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Robert H. Bradley, PhD; Deborah Lowe Vandell, PhD

Arch Pediatr Adolesc Med. 2007;161(7):669-676.

Objective  To evaluate studies of child care with specific attention to the impact of age at entry and amount, quality, and type of care on children's adaptive functioning.

Data Sources  MEDLINE, PsychINFO, and the SAGE Full-Text Collection.

Study Selection  The review considers correlational and experimental research conducted throughout the world that includes an adequate description of the type of care provided.

Main Exposures  Amount, quality, and type of child care.

Main Outcome Measures  Language, cognitive and social competence, achievement, behavioral problems, relationships with parents, communicable illnesses, and asthma.

Results  Children who began care early in life and were in care 30 or more hours a week were at increased risk for stress-related behavioral problems. Elevated risk was more likely if they had difficulties interacting with peers or had insensitive parents. Children in day care centers had higher language scores and early school achievement, especially if they came from disadvantaged backgrounds and the centers offered high-quality care. Attending arrangements with 6 or more children increased the likelihood of communicable illnesses and ear infections, albeit those illnesses had no long-term adverse consequences.

Conclusions  Child care is a multidimensional phenomenon. Guidance on when to place a child in nonparental care and what kind of care to use is complicated because of the multiplicity of sometimes offsetting effects on children. Child care experiences interact with experiences at home and the child's own characteristics, and research indicates that the quality of child care matters.

Author Affiliations: Center for Applied Studies in Education, University of Arkansas at Little Rock (Dr Bradley) and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock (Dr Bradley); and Department of Education, University of California at Irvine (Dr Vandell).

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