Too early, too much, too long

Parenting guru Steve Biddulph enters the childcare debate with a broadside on nurseries, and demands we find a way to allow women to work without sacrificing their children.

It began 30 years ago with a phone call. A friend, a young mother, is on the line, distraught. It's her first day back at work after four month's maternity leave. Her little boy is at a nearby nursery, howling. She is howling too. I'm about to say: "He'll be fine," but instead I ask how she got to this point. She tells a story that is very familiar to me now, 30 years later. Her husband and her boss want her back at work, and her peer group are all doing the nursery thing - but in her heart, she has never really asked, what do I want? And it's taken this separation to find out.

By the end of that day, and with no prompting from me - for in those days I was an advocate of 'quality care', she is back home, and doesn't return to work for 18 months more. And I am launched on a journey of concern. What do we do to parents in our society? We think we are free to choose our lives, but pressures from all around, not least the housing price crisis facing the UK, mean women, like men, are just as enslaved now as when feminism first stormed the barricades. The tyrant has changed, but the choices are just as poor. And then there's the babies, lying in rows of cots, then milling about in garish rooms through their toddler years, aching for one special adult to love them. Twelve thousand hours of this before they set foot in school.

Childhood today is nothing like it was for preceding generations, especially for very young children. In 1981, only 24% of mothers retuned to work before their baby was one. Today the figure is over 70%, with 95% of fathers working full-time. As a result, almost a quarter of a million British children under three attend a day nursery full or part-time.

Day care was originally intended for three and four-year-olds, but its use has spread downwards; some babies are now put into nurseries when they are a few weeks old. The hours have got longer too: throughout the industrialised world, millions of children under three are in nurseries 10 hours a day, five days a week. This large scale group care of the very young has happened without prior research (compared with the invention of kindergarten, which was designed with child development needs in mind).

Daycare, nurseries, home carers and nannies are an absolute necessity given our newly hurried lives. Day nurseries are an attempt to slot messy and needy young children into the new economic system, while at the same time reassuring us that it is good for them, socially and educationally. Nurseries are marketed so well that parents at home have even begun to feel that they are not as good for their babies and toddlers as 'experts' might be, despite the fact that these 'experts' may well be teenagers with minimal qualifications, who fell into this line of work. The critical, rarely mentioned core of nursery care is that our children will be looked after in bulk - on a 1:3 or 1:8 ratio, compared to 1:1 at home. Like McDonald's fast food, we can enjoy the convenience of drive-through; through the miracle of mass production.

The rapid adoption of nursery care in the early years has been a social experiment; a gamble taken by millions of parents. The results of the experiment are now emerging. The first generation of babies raised in this way are now entering their teens and early 20s.

Most western industrial countries are reporting record levels of young people with mental health problems. The proportion of teenagers in the UK with behaviour problems has doubled since 1980; the proportion with anxiety and depression has risen by 70%. The incidence of attention problems, violence problems, eating disorders, and of binge drinking and other addictions has also risen dramatically. These are not poverty-stricken children, lacking education, healthcare or food; affluent children are equally represented in this problem generation. In the past 10 years, researchers have learned that a baby's brain grows whole new structures in response to the love and affection, and caring firmness, given during its first two years of life. If this kind of intense love is not given at the right time, these areas of the brain do not develop properly. This is perhaps the most vital message: children raised without sufficient loving care do not fully become the human being they were meant to be.

In the 1990s, because of the critical importance of the whole question and the widespread disagreement among experts, a number of governments were persuaded that something had to be done. In the US, Britain and half a dozen other countries, large long-term studies were set in motion to try and establish the truth. Was nursery care harmful? And if so, under what circumstances, and why?

The most comprehensive US study undertaken, the National Institute of Child Health and Development study (NICHD), involved more than 1,000 children. Results have been released progressively since it began in 1991. In the UK, the Effective Provision of Pre-School Education (EPPE) study, based at the University of London, followed the lives of 3,000 children from babyhood, with extensive interviews and assessments of children's behaviour and academic performance. This study reported its results in 2004. Another large-scale study of 1,200 children was designed and carried out by the childcare expert Penelope Leach, together with the academics Kathy Sylva and Alan Stein. This study revisited babies at 10, 18, 36 and 51 months old and its results were published in late 2005.

In the NICHD 2004 results, three times as many children - 17% - had noticeable behaviour problems in the over-30 daycare hours a week group, while only 6% had those problems in the under-10 hours a week cohort. According to the researchers' report, these problems included 'disobedience, being defiant, talking back to staff, getting into fights, showing cruelty, bullying or meanness to others, physically attacking other people, being explosive and showing unpredictable behaviour'. These increases were small, but they were present in a large number of children. The EPPE study likewise reported that 'high levels of group care before the age of three (and particularly before the age of two) were associated with higher levels of antisocial behaviour at age three'.

The Leach study reported babies and toddlers in daycare to have 'higher levels of aggression', and to be 'more inclined to become withdrawn, compliant and sad'. It concluded: "The social and emotional development of children cared for by someone other than their mothers is definitely less good."

Perhaps most significantly for the researchers and parents, the quality of care - how good, stable, caring and educationally rich the settings were - had only a partial effect on the behaviour outcomes. Quality of care mattered a great deal, for reasons other than the ones being studied - it helped cognitive skills and literacy, and children receiving more one-to-one care in nurseries with more and better trained staff were less stressed, but it could not undo the damage done by 'too early, too much, too long'.

This finding had huge ramifications. The mantra of the 90s had been that poor outcomes were due to poor-quality nurseries. The studies seemed to indicate something that loving parents give in one-to-one care that cannot be substituted. Quality care was not the panacea that had been hoped for: it was still 'stranger care' in a group setting, and this mattered to the proper development of secure children.

The most significant factor of all in determining child mental health was called by researchers 'maternal sensitivity'; the ability to respond warmly and sensitively to the needs of the child. This depends on the mother - or father - being sufficiently calm, supported and free from pressures to make the child their focus, and sufficiently resourced materially and emotionally, so that they are not depressed, lonely or overwhelmed by the demands of parenthood. This quality relies on parents having the opportunity to get to know their baby, its needs and its means of communicating them. The studies found that one of the dangers to children was that too early, too much, and too long use of nursery care could weaken maternal sensitivity - or rather, prevent it from developing.

The negative effects of nursery care did not have a specific threshold or safety level in terms of the hours spent in care. The more nursery care a child receives, the more the effects received, in a proportional amount. The researchers refer to this as a dose-related effect. There isn't a safe level of nursery care usage for the under-threes (but a little is better than a lot). For anyone who knows children, this is common sense. The toddler is emotionally vulnerable, acutely aware of her social environment, who loves her, and with whom she feels safe. A toddler fears strangers, and is strongly bonded to one or two trusted adults. Babies do not have a sense of time; they cannot understand that 'in eight hours' time my mother will be back'. Indeed, they are programmed to assume that if their beloved caregiver leaves, they are in danger. Their body escalates into full panic, measurable in rising levels of the stress hormone cortisol in their blood.

A 2005 Cambridge University study reported these alarming results: "Toddlers starting at childcare experience high levels of stress in the first weeks after separating from their parents.Hormone levels doubled even in secure youngsters during the first nine days of childcare.The levels fell over time but five months later were significantly higher than for infants of the same age who stayed at home."

Children are incredibly resilient, but we should not take this for granted. The one factor agreed by all research in child development is the importance of the infant-parent bond, and how the closeness of relationship immunises a child against present and future stresses. If the only negative of long days spent in nursery is to weaken this connection, or prevent it ever growing, then this is a significant concern.

A nursery situation never has a one-to-one ratio of carer to baby - it would be prohibitively expensive. The best nurseries have one carer to three babies, and often this is one to five or six when carers are filling forms, taking a break, or performing other duties. So the child gets only a fraction of the time and energy that it ideally needs.

To find out what kind of interaction children receive from nursery-care workers, detailed studies have been carried out. Trained observers have rated the interaction quality between carers and children. The results are not good. Even when childcare workers know that they are being observed, they do not do as good a job as parents. There are far fewer intimate exchanges between carers and children, and interactions are more mechanical, brusque and shorter in duration. They are simply not as responsive.

This is not the fault of the carer - in most cases they try their best, but there are two significant factors working against them. They are not parent of the child, and they rarely have a long-term relationship with them. Both child and carer are just passing through each other's lives. Turnover of nursery staff is running at 30-40%, caused by low pay, poor training and low status.

Of course, parents at home are also sometimes stressed, depressed, angry, unresponsive or even positively dangerous to their kids, and some kids are better off in nursery, which at least is routine, safe and (hopefully) provides some level of warmth and stimulation. But we have to ask whether there is a better way to give parents a life, and children a life too. Why does it have to be a choice of two evils - parental loneliness and frustration, or children spending long hours in the care of strangers? Surely we can emancipate women, and yet not abandon children to indifferent care?

In those European countries that have better support for families, the situation is very different. In France, Germany and Denmark, low cost, good-quality housing is supported, jobs are secure and retraining available for parents after two or three years' absence. We look like misers by comparison. Britain spends only 0.3% of GDP on early years provision, compared with 2% in Sweden. Yet in Sweden today, there are almost no babies in daycare, a new generation of parents has opted instead for the excellent parental leave and job-sharing provisions in that country. In other words, a six-fold increase in expenditure would be needed to achieve a standard that Swedish parents have decided still isn't good enough.

The British government is moving tentatively in the right direction - there have been advances in parental and maternity leave. But our medieval workplace culture needs to shift dramatically to make parenthood possible. Meanwhile some parents are choosing less affluent, more time-rich lives, and finding the joys of simpler living. Since the world needs us to consume less, and live more, this must be a good thing. Let's hope that the care of babies in nurseries might soon go the way of child labour in factories or boarding school for six-year-olds.

(The Guardian, 08.02.06, extracted from Raising Babies: Should Under-3s Go to Nursery? by Steve Biddulph, published 6 March 2006)