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Child care and health in America

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National Public Radio; Robert Wood Johnson Foundation & Harvard T.H. Chan School of Public Health
Publication Date: 
1 Oct 2016


Executive summary

A new poll among parents in the U.S. with children in child care was conducted by NPR, the Robert Wood Johnson Foundation, and Harvard T.H. Chan School of Public Health to examine parents’ selection of and experiences with child care. The poll included parents of a child cared for regularly by someone other than a parent, including a relative, a non-relative (e.g., a family or home daycare, a nanny, or a babysitter), or a center (e.g., a daycare or preschool). This poll sought to answer several questions: 

  • How do parents rate the quality of their child care?
  • What are parents’ priorities when selecting child care, and what challenges do they face?
  • What impact do parents think child care has had on their child? On them personally?
  • Do parents believe child care has lasting effects?
  • How do parents feel about policies to promote health in child care?
  • What challenges do parents face when a child is sick and unable to receive their usual care?

Poll findings suggest a major gap between parents’ and research experts’ assessments of the quality of child care in the U.S. Studies by experts on the state of U.S. child care suggest a majority of child care is not high quality. The findings of this poll show that most parents share the opposite view. Parents rate the quality of their own child’s care highly, and many further believe their child care offers a range of activities to promote their child’s development. The poll findings also suggest parents seek quality when choosing a particular provider, and thus believe they find it. These findings amplify concerns that parents may overestimate what experts consider to be the quality of their child’s care.

In addition to quality, cost and convenience play a key role in child care choice. Cost is also the most commonly reported challenge in finding care. Further, it continues to be an issue once parents have found care, with many saying the cost of care is a problem for their families - especially for those who feel their financial situation is not strong. These findings correspond to a number of other recent surveys showing the burden of child care cost on families today.

Another critical issue in finding child care is the availability of options that parents feel suit their needs. A majority of parents felt they had limited options for child care, and a substantial number say finding care for their child was difficult. Parents who say their financial situation is not strong are especially likely to say this.

Despite the challenges, most parents report that child care has had a positive impact on their families. A majority believe child care has benefitted their child’s overall well-being, development, and health. Furthermore, many parents – especially mothers – feel child care has had substantial benefits for their own health and well-being and for their relationship with the child.

Parents also support the idea that child care has lasting effects on a child’s overall well-being, health, and success in their education and career.

Not all parents say their child care has policies to promote health, such as limiting sugary foods or screen time, but those whose child care does implement these policies view them favorably.

Parents face challenges finding back-up care when a child gets sick and cannot receive their usual care. Many working parents have to miss work, and parents report negative repercussions for themselves or their spouses such as docked pay or getting in trouble with a supervisor. Findings suggest that, in households with two working parents, mothers are more likely to stay home with a sick child than fathers. While parents most often cite job flexibility as a driver for this decision, traditional views of gender roles are also important.

Conclusion: Overall, findings suggest that parents value and seek out quality child care, believing it benefits their child, them and the parent-child relationship. However, parents face challenges related to limited options for child care, a lack of information about its quality, and cost.

These findings therefore highlight the importance of enhancing child care for parents in three ways. First, it is important to provide better information for parents about the quality of their child care. While parents may not have the same priorities as experts, the contrast in parent and expert assessments does suggest there is a more fundamental need for national standards and ratings about the features of child care that foster long-term developmental and health benefits for children. As part of these ratings, it may benefit parents to have robust data reflecting parents’ views of their experiences. Second, findings emphasize the need to make child care more affordable for parents and to help parents find financial means to pay for care. Finally, findings support expanding the availability of child care options that are both high quality and affordable. Addressing these challenges and thus improving access to high quality child care holds important benefits for U.S. children and their families.