspects of care- such as quantity and quality - are related to various aspects of children's development" (Peth-Pierce, 1998, p. 2). As noted in Chapter 2, the NICHD study was set up specifically to answer such detailed questions and to go beyond global issues of whether early day care was good or bad for children.

The NICHD findings are therefore of particular interest in this chapter as they constitute some of the newest wave of 'childcare effects' literature which, as predicted by Melhuish (2001, see Chapter 3), has emerged over the last decade from longitudinal research. Fox and Rutter (2010) describe this wave of research as employing "improved developmental and statistical methods for studying the effects of early experience" (p. 23). According to the NICHD (2005), earlier methods had not studied developmental and other consequences for sufficient lengths of time. They also had employed simplistic analytical methods that did not statistically control for other factors that might predict children's performance or adjustment - such as family or parental characteristics, or quality of the home environment. Additionally, the NICHD noted that earlier studies tended to assess information about one or other aspect of childcare while neglecting others that were theoretically important to the prediction of developmental outcomes. For example, information might have been collected about the quality of childcare or the types of childcare, or the number of hours children spend in childcare, but not all three simultaneously. Consequently, it was not possible to be certain whether observed effects on children's behaviour or development were due to the unique contribution of quality, or of the number of hours spent in the childcare centre, or the interaction of the many features of the childcare experience (NICHD Early Child Care Research Network, 2005a).

Another limitation of earlier studies identified by the NICHD Early Child Care Research Network (2005a) was that in assessing childcare, researchers often relied on indirect measures of quality, such as the ratio of children to adults, or the educational training of the childcare providers. Even when studies investigated qualitative processes, including the actual behaviour of the childcare providers, the quality of the setting was assessed as a whole rather than the quality of individual children's experiences, in spite of the fact that different children have different experiences in the same childcare setting, depending on their own characteristics and biases of the providers (a point noted also by Melhuish, 2001). Finally, studies of the effects of childcare on children's development did not focus on multiple domains of outcomes, thereby restricting the opportunity for finding that the effects of a specific feature of childcare (e.g., hours or quality) may appear in one domain, and not in another (as in fact proved to be the case in the NICHD data).

As noted in Chapter 2, when the NICHD Early Child Care Research Network Study of Early Child Care initiated its large-scale prospective longitudinal study of the effects of early childcare arrangements on children's development, it tried to overcome these methodological limitations. In its initial developmental phase (1991-1994), the NICHD Early Child Care Research Network followed the development of over 1300 children at ten sites in the US from birth through age three. The results from this phase, published largely between 1999 and 2005, are the most relevant to answering the first question of this review (reproduced above) about what quality for under two's should look like. Subsequent phases of the study (Belsky, 2006; Belsky et al., 2007) followed the same children with the newest results reporting findings at age 15 years (Vandell et al., 2010).

This chapter is organised around a set of questions deemed of interest in the commissioning of this report. This is to provide an easy entry point for considering different elements of quality and is not intended to suggest these elements function independently. As noted already, research now recognises that quality is a multi-dimensional construct rather than a list of ingredients.

5.1 Adult:child ratios

5.1.1 What is the ideal adult:child ratios with under-twos?

Recommendations for staff:child ratios in settings for under-two-year-old children can be found in numerous advisory documents prepared for policy makers in different jurisdications after substantial literature reviews (e.g., the Australian Expert Advisory Panel on Quality Early Childhood Education and Child Care, 2009; Fisher & Patulny, 2004, in New South Wales; Muenchow & Marsland, 2007 in North America; Munton et al., 2002 in the UK).

The recommendations are for a preferred adult:child ratio of 1:3 (Expert Advisory Panel on Quality Early Childhood Education and Child Care, 2009; Gevers Deynoot-Schaub & Riksen-Walraven, 2008; Muenchow & Marsland, 2007; Munton et al., 2002), or for a "good enough" ratio of 1:4 (Fisher & Patulny, 2004).

Within the Canadian context, Goelman et al. (2006) noted that while an adult:child ratio of 1:4 is good, a ratio of 2:8 is better because the teachers can confer and discuss the children's activities and behaviour, a feature of infant and toddler pedagogy that they consider to be of central importance.

Munton et al. (2002) provided a comprehensive list of recommended ratios across English-speaking countries. Despite variation by country and local authorities between recommended and enforced ratios, the optimum ratio for under two-year-olds in education and care settings was consistently stated as 1:3.

5.1.2 Why are adult:child ratios important?

The recommendations derive from research in which staff:child ratios, or group sizes, have been found to be predictive of sensitive, positive caregiving and of children's early socio-emotional development (e.g., Campbell & Pungello, 2000; Leach, Barnes, Malmberg, Sylva & Stein, 2008).

Adult:child ratios are related to other measures of childcare quality. For example, the NICHD Early Child Care Research Network (2000), among others (deSchipper, Rieksen-Walraven, & Guerts, 2006; Howes, 1997), identified that the strongest and most consistent predictor of observed positive caregiving in group-based early childhood settings was the adult:child ratio. That is, caregivers provided more sensitive, frequent, and positive care when they were responsible for fewer children. The NICHD Early Child Care Research Network suggested that if parents, researchers or policymakers were searching for the single best structural indicator that would suggest that young children were receiving warm, sensitive, stimulating attention from their caregiver, the adult:child ratio would be the ideal choice (2000).

Caregivers with fewer children in their care are more sensitive, responsive, warm, nurturing, and encouraging toward the children, exhibit more positive and less negative affect, exert less negative control, and provide more varied and developmentally appropriate activities for the children than caregivers with more children in their care (Ghazvini & Mullis, 2002; Whitebook, 2003).

The NICHD (2005a) reported that the extent to which children's childcare centre settings met professional guidelines was related to developmental outcomes at 24 and 36 months; children in settings that met the guidelines for child:staff ratios had fewer behaviour problems and more positive social behaviours at both ages.

Somewhat closer geographically, Australians Milgrom and Mietz (2004) rated the quality of the interactional behaviour between twenty infants and their centre-based caregivers and noted that adult:child ratios are particularly important because of the developmental needs of infants (see also Sosinsky, Lord, & Zigler, 2007). Milgrom and Mietz found that in centres with fewer infants per caregiver there were more reciprocal and synchronous interactions signifying the importance of low ratios for responsive interactions. However, the authors highlighted that the most striking result was that positive micro-interactional behaviours between particular children and caregivers were rare. Similarly, emotional displays by infants were few and far between irrespective of the infant:caregiver ratios. This suggested that ratios by themselves were not a sufficient indicator of quality. Rather, favourable ratios provide the pre-conditions for positive interactions but the nature of the interactions may be determined by other factors, a point that strikes a chord with the comments made by Goelman et al. (2006). Milgrom and Mietz argued that while staff:child ratios are particularly important because of the developmental needs of infants, further research was needed on infant-caregiver interactions in Australian childcare settings in order to inform policy on quality childcare indicators. Goelman et al.'s (2006) findings are consistent with this argument: Using path analyses within a large Canadian study, that adult:child ratios (along with parent fees and the use of the centre as a student teacher practicum site) were an indirect predictor of quality. The direct predictors of quality for infant and toddler rooms in Goelman et al.'s study were the number of adults in the observed rooms and their education levels. In combination these findings highlight the interactive nature of structural elements of quality with other characteristics.

The issue of adult:child ratios has been particularly debated in Australia over recent years where a national policy about minimal adult:child ratios in childcare settings only came into force in December last year. In a historic announcement at its Brisbane meeting the Council of Australian Governments issued a communiquė (COAG, 2009) which set the minimum adult:child ratio for under-two-year-olds at 1:4 with an implementation date of 1 January 2012. In a study on the likely impact of the introduction of this ratio on the experiences of children and staff, and the impact on costs, fees and the supply of childcare places for children aged under two years at a time of staff shortages, Fisher and Patulny (2004) argued that a 1:4 ratio would support a "good-enough" level of quality for under-twos (p. 10). They also argued that while the direct cost of staff under an improved staff:child ratio would increase salary expenditure, the indirect cost of staff turnover might decrease, mitigating some of the salary increase.

Another study carried out by Phillips et al. (2000, cited in Fisher & Patulny, 2004) also showed that two of the most significant predictors of better classroom/centre quality for infants and toddlers are lower numbers of children per adult and higher parent fees. Consistent with Phillips et al., an English study by Leach, Barnes, Malmberg, Sylva, & Stein (2008) reported that ratios of children to adults have a significant impact on quality of care. That is, the more infants or toddlers each adult has to care for, the lower the quality of care.

Do better quality ratios increase costs to parents and affect staffing supply?

Fisher and Patulny (2004) argued that although change to a better ratio in New South Wales would lead to an increase in the operating cost of services, the results of a survey of long day care centres (PriceWaterhouseCooper, 2003) suggested that the link between cost and fees was not direct and that centres were likely to mitigate that possible cost increase in a number of ways. The PriceWaterhouseCooper (PWC) study suggested three main reasons why parental fees were unlikely to increase: Firstly, many centres already voluntarily operated a 1:4 ratio and thus would experience little or no cost increase. Secondly, competition in NSW between privately-owned and community-based centres would constrain fee increases; and thirdly, centres were likely to cross-subsidise fees across ages which the authors noted was already a common practice in centres that operated with a better than minimum staff:child ratio. Lastly, the PWC report noted that the historic increase in demand for community-based under-two places indicated that families appeared willing, and had the capacity, to pay some fee differential for care for younger children. The authors interpreted this as suggesting that a small increase in fees could be managed by these families, without affecting demand.

Commenting on whether adopting a better ratio would decrease the supply of childcare, Fisher and Patulny (2004) acknowledged that this was a short-term danger of moving from a ratio of 1:5 to a ratio of 1:4 (especially for NSW which already had low rates of provision, and such a move could reduce supply further). However, they added that the PWC report (2003, cited in Fisher & Patulny, 2004) had already demonstrated that a large reduction in the supply of places was unlikely. The report provided further details of the type of centres likely to be affected.

Fisher and Patulny (2004) argued that their research suggested that a better staff:child ratio could improve the working conditions of staff and their job satisfaction as well as reduce stress which would thus address problems that aggravate staff shortages.

5.2 Group size in under-two settings

5.2.1 What is the ideal group size with under-twos?

Goelman et al. (2006), in discussing the need for a predictive model of early childhood education in Canada, emphasised that quality with infants and toddlers depends on "maintaining the balance between adult:child ratio, the number of adults, and smaller group size" (p. 290).

In the United States, the American Public Health Association and the American Academy of Pediatrics (1992, cited in NICHD Early Child Care Research Network, 1996) advocates that group sizes in settings for under-two-year-olds should not exceed six (6) children. Experts in American childcare writing for Working Mother magazine (Cadden, 1994, cited in NICHD Early Child Care Research Network, 1996) also focused on structural characteristics (i.e., group sizes not exceeding six to eight infants and adult:child ratios not higher than 1: 4). Their argument is based on the fact that small groups and familiar caregivers provide the consistency and familiarity of interaction that is necessary for this age group.

5.2.2 Why is group size important for childcare quality?

The increased interaction and communication possible in smaller classes have been shown to affect children's outcomes. In its revised accreditation criteria NAEYC (2008) states that smaller group sizes and larger ratios of staff to children are related to positive outcomes for children, reiterating that there is a substantial amount of evidence to support this. For example, Bowman, Donovan and Burns (2000) found that children in smaller groups were more likely to participate in child-initiated activities, and that when there are fewer children in the room, teachers can more closely mediate children's social interaction.

Similarly, Vandell and Wolfe's (2002) and Phillipsen, Burchinal, Howes and Cryer's (1997) studies both found that when groups are smaller, teachers provide more stimulating, responsive, warm, and supportive interactions. They also provide more individualised attention, engage in more dialogues with children, spend less time managing children and more time in educational activities.

In the still-cited National Day Care Staffing study (Ruopp, Travers, Glantz & Coelen, 1979, cited in NAEYC, 2008; Elicker, Langill, Ruprecht & Kwon, 2007), children in smaller classes had greater gains in receptive language, general knowledge, cooperative behaviour, and verbal initiative, and showed less hostility and conflict in their interactions with others. The NICHD Early Child Care Research Network (1999) also reported a link between smaller group sizes, higher levels of caregiver education and training, and lower ratios, and higher scores on measures of cognitive and language development, and lower behavioural problems at 24 months old. Combined, these studies clearly suggest that smaller group sizes play a significant role in quality early childhood education for under-two-year-olds.

5.3 Quantity of care

5.3.1 How is quantity of care implicated in outcomes for under-two-year-olds?

The effect of quantity of care in childcare during the first two years of life has been complex to untangle and subject to hot debate.

The NICHD Early Child Care Research Network (2003; 2004) reports indicated that longer hours in childcare centres had both positive and negative effects for children . Specifically, the NICHD Early Child Care Research Network (2003, 2004) reported that more time in centre-based childcare was related to better cognitive and language outcomes and to more positive peer interaction/social competence (at 4½ years), but it was also related to higher caregiver reports of behaviour problems (from 3 months to 54 months) (see Harrison, 2008, as a review; Jacob, 2009; Vandell et al., 2010). Reporting on a childcare study in Haifa, Israel, Sagi, Koren-Karie, Gini, Ziv & Joels (2002) also noted the possibility that infants may develop a less secure attachment to their mothers from longer hours in childcare.

A later report (NICHD, 2005a) from the NICHD Early Child Care Research Network pointed out that the quantity of non-maternal care was a significant predictor of some child outcomes and these effects of quantity of childcare are mediated by the age of the child, and the quality of care. Their findings suggest that it is not simply a question of how much is enough, but how good is the quality of education and care, in determining outcomes for under-two-year-olds.

In an evaluative review of the NICHD (2003) data as part of assessing how temperament and gender might be implicated in reported effects of out-of-home childcare in infancy, Crockenberg (2003) commented that:

the amount of time in child care is associated with differences in child aggression and social competence, independent of the quality of caregiving at home and in child care. This may mean that longer hours in child care during infancy and early childhood adversely affect development even when quality of care is high, but as the interactive effect of amount and quality of care was not tested, we cannot be certain that this is the case. However, given that most of the variance in child behavior that is associated with amount of care is shared with quality and type of care (compare conservative and liberal effect sizes in Table 4 in NICHD Early Child Care Research Network, this issue, p. 976–1005), it appears that negative effects occur primarily when children spend long hours in poor-quality, center-based care. Moreover, the relatively small effect size of amount of care as a predictor of externalizing behavior and social competence is compatible with the view that only some children are negatively affected by longer hours in child care. (p. 1034, italics not in original)

Another NICHD report (2005b), however, noted that the relations between amount of time in childcare and teacher-reported externalising (behaviour expressing negativity) problems and conflict were no longer significant by the time children were evaluated in third grade (age=seven to eight years). This suggested that the early-reported negative effect dissipated over time. At the same time, the NICHD Early Child Care Research Network (2005b) found some new sleeper effects that emerged over time. For example, children who spent more hours in early childcare had poorer work habits as measured via items such as "works well independently", "uses time wisely", and "completes work promptly".

The most recent paper published from the NICHD project (Vandell, Belsky, Burchinal, Steinberg, Vandergrift and the NICHD Early Child Care Research Network, 2010) reported another sleeper (or non-linear) quality effect. The study found that both quality and quantity of childcare remained linked to adolescent functioning. Additionally, they reported that "larger gains in cognitive-academic outcomes appear to accrue when children experience care of high quality" (p. 750). Reflecting on why this finding had not been detected at an earlier age, the researchers suggested the possibility that as high school students have to work more independently than at younger school grades, those who had attended higher quality early childhood centres might "be better positioned to oversee their own achievement in high school" (p. 751).

Vandell et al. (2010) argue that this evidence of the long-term effect of early childcare quality is one of the most important findings of the 15 years report because "it occurred in a large economically and geographically diverse group of children who participated in routine non-relative childcare in their communities" (p. 750) rather than in high quality interventions, and this suggests that "the quality of early childcare experiences can have long-lasting (albeit small) effects on middle class and affluent children as well as those who are economically disadvantaged" (p. 750).

With regards to the effects of quantity of childcare, the 15 years results showed that the link between more hours of childcare and behaviour problems found at four and a half years, was maintained. In other words, more hours of early childcare predicted reports by adolescents of more risk taking. However, a relation was not found between longer hours of non-relative childcare and more externalising behaviour. Rather, high quality non-relative childcare was related to less externalising behaviour; this finding had been detected when the children were toddlers but not at four and a half years and middle childhood.

The authors concluded that although effect sizes were small, the findings were important because of the link they established between childcare effects and cognitive-academic achievement and risk-taking more than ten years after the children had left childcare.

Adi-Japha and Klein (2009), using data from the NICHD database, additionally noted that children with high quality parenting were better prepared for school and had better language skills than those with less optimal parenting. That should not be a surprise. But what was surprising was the finding that young children who had good parenting and had spent a medium amount of time in childcare (10–32 hrs) did much better on basic preschool concepts than children who had been in childcare for longer amounts of time. The results suggest that the quality of parenting and the amount of time children spend in non-relative childcare are not independent of each other; rather they interact to shape children's development, a comment repeated by Vandell et al. (2010).

In summary then, the current picture from the NICHD prospective longitudinal study in relation to the effects of quantity of care, seems to be that measures taken when children were between three months and four and a half years indicated some negative impact on the security of attachment of the children, but this was primarily when the children were in poor quality centres for long hours, and the effect was only for some of these children. By 2005, the NICHD reports showed that these negative effects had dissipated over time and some sleeper effects from long hours in childcare emerged in relation to work habits when the children were in Grade 3 (aged seven to eight years) of school. The most recent results reporting measures taken at age 15 years show that long hours of out-of-home childcare were linked to more risk-taking behaviours in adolescence. A link between high quality childcare and cognitive-academic achievement was also found. Additionally, the NICHD data show that the amount of time spent in childcare interacts with quality of parenting. As a result, it is difficult to separate these effects from one another.

5.4 Teacher characteristics: qualifications, education and experience

5.4.1 What difference does training make to quality outcomes for infants and toddlers?

Much of the literature considering effects pays attention to the notion of training as a key variable. It is important to note that when considering the impact of training on quality education for under-two-year-olds the nature of the training referred to differs by cultures, countries, states and statutes which promote specific benchmarks or thresholds to determine what constitutes 'quality' (Munton et al., 2002; Tout, Zaslow & Berry, 2005; Pessanha, Aguiar & Bairrão, 2007). 'Training' may or may not incorporate certification; and be credit-bearing at either a low or higher levels (or anything in between). Training can refer to a teacher-education qualification such as a certificate, diploma or bachelor's degree; or it may involve the ongoing, on-the-job process of professional development. Thus, the variability of training must be taken into account when reporting on studies regarding effects such as impacts on the status, working conditions and pay for the 'trained' member of staff. As Munton and her colleagues (2002) stated:

The weight of evidence suggests that the sheer complexity of early years environments makes it difficult for research to identify independent effects of individual elements including qualifications and group size. The same conclusions apply across settings and age groups. (p.109)

Despite these difficulties reported research has consistently demonstrated that high levels of training – both pre-service and in-service – are necessary for quality outcomes with infants and toddlers (Munton et al, 2002). In examining the impact of training on quality, two key aspects are implicated: firstly, the necessity for it to provide specialised professional knowledge for teachers with infants and toddlers; secondly, the need to investigate whether there is appropriate and specialised content regarding infant-toddler care and education in the relevant training or professional development programme that has accreditation, i.e., the type of qualification. A third, largely forgotten, aspect of training that was brought to the debate during the eighties, is the point that education that is not specifically early childhood related may also contribute to quality education and care for under-two-year-olds. The evidence for this argument lies primarily in the literature related to parents (or home-based educators) rather than teachers in centres and is therefore beyond the scope of this report. In contrast Howes, Whitebook & Phillips (1992, cited in Tout, et al., 2005) found that when data were analysed according to age group, education with an early childhood education focus was found to be a predictor of appropriate caregiving for infants: "For infants, education with ECE content appeared to be a more important factor in appropriate caregiving than education alone" (p. 95). This analysis showed that "training alone did not bring teachers with lower ECE educational qualifications (i.e., less than a bachelor's degree) up to the level of sensitivity and classroom quality observed by teachers holding a bachelor's degree with ECE content" (p. 92). The authors noted the limited data available about training for work with under-two-year-olds and that further study is required in the area.

Ireland (2006) made a strong argument that "it is important to recognise that education for infants and toddlers should not look like education for children of other ages" (p. 4). She draws on the caution from Katz (1999, cited in Ireland (2007) that teachers need to carefully establish what would be learned and when. In addition, she advocates that group infant-toddler education should mirror high quality home environments that provide a sense of belonging for the child with caring adults who are in tune with each child.

In a study by Hestenes, Cassidy, Hegde & Lower (2007) the higher quality provision in inclusive infant toddler classrooms compared to non-inclusive classrooms was attributed to teacher education and staff/child ratios. The study involved 466 classrooms across 82 counties with children aged 12 months to 21 months; data were gathered between 2003 and 2004 and quality was gauged using the ITERS-R scale with the higher quality measures related to differences in language/interactions, safety/organisation and parents/staff variables rather than activities in the classroom.

In a recent discussion of the challenges in relation to the design and practices in infant-toddler group programmes, Nyland (2007) stated that as the curriculum is relationship driven, adequate numbers of staff need to be involved and more time is needed to spend on interactions. She argued that trained staff (with supportive work conditions and good remuneration) are part of the quality provision involving ratios, space and group size. She expressed concern that despite research regarding intersubjectivity (see Chapter 4) and claims that the infant's growth between birth and second year is formidable (see Chapter 3), the minimum standards set by regulations have become accepted as the measure of quality.

5.4.2 Research regarding teacher qualifications

A research team based at the Thomas Coram Research Unit Institute of Education at the University of London (Munton et al, 2002) carried out a comprehensive review of the known relationships between ratios, staff qualifications and training, group size and the quality of provision in early years and childcare settings. Munton et al. (2002) concluded that teacher education and training has a mediating effect on positive child outcomes along with a number of other important variables, such as ratios, group size, staff salary, management practices and the "organisational characteristics of the setting" (p. 104). The authors note, for example, that the evidence overall suggests that group size, qualifications and training can be understood to have: "a positive influence on developmental outcomes for children. Small group sizes and better trained staff are more likely to provide environments for effective child development" (p. 10). The authors concluded with a reminder that:

while there are clearly some differences between early years sectors in the US and UK, there are important similarities. Both are heavily influenced by the same underlying philosophy: attachment theory, and both have a burgeoning private sector. Early years services in the US and the UK both have a structure of staffing based on a split system. Consequently, findings from US research are often relevant to the situation facing early years provision in the UK. In contrast, early years research and practice in mainland Europe is often based on different philosophies, and more relevant to countries with integrated services and little or no private provision. (p. 11)

In their review the authors emphasised that the types and levels of qualification among early years workers in different countries varied considerably. For example, the authors noted that changes in New Zealand and Spain – resulting from the shift from a split system (education and welfare) to an integrated system based on education – had developed a new type of early childhood professionalism (see also Dalli, 2008; Miller & Cable, 2008). This resulted in a shift in terminology from the early childhood worker to the early childhood teacher. The review described the split workforce model of teachers and childcare workers that is still found in countries such as Brazil and Britain and highlighted the differences for both groups in terms of training, pay and status. Munton et al. (2002) pointed out the disproportionate numbers of 'workers' as opposed to 'teachers' who work with infants and toddlers, suggesting that the underpinning ideologies are worth consideration:

What are the purposes of early childhood institutions and the work they undertake? How do we conceptualise or construct the young child and the early childhood worker? How do we understand concepts such as care, knowledge and learning? What pedagogical theories and practices underpin services? Different countries (or even groups within countries) do, and will, come up with different answers to these questions. (p. 72)

Dahlberg, Moss and Pence (1999, cited in Munton et al. 2002) challenged the idea of the "worker as a technician" (p. 74) as one who transmits predetermined knowledge and culture to the child, facilitating the child's development, ensuring milestones are reached with use of appropriate activities for the child's stage of development. They contrast with this the idea of the worker as a "co-constructor of knowledge and culture" (p. 74) (both the children's and their own), viewing the child as an active rather than a passive learner. Munton et al. suggest that the latter idea is consistent with Swedish reforms where all early childhood education staff working with children were, from 2001, to be trained as teachers with a minimum period of three and a half years at degree level. This included 18 months of specialised training relevant to the professional knowledge required to work with a specific age group and type of teaching. Infants and toddlers are one of those specialisations.

What difference does professional development make to quality?

Tout, et al. (2005) provided a rigorous analysis of 16 large-scale studies conducted in the United States and published in peer reviewed journals (while the datasets the studies drew on may not have come from the US) that considered the relationship between professional development and observed programme quality. They found that more professional development is associated with better quality early childhood education programmes, commenting: "the work to date is clear that more education, more education with early childhood education content, and more training, are each associated with better quality early childhood environments" (p. 105). However, it was noted that "it is not clear with respect to the threshold (or absolute level) of professional development needed to obtain a particular level of quality in the early childhood setting" (p. 94).

Tout et al. (2005) noted a range of challenges and limitations in existing research on professional development; these limit the ability to draw refined conclusions from the evidence. For example, there is a lack of specification of the content of bachelor degrees and thus a lack of comparability, along with problems with generalising findings to other environments. They proposed that greater attention was needed in the study of the input, including a closer examination of the content of various types of professional development and its effect on the output (programme quality) and greater specification about desired teacher practice.

Tout et al. (2005) concluded that the evidence, to date, suggested that quality is affected by both training and certification and argued that:

The ECE field urgently needs better specification of the features of training that are important to quality of the early childhood environment, including an examination of content, intensity, and the auspices offering the training … the ECE field will only gain a clear understanding of the levels of each of these that are critical to quality when professional development terms (e.g., a bachelor's degree in ECE) are more specific about the content and extent of course work that are needed and the requirements to demonstrate that knowledge translates into practice. (pp. 105, 106).

Degree study and a positive attitude towards infants and toddlers as learners

An important attribute that is gained as a result of a higher level qualification, according to the literature, is that of a positive attitude towards infants and toddlers and their learning. In a Sydney study Kowalski et al. (2005) examined the influence of the long-day childcare environment within a curriculum centred on play, on 48 toddlers and 37 pre-schoolers. They found that it was highly beneficial for young children's cognitive development when positive attitudes were displayed towards children by the teachers. The importance of specific education in developmental principles as a component of teacher training led to strategies employed when guiding the young children's pretend play. The authors cited another study by Arnett (1989) where teachers who gained a four-year university-based degree in early childhood education also displayed more positive behaviours.

Reporting on a case study that gave priority to employing degree qualified teachers for infants and toddlers in three community-based centres in New South Wales, Australia, Ireland (2006) points out that it is common for a university qualified teacher to be in the three to five age year group of children but not with infants and toddlers. She explains that there has been substantial discussion, research, and increasingly, practice within the field, advocating that qualities of children's experiences are affected by the staff qualifications, yet she is concerned that this is not reflected in regulations.

Ireland (2006, 2007) also provided a comprehensive review of the literature indicating strong evidence between the quality of a programme and the level of teacher education. She identified barriers to providing university qualified teachers and explored the tensions evident among service providers, government, parents and the wider community as to who pays for the funding required. Ireland added that "poor employment conditions are disincentives for early childhood professionals to remain in the workforce" (p. 5) and that the 2000 OECD Thematic Review (Press & Hayes, 2000, cited in Ireland, 2007, p. 23) cited industrial issues that indicate disparities between long-day care, preschool and school teaching. Ireland (2006) quoted McMullen and Alat (2002) who suggest that: "the knowledge and skills that are more likely to lead to the provision of high quality early care and education may more readily be present in well-educated individuals, those with 4-year degrees" (p. 3). In acknowledging that elements of the profession are moving beyond parameters set by policymakers to improve quality outcomes, she commented on emerging evidence that "about 50 percent of services which provide infant-toddler education have already improved their ratio of adults to children (Department of Community Services, 2003; Fisher & Patulny 2004)" (2006, p.5). Ireland also cited data from the Growing up in Australia longitudinal study of Australian children that showed that: "of the 221 participating infants being cared for in long day care centres across Australia, 19.7 percent had a staff member who held a bachelor degree or above working in the infants-toddlers' room" (Harrison, pers.comm., 1 February 2006, cited in Ireland, 2007).

5.4.3 Time for ongoing reflection on practice

The absence of time for ongoing and continuous training for staff to reflect on their practice, no matter which level and quality of the initial training, was raised as an additional issue in Munton et al.'s (2002) review. The authors argued that this lack of provision for ongoing training reflects an understanding of the early childhood worker as technician, rather than a reflective practitioner and researcher (as discussed above). They suggested that the provision for continuous training should be examined in relation to basic and initial training, and how these types of training might intersect. The issue of teacher motivation and beliefs responsible for relationships between ongoing professional development and quality was also raised by Tout, et al. (2005) as an area for further research.

Professional development that takes into account ongoing new ideas based on current research was also seen as essential to inform the professional understandings of teachers of under-two-year-olds, since (as outlined in Chapter 3) new knowledge is being generated constantly and, as a result, teachers of under-two-year-olds face additional challenges in their pedagogical practice (as outlined in Chapter 2). In their Early Years Report McCain & Mustard (1999) stated that:

Young children deserve the best-prepared staff to work with them. All those who work with young children and parents must understand the brain story and the relationship of play-based problem-solving learning to early brain development. The competencies that are required can be attained through different educational and experiential pathways. (p. 145)

An infant caregiving mentoring project by Fiene (2002) in Pennsylvania, US compared the intensive one-on-one mentoring approach to the more commonly used workshop training. Training interventions were found to be necessary in infant toddler programmes because of the low scores on various programme quality measures. The study employed a randomised design with two self-selected groups, either the mentoring group (with an experienced early childhood professional of five to seven years' experience as both director and teacher) or the comparison non-mentoring control group over a four-month period. The results indicated that the mentoring programme positively improved the overall quality of the classroom with caregivers becoming more sensitive to infants' needs.

5.4.4 A career structure to enhance a quality workforce

McCain and Mustard (1999) stated that staff expertise for a quality programme will require "appropriate recognition, clear career pathways and remuneration commensurate with the importance of early child development" (p. 146). To this end the authors made a policy recommendation to the Canadian government to require that "professionals who work with children are aware of the new knowledge about early child development and learning, and that new professional training programs are developed that reflect this new knowledge" (p. 158).

To support the notion of a career structure with high status and appropriate pay in recognition of professional expertise in working with infants and toddlers, Pessanha et al. (2007) argued that it is also important to have leadership from knowledgeable and experienced directors and teachers. Findings from a number of studies focusing on 0–2 or 0–3 years cited by Pessanha et al. (2007) examined the impact of structural indicators of quality such as teacher experience, pay, and director leadership experience on levels of process quality. For example, Phillipsen et al. (1997, cited in Pessanha et al. 2007) found that process quality was higher in settings for 0–24 month old infants and toddlers when teachers were more experienced, better paid, and under the leadership of experienced "directors" (p. 206).

Reflecting on her research investigating barriers to the employment of university-qualified teachers to work with infants and toddlers in Australian childcare centres, Ireland (2007) referred to the need for leadership from a leader who focuses on the service's philosophy and goals. She concluded that:

… research makes a clear link between a university qualified teachers' contribution to high quality interactions with children and staff, increased knowledge of child development, improved pedagogical outcomes and early childhood practices. (Ireland, 2007, p. 12).

Ireland also added that professionals need maturity to be able to deal with the unique, complex and ethical decisions required in working with infants and that this will only occur if competent people are brought into the field and retained by improving work and pay conditions.

5.4.5 What is appropriate content for training, teacher-education qualifications and professional development programmes?

Debates on quality in Germany have also focused on the nature of staff training (Oberhuemer, 2004) necessary to promote high quality education and care for under-two-year-olds. While it is evident that the research base is still slim, a number of qualities and attributes have been identified as highly significant in terms of preparing adults to work effectively with infants and toddlers. These identify a need for all training programmes to address the specialist pedagogies, developmental needs and structural features that are required for under-two-year-olds. For example, awareness of the implications of emotional engagement and attachment relationships for the well-being of under-two-year-olds (as discussed in Chapter 4) illustrates the important role that intimate emotional experiences play in the first years, and the significance of reflective practice for teachers as they examine their practice in this instance. Five identified areas in the training of under-two-year-old teachers are i) emotional engagement; ii) critical reflection; iii) awareness of diversity; iv) a research/evaluation focus; and v) child development knowledge.

Emotional engagement

Support for the argument that emotional aspects of a teacher's practice with infants and toddlers need to be catered for in training and professional development comes from an action research project described by Elfer and Dearnley (2007). The project involved a group of nursery staff participating in a professional development programme that specifically explored emotional experiences in professional work. The research concluded that there is a need for an ongoing culture of attention to the emotional experience of nursery staff as an increasing emphasis is currently being placed on the emotional well-being of infants and toddlers. This study, coupled with the overwhelming number of pedagogical studies (cited in Chapter 4) and the implications of attuned caregiving for development (discussed in Chapter 3), provide a strong argument for training programmes to introduce infant and toddler pedagogy as a unique and specialist framework.

Critical reflection, shared inquiry and dialogue

Macfarlane, Noble and Cartmel (2004) noted that the fast increase in women in the paid workforce has created a dilemma regarding the necessary training to prepare practitioners for important pedagogical work with infants and toddlers. The authors explain that traditional approaches to training and preparation of practitioners for work in this field do not always highlight the significance of relationships. They point out that adherence to the traditional rather than contemporary understandings of childhood, mothering and institutional care has caused much debate and contributed to a caregiving-teaching paradox that is unhelpful (a point already discussed in Chapter 4). Because of the enormous cognitive, emotional and social developments that take place in the first years, the authors call for research into teachers' experiences in infant and toddler care and education; and to reform training. They state that, as a result of this and other complexities, staff who work with infants and toddlers require specialised training and support. They call for critical reflection, and self-directed learning through shared inquiry and dialogue as a key mechanism for teachers to employ in addressing these dilemmas and promoting high quality pedagogical practice.

Understanding the contemporary diversity of children's lives

Another important subject area for infant-toddler education, as evidenced in a study of undergraduate early childhood programmes in the United States (Hallam, Buell & Ridgley, 2003), is the inclusion of subject matter in infant-toddler programmes related to young children and their families living in poverty. Findings from this study point out that while most programmes provide some type of field-based experience, the preparation of students in coping with the issues faced by children and families in poverty is not always provided. The focus on family systems and context as a microsystem for child development would suggest that a focus on adult development and methods of interacting with parents/caregivers to support children's development would exemplify ecological theory in the early childhood curriculum. The increase in early care and education services for children and families in poverty requires advocacy for child achievement and family cohesion in the long term (Gammage, 2003).

Morgan and Fraser (2007), in their overview of the current state of professional development, state that teachers need to understand the lives that children and parents lead. They cite Fuller and Kagan (2000, cited in Morgan & Fraser, 2007, p. 169) in stating that mothers living in poverty with infants in full-time, high quality childcare, "showed more positive involvement with their six-month-old children compared with poor mothers raising their children at home or those using full-time, lower quality infant care". The authors discuss how American families are fast becoming increasingly culturally diverse and that the teachers with bachelor degrees may not be from such diverse backgrounds as the children so teacher preparation may not be keeping up with the multiple needs of the increasingly diverse population of children and families. They acknowledge that systemic changes made over the last decade are dynamic, but that this needs to continue. They also recommend offering other types of qualifications such as the infant-toddler credential, which is reported as being established in 18 states in the US.

In relation to teachers understanding the lives of children and their families, Nyland's (2004) study of infants in centre contexts that hold the notion of a childcare centre as a developmental niche is promising. This notion endorses the importance of the subjectivities of caregivers' lives needing to connect with the values and beliefs of families to benefit the daily lived experiences of infants and toddlers in the context of the early childhood centre. The author points out that "children learn whatever is happening in the context and therefore the context is continually promoting experiences that help children make sense of their lives, either good or bad" (p. 35). The beliefs and values of caregivers impacted on children through the different views of infants and toddlers within this developmental niche. This same point is also highlighted in White's (2009) New Zealand study in which the subjectivities of the teacher were found to limit what she was able to recognise as learning. In this case the teacher was diploma trained but her qualification did not sufficiently take account of specific knowledge of infants or toddlers.

A research/evaluation focus

In a study investigating the impact of participation in a research mentorship team on early childhood teachers' professional identities, Nimmo and Park (2009) argue for the role of teacher as active researcher. Their study was conducted from 2003–2006 at a university laboratory childcare centre with 124 children, infants through to kindergarten, in rural New England with goals to foster collaborative inquiry. There have been increased efforts over the last two decades to understand the contribution of teachers' reflective practice to professional development and educational improvement. The authors point out that when there is an emphasis on caring for children the job is viewed more as babysitting and not as real teaching, which is also reflected in the low wages. This narrow view of teaching places emphasis on the technical role of an early childhood teacher, rather than as a reflective teacher to support pre-service teachers under their supervision to form a disposition of inquiry.

The findings of this study are particularly significant for teachers engaged in supervising preservice student-teachers in a process that facilitates respect for multiple perspectives and takes a metacognitive stance toward practice, in order to model reflective thinking. The notion of mentorship within a team approach is an effective method for promoting an inquiry approach to ongoing professional growth and lifelong learning and provides a model of how practice and research should be intertwined (Nimmo & Park, 2009).

The outcomes generated from those projects funded under New Zealand's COI action research programme that have focused on under-two-year-olds tell a similar story, as reported in Chapter 4. As Meade (2010) has pointed out, such engagement not only enhances practice within services, but provides important pedagogical information for wider dissemination. As a result, it is possible to generate new knowledge about what works for very young children in early childhood education (A summary of this new knowledge is included in Chapter 4).

5.5 What impact do factors in the physical early childhood environment have on health issues?

5.5.1 Noise levels, infections, otitis media (middle ear infection)

New Zealanders Bedford and Sutherland (2008) have drawn attention to the need to consider the effect that elements of the physical environment of early childhood settings, like crowded settings and noise levels, can have on the health of infants and toddlers, such as ear infections and other childhood illnesses. Their critique of current space requirements for infants and toddlers in New Zealand, in comparison with other countries, suggested that current standards need to be improved.

A doctoral study by McLaren (2008) investigated the noise levels in early childhood centres and the effects on children and their teachers. He found that reverberation times in most centres typically exceeded the 0.6 seconds prescribed by the Australasian standard for schools and learning spaces. Very high levels of noise were recorded in a number of centres with a significant number of children and staff members exceeding the maximum daily sound exposure of 100 percent permitted for workers in industry. Some children with a range of special needs were identified as being particularly at-risk to noise, with the most adverse outcomes reported for those experiencing sensory integration disorder. McLaren noted that while there are little or no data on how sound affects a child, compared to an adult, the early years of life are critical for the development of speech, hearing and auditory processes, as well as being the most vulnerable time for middle ear infections.

McLaren's findings support Bedford's (1999) conclusion from his investigation of the physical environments in Wellington early childhood education services, based on analyses of reports, interviews and questionnaires sent to early childhood education services that high noise levels in early childhood settings can have a significant impact on young children's stress, a point consistent with research reviewed in Chapter 3. He also concluded that:

Early Childhood Centre environments are capable of increasing the spread of non vaccine-preventable communicable diseases among the under five population and their families, with major associated costs. Gastrointestinal infections, upper respiratory infections and otitis media as a consequence of upper respiratory tract infections, are of particular concern. New Zealand notifiable diseases data, combined with Early Childhood Centre staff and parent comments, indicate that these infections are a significant quality of life issue for the Early Childhood Centre community. (p. i)

Vernon-Feagans and Manlove (2005) noted that many young children suffer from frequent and long bouts of otitis media (OM) or and accompanying mild-to-moderate hearing loss. They argued that OM is a risk factor for children's overall development because infants (aged 12–18 months old) with chronic OM have been found to attend less to language in childcare, are rated by their mothers as having poorer attention, and are observed to use fewer gestures in interaction with their parents (Feagans, Kipp, & Blood, 1994, cited in Vernon-Feagans & Manlove, 2005). Furthermore, children who experienced chronic OM during the first three years of life initiated fewer verbal exchanges and played more by themselves in childcare during free play, even when they were well, compared to children who did not have chronic problems with OM (Vernon-Feagans, Manlove, & Volling, 1996, cited in Vernon-Feagans & Manlove). In a study that investigated the combined effects of OM and the quality of childcare, Vernon-Feagans and Manlove followed 72 children with OM who began childcare in infancy (i.e., before the age of 1 year) to 24 months when they were observed when they were well. They reported that children with chronic OM and low quality care exchanged more negative gestures with peers, initiated fewer verbal approaches to teachers and peers and were spoken to less by teachers and peers in comparison to all other children.

Vernon-Feagans and Manlove (2005) concluded that research needs to explore the quality of the childcare context as a possible moderator of the effects of OM because this context is an increasingly common one for infants and young children (Vernon-Feagans & Manlove, 2005). They also emphasised that future research seeking to understand the conditions under which OM might have effects on development needs to use a "cumulative risk/moderator model" because:

otitis media, like other early childhood risk factors may only lead to negative outcomes in combination with other adverse conditions, as has been found in other cumulative risk studies… It is not clear all the processes in low quality child care that might be implicated in the effects found in this study…It would be important in future studies to understand not only the factors in low quality care that might exacerbate the effects of chronic otitis media but the possible buffering effects that high quality child care and rich home environments might have on children's communicative behavior. (p. 324)

In other words, early experience with OM may not always produce negative effects because supportive environments could buffer children against negative outcomes. For example, children with chronic OM may do well in language rich environments where there are many high quality one-to-one interactions with adults that help children compensate for the hearing loss associated with OM. On the other hand, poor environments that do not promote high quality language interactions may actually exacerbate the negative effects of OM, producing an interaction between the quality of care and experience with OM. Vernon-Feagans and Manlove concluded that children with chronic OM who are also in poor environmental settings may be the group at highest risk of poor outcomes.

Within the longitudinal NICHD Study of Early Child Care (2005) (total sample=1364) researchers have confirmed that children attending childcare centres and childcare homes had more ear infections and upper respiratory illnesses than children cared for at home, especially during the first two years of life. Furthermore, the number of other children in the childcare setting was also positively related to frequency of upper respiratory illnesses and gastrointestinal illnesses through to age three years. However, these heightened rates of illness did not seem to have significant adverse developmental consequences over the first three years of life.

Is there evidence of long-term impact from the increased rate of childhood illnesses in the first two years?

According to the longitudinal NICHD (2005) study, although attending non-parental care centres increases the possibility of having communicable illnesses, there was no evidence that this led to later health problems. Rather, the NICHD (2005) report indicated that at age two, children who were being cared for in childcare centres and childcare homes did better on measures of cognitive and language development than children in other forms of care. By age three, greater cumulative experience in centre care and early experience in childcare homes were both associated with better performance on cognitive and language measures than other forms of care, assuming comparable quality of the caregiving environment. At 54 months cumulative experience in centre care continued to be positively associated with performance on cognitive and linguistic measures. Furthermore, experience with group care (settings with at least three other children, not counting siblings), whether in centres or childcare homes, made some difference in several social-emotional outcomes at age two and three years. Specifically, children with more cumulative experience in group care showed more cooperation with their mothers in the laboratory at age two, less negative laboratory interaction with their mothers at age 3 and fewer caregiver-reported behaviour problems at both ages. However, greater group experience before 12 months was associated with more mother-reported behaviour problems at age 3. This has been interpreted as suggesting that benefits from group care may begin in the second year of life.

5.5.2 Food, obesity and physical activity

The increasing health issue of obesity among American children led Story, Kaphingst and French (2006) to argue that more attention should be directed to the food and physical activity offered in childcare settings to help stem childhood obesity. They reported that The Feeding Infants and Toddlers Study in the US, with a national random sample of 3,022 infants and toddlers aged four to twenty-four months, showed that energy intakes were higher than recommended (Devaney et al., 2004, cited in Story et al., 2006). Specifically, up to a third of children aged seven to twenty-four months ate no vegetables or fruit on the day of the dietary survey. For fifteen- to eighteen-month-olds, the vegetable most commonly eaten was French fries. Although Devaney et al. did not distinguish between foods and beverages consumed at home and at childcare, the results of their study suggest the need to be alert to young children's diets.

Making a similar point within the Australian context, Smith (2003) argued that food eaten in childcare centres is important not only to young children's nutritional intake but also to the development of good eating habits. She outlined some strategies adopted in Australian childcare centres to promote healthy eating, arguing that many childcare centres still had menus that were low in calcium, iron, zinc, and energy. Referring to research from the US, Smith argued that nutrition education delivered through health services to caregivers can decrease the prevalence of malnutrition in childcare settings where access to food is not a limiting factor (Penny, et al. 2005). At the same time, she argued that some staff-parent interactions, such as involvement in menu planning, nutrition policy development, and provision of information to parents in newsletters and pamphlets, should be encouraged (Smith, 2003).

With regards to the links between obesity and specific foods, the American Academy of Pediatrics (American Academy of Pediatrics, Committee on Nutrition, 2001, cited in Story et al., 2006) recommends that children aged one to six should drink no more than four to six ounces (approx. 118–177ml) of fruit juice a day. Although evidence about the link between juice consumption and overweight is mixed, Story et al. point out that fruit juice and fruit drinks are easily overconsumed by toddlers and young children due to many reasons. For example, because juice is viewed as nutritious, childcare providers or parents may not set limits. However, like other sweetened drinks, too much juice can contribute to obesity. Story et al. suggest that whole fruit should be encouraged as an alternative because of the fibre benefit and because whole fruit takes longer to eat.

Story et al. (2006) called for more research on the current food environment in childcare centres, including what foods are served, their nutritional quality, and staff training on nutrition. At the same time, to prevent obesity, Story et al. suggested that physical activities in childcare settings need to be promoted through structured and unstructured play.


The finding by Arenz, Rückerl, Koletzko and von Kries' (2004) that "breastfeeding might have a small but consistent protective effect against obesity in children" (p. 1247) offers another possible pathway through which obesity might be prevented. Arenz et al. arrived at this conclusion through a systematic review and meta-analysis of published epidemiological studies comparing early breast-feeding modes and adjusting for potential confounding factors. While the exact mechanisms for this effect remain unknown, the authors are clear about the "role of breastfeeding in the reduction of the prevalence of obesity in later life" (p. 1254).

The association between breastfeeding and prevention of obesity is only one of many claims about the benefits of breastfeeding which has led to advocacy for better support in childcare centres for mothers who wish to continue breastfeeding their child in early childhood education and care services (Akitt, 2007; Banks, 2005; Bartle & Duncan, 2009; Farquhar & Galtry, 2003; Mortlock, 2009; National Breastfeeding Advisory Committee of New Zealand, 2009). Beyond the numerous documented health benefits (e.g., pediatric immunological benefits and fewer gastrointestinal disorders – see Arenz et al., 2004) there are more controversial claims of a connection between breastfeeding and cognitive gains, including by the American Academy of Pediatrics (Soliday, 2007). Soliday, however, has cautioned that advocacy for breastfeeding on the basis of cognitive benefits is "premature" (p. 19) and "unwarranted" (p. 23); she calls for "a stronger developmental perspective" that among other aspects would include research designs "precisely defining infant feeding practices, establishing the mechanisms of feeding effect on cognition, ...addressing the stability of infants' cognitive test scores, as well as the clinical significance of test score differences among various feeding groups" (p. 19). Soliday does, however, agree that there are important practice and policy implications from research on breastfeeding; she urges that when these are drawn they must also take account of the cultural context in which particular infant feeding practices have their history.

5.6 Are boys and girls affected differently by the quality of childcare in the first two years?

One study (Crockenberg, 2003) within our search data argued that the issue of gender (and temperament) differences in responses to childcare needs more attention by researchers. Crockenberg pointed to earlier research by Howes and Olenick (1986, cited in Crockenberg, 2003) and the NICHD Early Child Care Research Network (1997, cited in Crockenberg, 2003) which had reported that boys of a toddler age were more adversely affected by lower quality childcare than girls after controlling for a number of other predictors.

The NICHD study had also reported that boys were more likely than girls who experienced more than 30 hours a week of nonparental care to be insecurely attached at 15 months. Crockenberg argued that although the gender differences in the attachment results had failed to be replicated at later ages (p. 1035), they seemed consistent with other evidence that boys responded to some aspects of early daycare (e.g., in measured cortisol levels over the day) differently to girls. She linked this to evidence that by the middle of the first year, girls have been found to be better able to regulate negative arousal than boys (Weinberg, Tronick, Cohn, & Olson, 1999, cited in Crockenberg, 2003); this may allow girls to behave more competently when they are stressed. Crockenberg noted further that untangling the way that different variables worked to produce these results was complex and suggested that existing measures of quality may not be sophisticated enough to distinguish the effect of the environment on infants and young children who are "easily stressed and lack the capacity to calm themselves" (p. 1036). She suggested that changes in full-time, center-based childcare are needed to reduce stress experienced by some children and their providers. In the meantime, she recommended that "professionals have an obligation to inform parents and childcare providers that males and reactive children who lack adequate regulatory abilities may be adversely affected when they spend long hours in certain types of nonparental care" (p. 1036).

Exploring whether there were associations between patterns of childcare centre activities and the ethnicity, gender and age for 2,194 children from 192 randomly selected centres in Florida, Tonyan and Howes (2003) found no significant gender differences for children aged between 10 and 36 months. For older children, a gender difference was found with boys favouring activities that involved "slightly higher levels of gross motor play" (p. 138). Similarly to Crockenberg, Tonyan and Howes call for more research to explore what contributed to such findings.

In the most recent report from the NICHD project (Vandell et al., 2010) gender was not found to be a significant moderator of childcare effects either in cognitive-academic performance or problem behaviours. The authors hypothesise that "perhaps secular changes in the 1990s, when maternal employment and nonmaternal childcare became normative (i.e., characteristic of the majority of households in the United States) contributed to the similar developmental pathways among adolescent boys and girls observed in this study" (p. 752).

5.7 Summary points

In answering the question "what is new knowledge about the links between regulable elements of early childhood education provision and outcomes for under-two-year-olds?" this chapter has emphasised that structural elements of quality are only one dimension of the equation of quality. Ecological understandings of quality (e.g., Goelman, et al., 2006) emphasise that structural characteristics work in conjunction with process characteristics and interact with other contextual factors in a web of influences, such as philosophical beliefs within the local context, attitudes of staff towards children, auspices of the centre, as well as organisational structure. This is in tune with findings from the last decade of NICHD studies which have provided detailed understandings on how different aspects of care are related to various aspects of children's development.

5.7.1 Structural indicators of quality

Focusing on research indications about how specific structural, and regulable, components of provision enable higher quality provision for under-two-year-olds in early childhood centres, the following findings are relevant:

  1. Adult:child ratios of 1:3 are considered ideal (Expert Advisory Panel on Quality ECE and Child Care, 2009; Muenchow & Marsland, 2007; Munton et al., 2002) to enable the style of interaction needed for optimal outcomes for children (see Chapter 4). But ratios by themselves are not sufficient to guarantee good outcomes; they interact with other factors.
  2. Ratios provide pre-conditions for positive interactions, but the nature of the child-teacher interactions may be determined by other factors (Goelman et al., 2006; Milgrom & Mietz, 2004). Ratios interact with higher levels of staff satisfaction, which interact with other factors like appropriate levels of remuneration (Goelman, et al., 2006). Together, these factors help define the possibilities and limitations of experiences for children and staff.
  3. The higher cost of staff with an improved staff:child ratio can be mitigated by low staff turnover as improved working conditions and job satisfaction reduce stress (Fisher & Patulny, 2004).
  4. Qualified staff with up-to-date professional understandings of under-two-year-olds have positive effects: "All those who work with young children and parents must understand the brain story and the relationship of play-based problem-solving learning to early brain development" (McCain & Mustard, 1999, p. 145).
  5. High levels of training – both pre-service and in-service – are necessary for quality outcomes with infants and toddlers (Munton et al., 2002).
  6. Content for training, teacher-education qualifications and professional development programmes for work with infants and toddlers must be relevant to the age group and reflect what is known about infant learning and development (Elfer & Dearnley, 2007; Hallam, Buell & Ridgley, 2003; Macfarlane, Noble & Cartmel, 2004).
  7. The content of undergraduate programmes of early childhood teacher education should additionally (to preceding bullet point) include: (i) critical reflection; (i) a focus on understanding the diversity of children's and families' contemporary lives (McFarlane et al., 2004); and (iii) a research and evaluation focus (Nimmo & Park, 2009).
  8. Mentoring of less experienced staff by more experienced staff can be an effective professional development model in enhancing sensitivity to infants (Fiene, 2002).
  9. There is a link between higher level qualifications and a positive attitude towards infants and toddlers and their learning (Arnett, 1989; Kowalski et al., 2005).
  10. Inclusive practices with infants and toddlers are associated with higher levels of teacher education and ratios (Hestenes et al., 2007).
  11. Having the possibility of a career structure, with high status that recognises the professional expertise of staff, is seen as benefitting quality (McCain & Mustard, 1999).

5.7.2 Factors that are recognised as barriers to positive effects

  1. Large group size, untrained staff, high child:staff ratios (Munton et al., 2002).
  2. Variability of levels of training. 'Training' can refer to a certificate, diploma or bachelor's degree, or involve on-the-job professional development.
  3. Low status, lack of appropriate pay in recognition of professional expertise in working with infants and toddlers leading to high staff turnover, and therefore lack of career structure and leadership from knowledgeable and experienced directors and teachers (Ireland, 2007; Nyland, 2007; Pessanha, Aguiar & Bairraeo, 2007).
  4. Lack of professional development of staff is related to lower programme quality (Ireland, 2007; Tout, et al., 2005).
  5. Lack of optimal environmental factors, such as high noise levels, infections, otitis media (Bedford & Sutherland, 2008; McLaren, 2008; Vernon-Feagans & Manlove, 2005); along with lack of knowledge about appropriate nutrition for infants and toddlers (Story, et al., 2006).

5.7.3 Indications from recent research about the effects of early childhood education in the first two years

  1. Higher quality care is associated with more positive outcomes and fewer negative ones (Jacob, 2009; NICHD, 2004). Quality in these studies is defined as:
  • more highly-educated caregivers
  • lower ratios of children to caregivers
  • positive social interactions promoted.
  1. The NICHD study has shown that high quality centre-based early childhood education and care is related to larger cognitive-academic outcomes for children at age 12 years (Belsky et al., 2007), and higher quantity of care predicts more teacher reported externalising (negative) behaviours (Belsky et al., 2007). These outcomes are maintained into adolescence (Vandell et al., 2010).
  2. This finding is important because it shows the benefits of routine high quality early childhood education for all children not just those enrolled in intensive high quality intervention programmes (Vandell et al., 2010).
  3. Recent results from the longitudinal NICHD study (Adi-Japha & Klein, 2009; Belsky et al., 2007; Vandell et al., 2010) emphasise that parenting quality is also connected to the effects of centre-based childcare.
  4. Reports of more behaviour problems associated with increased use of childcare in infancy appear mediated by the age of the child and quality of care (Jacob, 2009; NICDH, 2005). Small effect sizes of the connection between quantity of hours in childcare and more externalising behaviour (expressed as risk-taking behaviour) are maintained into adolescence (Vandell et al., 2010).

Given the interrelated nature of different structural elements in the construction of a quality experience for children and their families within centre-based early childhood provision, a key implication from the studies reviewed in this chapter is that any changes to regulable elements of quality are likely to have repercussions beyond the immediate change of the element itself.


  • Adi-Japha, E., & Klein, P. (2009). Relations between parenting quality and cognitive performance of children experiencing varying amounts of childcare. Child Development, 80(3), 893–906.
  • Akitt, C. (2007). Enhancing infant health and development by supporting breastfeeding mothers. The First Years. Nga Tau Tuatahi NZ Journal of Infant and Toddler Education, 9(1), 31–34.
  • American Public Health Association & American Academy of Pediatrics. (1992). Caring for our children: National health and performance standards: Guidelines for out-of-home child care programs. Ann Arbor, MI: Author.
  • Arenz, S. R., Koletzko, B., & Von Kries, R. (2004). Breast-feeding and childhood obesity: A systematic review. International Journal of Obesity & Related Metabolic Disorders, 28(10), 1247–1256.
  • Arkansas Framework for Infant and Toddler Care Work Group. (2002). Arkansas framework for infant and toddler care. Little Rock, AR: The Arkansas Division of Child Care and Early Childhood Education.
  • Arnett, J. (1989). Caregivers in day-care centers: Does training matter? Journal of Applied Developmental Psychology, 10, 541–552.
  • Banks, S. (2005). A place for breastfeeding in early childhood centres. The First Years: Nga Tau Tuatahi NZ Journal of Infant and Toddler Education, 7(1), 27–30.
  • Bartle, C., & Duncan, J. (2009). Ten steps for the protection, promotion and support of breastfeeding in early childhood (Draft). Consultation document distributed to the early childhood sector before submission to the Ministry of Health, New Zealand.
  • Bedford, M. (1999). A needs assessment of early childhood centres with respect to non vaccine-preventable communicable diseases. Unpublished Master of Public Health thesis, University of Otago.
  • Bedford, M., & Sutherland, K. (2008). Early childhood education and care in New Zealand: Do we have a runaway train? The First Years Nga Tau Tuatahi NZ Journal of Infant and Toddler Education, 10(1), 38–42.
  • Belsky, J. (2006). Early child care and early child development: Major findings of the NICHGD Study of Early Child Care. European Journal of Developmental Psychology, 3(1), 95–110.
  • Belsky, J., Vandell, D. L., Burchinal, M., Clarke-Stewart, K. A., McCartney, K., Owen, N. T., & NICHD Early Child Care Research Network. (2007). Are there long-term effects of early child care? Child Development, 78(2), 681–701.
  • Bowman, B. T., Donovan, M. S., & Burns, M. S. (Eds.). (2000). Eager to learn: Educating our preschoolers. Washington, DC: National Academy Press.
  • Campbell, F. A., & Pungello, E. (2000). High quality child care has long-term educational benefits for poor children. Presentation at Head Start's Fifth National Research Conference: Developmental and contextual transitions of children and families: Implications for research, policy and practice. Washington, DC.
  • COAG (2009). Council of Australian Governments' communiquė at its December 2009 meeting in Brisbane.
  • Crockenberg, S. C. (2003). Rescuing the baby from the bathwater: How gender and temperament (may) influence how child care affects child development. Child Development, 74, 1034–1038.
  • Dalli, C. (2008). The new teacher in New Zealand. In L. K. Miller & C. Cable (Eds.), Professionalism in the early years (pp. 142–153). London: Hodder Arnold.David, T., Goouch, K., Powell, S., & Abbott, L. (2003). Birth to three matters: A review of the literature compiled to inform The Framework to Support Children in their Earliest Years.
  • Department for Education and Skills Research Report, 444.
  • deSchipper, E., Rieksen-Walraven, M., & Guerts, S. (2006). Effects of child-caregiver ratio on the interactions between caregivers and children in child care centers: An experimental study. Child Development, 77, 861–864.
  • Elfer, P., & Dearnley, K. (2007). Nurseries and emotional well-being: Evaluating an emotionally containing model of professional development. Early Years, 27(3), 257–279.
  • Elicker, J., Langill, C. C., Ruprecht, K., & Kwon, K-A. (2007). Paths to QUALITY: Child care quality rating system for Indiana. What is its scientific basis? Indiana: Purdue University.
  • Expert Advisory Panel on Quality Early Childhood Education and Child Care. (2009). Towards a national quality framework for early childhood education and care: Report of the expert advisory panel on quality early childhood education and care. Canberra, Australia: DEEWR.
  • Farquhar S., & Galtry, J. (2003). Developing breastfeeding-friendly childcare to support mothers in paid employment and studying. Equal Employment Opportunities' Contestable Fund Project.
  • Fiene, R. (2002). Improving child care quality through an infant caregiver mentoring project. Child & Youth Care Forum, 31(2), 79–87.
  • Fisher, K., & Patulny, R. (2004). Impact of staff ratios on under 2 year olds in children's services (No. 07334216521446-4179). Kensington, NSW, Australia: SocialPolicy Research Centre.
  • Fox, N. A., & Rutter, M. (2010). Introduction to the special section on the effects of early experience on development. Child Development, 81(1), 23–27.
  • Gammage, P. (2003). The sacred and the profane in early childhood: An Englishman's guide to context and policy. Contemporary Issues in Early Childhood, 4(3), 337–356.
  • Gevers Deynoot-Schaub, J., & Riksen-Walraven, J. M. (2008). Infants in group care: Their interactions with professional caregivers and parents across the second year of life. Infant Behavior & Development, 31(2), 181–189.
  • Ghazvini, A., & Mullis, R. L. (2002). Center-based care for young children: Examining predictors of quality. The Journal of Genetic Psychology, 163, 112–125.
  • Goelman, H. B., Forer, P., Kershaw, G., Doherty, G., Lero, D., & LaGrange, A. (2006). Towards a predictive model of quality in Canadian child care centres. Early Childhood Research Quarterly, 21(3), 280–295.
  • Hallam, R., Buell, M. J., & Ridgley, R. (2003). Preparing early childhood educators to serve children and families living in poverty: A national survey of undergraduate programs. Journal of Research in Childhood Education, 18(2), 115–124.
  • Harrison, L. J. (2008). Does child care quality matter? Family Matters, 79, 14–25.
  • Hestenes, L. L., Cassidy, D. J., Hegde, A. V., & Lower, J. K. (2007). Quality in inclusive and noninclusive infant and toddler classrooms. Journal of Research in Childhood Education, 22(1), 69–84.
  • Howes, C. (1997). Children's experiences in center-based child care as a function of teacher background and adult-child ratio. Merrill-Palmer Quarterly, 43(3), 404–425.
  • Ireland, L. (2006, November). When babies have teachers: A study of how three community-based children's services employ early childhood teachers in infant-toddler programs. Paper presented at the Australian Association for Research in Education (AARE) Conference, University of South Australia, Adelaide.
  • Ireland, L. (2007). Life is good for babies: The pedagogical and management decisions enabling a teacher to be employed in a rural infant-toddler program. Education in Rural Australia, 17(2), 21–36.
  • Jacob, J. I. (2009). The socio-emotional effects of non-maternal childcare on children in the USA: A critical review of recent studies. Early Child Development and Care, 179(5), 559–570. doi: 10.1080/03004430701292988
  • Kentucky State Department of Education. (2009). Building a strong foundation for school success: Kentucky's early childhood standards. Frankfork, KY: Kentucky State Department of Education.
  • Kowalski, H. S., Wyver, S. R., Masselos, G., & de Lacey, P. (2005). The long-day childcare context: Implications for toddlers' pretend play. Early Years, 25(1), 55–65.
  • Leach, P., Barnes, J., Malmberg, L.-E., Sylva, K., & Stein, A. (2008). The quality of different types of child care at 10 and 18 months: A comparison between types and factors related to quality. Early Child Development and Care, 178, 177–209.
  • Marshall, N. L., Creps, C., Burstein, N. R., Roberts, J., Glantz, F. B., & Robeson, W. W. (2004). The cost and quality of full-day year-round early care and education in
  • Massachusetts: Infant and Toddler Classrooms. Massachusetts: Wellesley Center for Women.
  • McCain, M. N., & Mustard, J. F. (1999). Reversing the real brain drain: Early years study: Final report. Toronto: The Canadian Institute for Advanced Science.
  • Mcfarlane, K., Noble, K., & Cartmel, J. (2004). Pedagogy in the nursery: Establishing practitioner partnerships in high-quality long day care programs. Australian Journal of Early Childhood, 29(4), 38–44.
  • McLaren, S. J. (2008). Noise in early childhood education centres: The effects on the children and their teachers. Unpublished thesis for Doctor of Philosophy at Massey University, Wellington.
  • Melhuish, E. (2001). The quest for quality in early day care and preschool experience continues. International Journal of Behavioural Development, 25(1), 1–6.
  • Milgrom, J., & Mietz, A. (2004). Quality of infant experience in day care. Australian Research in Early Childhood Education, 11, 39–50.
  • Miller, L. K., &. Cable, C. (Eds.).(2008). Professionalism in the early years. London: Hodder Arnold.
  • Morgan, G. G., & Fraser J. (2007). In C. J. Groark (Ed.), Professional development and higher education systems to develop qualified early childhood educators: Evidence-based practices and programs for early childhood care and education (pp. 159–180). Thousand Oaks, CA: Corwin Press.
  • Mortlock, A. (2009). Keeping a-breast of it: Raising a breastfeeding-consciousness in care and education. The First Years Nga Tau Tuatahi NZ Journal of Infant and Toddler Education, 11(2), 9–12.
  • Muenchow, S., & Marsland, K. W. (2007). Beyond baby steps: Promoting the growth and development of U.S. child-care policy. In J. L. Aber (Ed.), Child development and social policy: Knowledge for action. APA Decade of Behavior volumes (pp. 97–112). Washington, DC, American Psychological Association.
  • Munton, T. Mooney, Moss, P., Petrie, P. Clark, A., & Woolner, J. (2002). Research on ratios, group size and staff qualifications and training in early years and childcare settings. Research Report No.320. London: Thomas Coram Research Unit, Institute of Education, University of London.
  • NAEYC (National Association for the Education of the Young Child). (2008). Overview of the NAEYC Early Childhood Programme Standards and accreditation criteria. 
  • National Breastfeeding Advisory Committee of New Zealand. (2009). National strategic plan of action for breastfeeding 2008–2012: National Breastfeeding Advisory Committee of New Zealand's advice to the Director-General of Health. Wellington: Ministry of Health.
  • NICHD Early Child Care Research Network. (1996). Characteristics of infant child care: Factors contributing to positive caregiving. Early Childhood Research Quarterly, 11, 269–306.
  • NICHD Early Child Care Research Network. (1999). Child outcomes when child care centre classes meet recommended standards for quality. American Journal of Public Health, 89, 1072–1077.
  • NICHD Early Child Care Research Network. (2000). Characteristics and quality of child care for toddlers and preschoolers. Applied Developmental Science, 4, 116–135.
  • NICHD Early Child Care Research Network. (2003). Does amount of time spent in child care predict socio-emotional adjustment during the transition to kindergarten? Child Development, 74(4), 976–1005.
  • NICHD Early Child Care Research Network. (2004). Type of child care and children's development at 54 months. Early Childhood Research Quarterly, 19(2), 203–230.
  • NICHD Early Child Care Research Network. (2005a). Child care and child development: Results from the NICHD study of early child care and youth development. New York: The Guilford Press.
  • NICHD Early Child Care Research Network. (2005b). Familial factors associated with the characteristics of nonmaternal care for infants. In Child care and child development: Results from the NICHD study of early child care and youth development (pp. 109–126). New York: Guilford Press.
  • NICHD Early Child Care Research Network. (2006). Child-care effect sizes for the NICHD study of early child care and youth development. American Psychologist, 61(2), 99–116.
  • Nimmo, J. (2009). Engaging early childhood teachers in the thinking and practice of inquiry: Collaborative research mentorship as a tool for shifting teacher identity. Journal of Early Childhood Teacher Education, 30(2), 93–104.
  • Nyland, B. (2004). The Australian child-care centre as a developmental niche. Journal of Australian Research in Early Childhood Education, 11(2), 27–38.
  • Nyland, B. (2007). Education, care and rights of children under three: Is there a crisis at the policy, theoretical and practical level. In AARE refereed conference proceedings. Adelaide.
  • Oberhuemer, P. (2004). Controversies, chances and challenges: Reflections on the quality debate in Germany. Early Years: Journal of International Research and Development, 24(1). 9–21.
  • Penny, M. E., Creed-Kanashira, H. M., Robert, R. C., Narro, M. R., Caulfield, L. E., & Black, R. E. (2005). Effectiveness of an educational intervention delivered through the health services to improve nutrition in young children: A cluster-randomised controlled trial. The Lancet, 365, 1863–1872.
  • Pessanha, M., Aguiar, C., & Bairrāo, J. (2007). Influence of structural features on Portuguese toddler child care quality. Early Childhood Research Quarterly, 22(2), 204–214.
  • Peth-Pierce, R. (1998). The NICHD study of early child care. National Institute of Child Health and Human Development: Public Information and Communications Branch. 
  • Phillipsen, L. C., Burchinal, M. R., Howes, C., & Cryer, D. (1997). The prediction of process quality from structural features of child care. Early Childhood Research Quarterly, 12, 281–303.
  • Pianta, R. C., La Paro, K. M., & Hamre, B. (2008). Classroom assessment scoring system (CLASS) manual. Pre-K. Baltimore. Paul H. Brookes.
  • PriceWaterhouseCoopers (PWC). (2003). Within and beyond the classroom door: Assessing quality in child care centers. Early Childhood Research Quarterly, 15(4), 475–496.
  • Sagi, A., Koren-Karie, N., Gini, M., Ziv, Y., & Joels, T. (2002). Shedding further light on the effects of various types and quality of early child care on infant-mother attachment relationship: The Haifa Study of Early Child Care. Child Development, 73(4), 1166–1186.
  • Smith, A. (2003, May). Promoting healthy eating in early childhood services. Paper presented at the Our children, the future 3: Early Childhood Conference, Adelaide Convention Centre.
  • Soliday, E. (2007). Infant feeding and cognition: Integrating a developmental perspective. Child Development Perspectives, 1(1), 19–25.
  • Sosinsky, L. S., Lord, H., & Zigler, E. (2007). For-profit/nonprofit differences in center-based child care quality: Results from the National Institute of Child Health and Human Development
  • Study of Early Child Care and Youth Development. Journal of Applied Developmental Psychology, 28(5–6), 390–410.
  • Story, M., Kaphingst, K. M., & French, S. (2006). The role of child care settings in obesity prevention. The Future of Children. Special Issue: Childhood Obesity, 16, 143–168.
  • Tonyan, H. A., & Howes, C. (2003). Exploring patterns in time children spend in a variety of child care activities: Associations with environmental quality, ethnicity, and gender. Early Childhood Research Quarterly, 18, 121–142.
  • Tout, K., Zaslow, M., & Berry, D. (2005). Quality and qualifications: Links between professional development and quality in early care and education settings. In M. Zaslow & I. Martinez-Beck (Eds.), Critical issues in early childhood professional development. Baltimore: Brooks.
  • Vandell, D. L., & Wolfe, B. (2002). Child care quality: Does it matter and does it need to be improved? USAL Institute for Research on Poverty, University of Wisconsin-Madison.
  • Vandell, D. L., Belsky, J., Burchinal, M., Steinberg, L. D., Vandegrift, N., & NICHD Early Child Care Research Network. (2010). Do effects of early child care extend to age 15 years? Results from the NICHD Study of early child care and youth development. Child Development, 81(3), 737–756.
  • Vernon-Feagans, L., & Manlove, E. E. (2005). Otitis media, the quality of child care, and the social/communicative behavior of toddlers: A replication and extension. Early Childhood Research Quarterly, 20, 306–328.
  • White, E. J. (2009). Assessment in New Zealand early childhood education: A Bakhtinian analysis of toddler metaphoricity. Unpublished PhD thesis, Monash University, Melbourne.
  • Whitebook, M. (2003). Bachelors degrees are best: Higher qualifications for pre-kindergarten teachers lead to better learning environments for children. Washington, DC: The Trust for Early Education.
  • Zaslow, M. S., & Hayes, C. D. (1986). Sex differences in children's responses to psychosocial stress: Toward a cross-context analysis. In M. Lamb & B. Rogoff (Eds.), Advances in developmental psychology (Vol. 4, pp. 289–337). Hillsdale, NJ: Erlbaum.


  1. Later renamed the NICHD Study of Early Child Care and Youth Development (NICHD Early Child Care Research Network, 2005)

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