When It Comes to Infant-Toddler Care and Development, It's All About the Relationships

A new brief focuses on two practices that child care centers should make a priority: primary caregiving and continuity of care
Blog Post
Nov. 7, 2016

In conversations about early education it’s pre-K programs for three- and four-year-olds that typically garner the most attention. But a well-connected early education system isn’t one that begins at age three or four. Rather, it’s a continuum of early learning that is available from a child’s earliest months of life, continuing into pre-K for children ages three and four, and ending with the early elementary grades.

It’s the early years of infant and toddler care, in particular, that are often overshadowed by contentious debates around the efficacy of pre-K. This is despite the fact that about half of children under age three regularly receive child care from someone other than a parent. And we know from research that high-quality care beginning from birth can improve developmental outcomes for children and help close gaps in educational achievement.

A recent research brief written jointly by members of the Network of Infant Toddler Researchers and the Quality Initiatives Research and Evaluation Consortium, focuses on practices that child care centers can adopt in order to develop and support caring relationships between young children and their caregivers.

There’s a reason why the researchers focus exclusively on methods to improve what they call “relationship-based care practices” in infant and toddler care. There’s a great deal of research that illustrates the importance of warm, supportive relationships between caregivers and young children. Receiving sensitive, responsive caregiving is linked to positive cognitive and behavioral outcomes later in life, including for babies deemed at-risk based on early neurodevelopmental screening. Research also suggests that babies who experience a close, secure attachment to their caregivers are more likely to have the confidence necessary to explore their surroundings and gain experiences that aid future learning.

The research brief focuses specifically on two relationship-based care practices that child care centers should make a priority: primary caregiving and continuity of care.

Primary caregiving is the act of having one teacher bear the primary responsibility of caring for a small group of three to four children within a larger group setting. Under this model, rather than having a rotating set of caregivers throughout the week, children receive the majority of their care from just one adult, allowing for the formation of close, secure attachments between child and adult. The primary caregiver is responsible for feeding, diapering, and helping children get to sleep at least 75 percent of the time. The primary caregiver also serves as the main point-of-contact with the parents of his or her small group of kids, allowing for trusting relationships to develop between parent and caregiver as well.

In order to enable children to receive the majority of their care from the same adult, child care centers organize staff schedules in ways that prioritize primary caregiving. For example, primary caregivers are sure to begin the week with their small group of children in order to provide an easier transition from the weekend. Staff can choose to work ten-hour shifts for four days a week so that they’re with their small group of children the whole day. On the fifth day, a designated secondary caregiver takes over, ensuring that children do not experience a change in caregivers on any one day. Studies show that young children who experience multiple caregivers or child care settings in the course of a day are more likely to have behavioral problems.

Closely related to the idea of primary caregiving is the second relationship-based practice covered in the brief: continuity of care. Continuity of care is the practice of keeping young children and their caregivers together for an extended period of time, ideally up to 36 months of age. This differs from the traditional practice of moving a child to a new caregiver and classroom once he or she has a birthday.

Under a continuity of care model, children have the same caregiver from infancy all the way to age three. Once the children reach age three, the caregiver loops back to the infant room and starts again with a new group of children. Just as in primary caregiving, the emphasis is on having a consistent caregiver with whom young children can form a long-lasting, secure attachment, as opposed to a rotating cast of adults who provide care. Research suggests that children who change caregivers before 24 months of age are likely to be less securely attached and more aggressive compared to children who experienced a consistent caregiver.

Both primary caregiving and the importance of continuity of care are referenced in the Early Head Start Performance Standards. But while research backs the importance of primary caregiving and continuity of care in child care settings, studies suggest that few centers currently implement these practices. There are a few reasons for this. It can be difficult for child care centers to provide children with the same caregiver from infancy to 36 months of age when employee turnover is often high. There can also be staff resistance to the idea of changing routines and procedures that have been in place for many years.

The brief points out that implementing relationship-based care practices is not something that is done once and then forgotten about. Rather, increasing focus on the quality of the caregiver-child relationship is a continual process that requires updates to professional development, policies, and procedures in order to communicate to parents and staff the importance of shifting towards a model that values continuity of care.

States can incentivize relationship-based care practices by implementing lower child to staff ratios at higher levels of their QRIS or providing other supports to programs that choose to implement ratios lower than state regulations. States can choose to increase subsidy rates to centers offering lower child to staff ratios. These extra funds could enable center directors to increase worker compensation, possibly leading to lower rates of staff turnover. There is also a need for continual professional development for center directors and staff about best practices for implementing relationship-based care practices.

When pre-K for three- and four-year-olds is discussed, it’s taken as a given that students should have a consistent teacher throughout the year with whom they can build a warm, supportive relationship in order to enhance their learning. Science increasingly tells us this is also true for infants and toddlers. While infant and toddler care doesn’t generate the same amount of debate as pre-K it’s time to follow the research and move towards practices that will strengthen the very first stages of the birth to third grade continuum.