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Why Quality Matters in Early Child Care: AAP Policy Explained

Currently, more than half of children under 5 in the United States regularly attend some type of out-of-home child care or preschool program. These children's experiences in these settings will affect their future lives. For many families, unfortunately, high-quality early education and child care is not available or affordable.

In an effort take steps forward to address the issues at hand, the American Academy of Pediatrics (AAP) policy statement, Quality Early Education and Child Care from Birth to Kindergarten, outlines both the importance of quality early education and child care and what your pediatrician can do to help you find it near you.

Quality vs. Cost and Convenience:

When it comes to supporting healthy brain development, the type of child care arrangement is less important than the quality of care a child receives. However, some parents choose child care based on factors that have little to do with quality and more to do with cost and convenience.

Millennial moms and dads, specifically, are in the thick of it and have unique challenges related to access. For those lucky enough to be employed, the average cost of center-based infant child care in the U.S. (adjusted for inflation) exceeds 27% of millennial median income—a figure 20% higher than the federally-recommended 7%. The cost burden is a reality.

However, research on high-quality, intensive early child care education programs for low-income children confirm lasting positive effects—improved cognitive and social abilities and better math and language skills. Quality early child care education and preschool can, therefore, be viewed as an investment—one with good returns!

Good indicators of high-quality:

  • Small groups of children. Children receive more individual attention and nurturing when they are in smaller groups and when each caregiver is responsible for fewer children. Do the child-staff ratios and the size of groups of children fall within nationally recognized standards? For example, in a room with 4 children aged 13 to 35 months, there should be 1 trained caregiver. In a room with 5 to 8 children aged 13 to 35 months, there should be 2 trained caregivers. There should be no more than 8 children aged 13 to 35 months in a room.

  • Low staff turnover. Young children—especially infants and toddlers—need stable, positive relationships with their caregivers to thrive, and staff retention helps to maintain those strong relationships. How long have the staff worked at the center? What type of additional training have the staff had during the past year? High-quality programs keep children with the same caregiver for as long as possible. Good pay, benefits, training, and supportive program directors are some of the factors that may reduce staff turnover and promote quality.

  • Regular visits from a child care health consultant. Early child care educational settings rarely have health professionals, like a school nurse, on staff—even though the children served are younger, less able to express their symptoms, and more prone to frequent infections and illness. Some states require child care health consultants to visit infant and toddler programs regularly—health professionals who are trained to provide assistance and develop policies about health issues such as medication administration, infection control, immunization, and injury prevention. Child care health consultants also can provide developmental, hearing, oral health, and vision screenings onsite, as well as assistance integrating children with special health care needs into care.

Need Help Searching for High-Quality Child Care or Preschool?

Finding and choosing quality child care and preschool can be challenging—and is one of the most important decisions you will make as a parent. Unfortunately, in most areas there isn't a "consumer report" on the best care available. Although, here are some resources that can help you in the decision-making process:

  • Licensed care. The National Association of Child Care Resource & Referral Agencies (NACCRRA) through Child Care Aware®, helps parents find affordable licensed care. Because licensing and regulations vary widely, parents need more information to make informed decisions. Note: Each state has dramatically different regulations for their early childhood education programs—a major contributing factor to the variation in quality. Family child care settings have different regulations than center-based care, and some forms of child care are exempt from regulation all together. Even when regulations are present, enforcement varies.

  • Star rating system. More than 75% of states have quality rating and improvement systems (QRISs) to help parents with this decision. QRISs use research-based, measurable standards to define quality levels, often denoted by a star rating system. QRISs often use incentives such as staff scholarships, tiered reimbursement for child care subsidies, and technical assistance/professional development as strategies to improve early childcare education quality. Unfortunately, the QRISs do not always include key health and safety standards. Parents can learn if their state has a quality rating system on the National Center on Early Childhood Quality Assurance website.

  • Accredited care. The National Association for the Education of Young Children (NAEYC) provides a list of their accredited child care centers on their website, as does the National Accreditation Commission (NAC) For Early Care and Education Programs, and the National Early Childhood Program Accreditation (NECPA).

  • Family child care providers. The National Association of Family Child Care (NAFCC) lists accredited family child care providers.

It's important to note, however, only a small percentage of child care programs in the United States are accredited by any organization or are part of a quality rating system.

How You Can Advocate for Change:

It may seem like there's nothing you can do about big government decisions, such as how much money to spend on child care. But actually, you are exactly the right person to make a difference!

  • You have a story to tell: about your child and your family, about the barriers to finding high-quality child care, and about why it's so important.

  • Your story can make a difference. Parents' stories about the need for high-quality child care have been effective in convincing decision-makers to provide funds for child care subsidies. You can tell your story on social media, in your local newspaper, and to elected officials to make sure they understand how important affordable, high-quality child care is for your family.

Remember, Early Education Does Not Exist in a Silo.

Education starts and ends at home. Sharing books with your little ones, for example, can help teach them to talk and get ready to listen and learn in school. You can also reinforce what your child is learning in child care or preschool. Find time to talk with your children about their respective days—in­cluding what they did at school. Plan some activities that you can do with your child—such as an art project. Get more ideas here.

Additional Information & Resources:

Last Updated
Council on Early Childhood (Copyright © 2017 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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