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5 Supporting Physical and Psychological Development in Child Care Settings In Chapters 3 and 4, our discussion of child care and child devel- opment traced the evolution of research on child care and identified the key structural dimensions of quality in child care. This chapter takes a more differentiated look at specific aspects of physical and psychological development In the context of child care. Our aim is to identify practices that support both physical and psychological health in child care settings. We turn first to research on physical health and safety. We ask whether and to what extent participation in child care is associated with risk for infectious diseases, injury, abuse, or neglect; and we point to practices that protect children's health and safety in child care settings. We turn next to the psychological outcomes and examine practices supportive of specific developmental processes in child care. The research on child care is not "developmental" in the sense of yielding a detailed theory or picture of children's changing needs in child care with increasing age (beyond the in- fancy/postinfancy demarcation). It is developmental, however, in the sense of focusing on particular developmental processes (e.g., peer relations, language development) and asking how these are affected by child care settings. Accordingly, our discussion in this section is organized around developmental processes rather than age groups. In the last part of the chapter we address the needs of two special groups of children: children with developmental disabilities and school-age children. These children's needs differ from those of normally developing infants and preschoolers, and we consider child care practices that are supportive of their develop- ment. 108

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT PHYSICAL HEALTH AND SAFEI Y IN CHILD CARE 109 There is a burgeoning literature on children's physical health and safety in child care. Jarman and Kohlenberg (1988) reviewed more than 200 studies for the panel; they concluded that, despite a bewildering array of methodological obstacles and gaps in the research, the findings on several issues converge and lead to conclusions that have significant implications for policy and practice. Infectious Diseases Respiratory Pact Infections Respiratory tract infections (colds, ear infections, sore throats, laryngi- tis, croup, epiglottitis, bronchiolitis, bronchitis, pneumonia, and flu) account for the majority of young children's illnesses and absences from school and child care (Denny et al., 1986; Doyle, 1976; Fleming et al., 1987; Strangert, 1976; Wald et al., 1988~. The evidence indicates that children in child care tend to experience more of these infections and at a younger age (Denny et al., 1986; Doyle, 1976) than children cared for at home, although some question the strength of the pattern (Haskins and Kotch, 1986~. Studies show that children under 3 years of age who are in child care have more episodes of respiratory tract infection than children cared for at home; yet after the age of 3, they appear to have fewer infections of these kinds. Health experts indicate it is likely that these children encounter the common childhood viral pathogens at a younger age, and acquire immunity earlier, than children who first encounter them when entering group settings such as nursery school or kindergarten. In general, the respiratory tract infections that child care children ex- perience appear to be minor, self-limited, and inevitable. However, findings suggest that frequent early respiratory infections predispose these young- sters to ear infections that are more frequent, persistent, and recurrent (Daly et al., 1988; Fleming et al., 1987; Haskins and Kotch, 1986; Hen- derson and Giebink, 1986~. Such a pattern of early ear infections may have implications for children's language development. Accordingly, there is an urgent need for prospective studies that encompass not only micro- bial surveillance and measures of illness, but also audiological assessment and measures of language development. Studies of the developmental and family effects of the increased frequency of minor illnesses in infants and young children in child care are also needed.

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110 Diarrheal Disease WHO CARES FOR AMERICA'S CHILDREN? The evidence regarding diarrhea! disease among children in child care is less consistent than that regarding respiratory illnesses; some but not all studies show these children at increased risk relative to children cared for at home (Bartlett et al., 1985; Dingle et al., 1964; Reeves et al., 1988; Sullivan et al., 1984~. Wide variation in risk estimates for diarrhea may partly reflect seasonal and geographic variations in the prevalence of infecting organisms. However, the evidence is consistent in identifying particular child care features that are associated with higher rates of diarrhea. By far the best-established risk factor is the presence of children who are not yet toilet trained (Ekanem et al., 1983~. The risk of diarrhea! disease is also higher when caregivers both diaper children and prepare food (Lemp et al., 1984~. The risk of diarrhea! disease can be diminished by limiting group size; separating same age from different age children (Pickering et al., 1981~; strictly adhering to the hygienic practice of hand washing after diapering infants and before food preparation (Gehlbach et al., 1973~; and excluding from child care and treating those children suspected of having bacterial diarrhea on the basis of blood or mucus in the stool (Weissman et al., 1975~. Meningitis Meningitis is an example of a formidable disorder of low prevalence that has major consequences for those children who become infected. There is strong agreement across studies that bacterial meningitis (most often caused by H. in~uenzue type b tHib]) can be transmitted among children and, further, that children attending child care are at increased risk of contracting primary cases of this disease (Cochi et al., 1986; Haskins and Kotch, 1986; Istre et al., 1985; Redmond and Pichichero, 1984~. However, there is no agreement across studies as to the extent of the risk to children in child care, once a primary case has occurred: some studies indicate a substantial risk of secondary disease and some do not (Band et al., 1984; Fleming et al., 1985; Ginsburg et al., 1977; Osterholm et al., 1987~. The evidence on the household contacts of primary cases more consistently documents increased risk than the evidence for child care contacts of primary cases (Filice et al., 1978; Granoff and Basden, 1980; Ward et al., 1979). For treatment, Rifampin may reduce the risk of secondary acquisi- tion of Hib meningitis in susceptible youngsters, but recommendations for this therapy vary. The American Academy of Pediatrics recommends such therapy only for household contacts of an index case in households with at

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 111 least one person 4 years old or younger, whereas the Immunization Prac- tices Advisory Committee of the Centers for Disease Control recommends Rifampin for all contacts in households as well as child care groups with one or more children under 2 years who have been exposed (American Academy of Pediatrics, 1986; Granoff and Basden, 1980~. New vaccines currently under development may offer protection for even very young chil- dren, thereby further reducing the threat of disease in child care settings (American Academy of Pediatrics, 1986~. Human Immunodeficiency Virus (HIV) The risk of transmission of HIV infection in a group care setting appears to be extremely low, and to date there is no report of a child or a caregiver becoming seropositive for HIV because of exposure in a child care center or family day care home. Despite the very low risk of transmission of HIV infection in child care settings, however, extremely restrictive guidelines have been promulgated for the exclusion of infected children (American Academy of Pediatrics, 1987; Blackman and Appel, 1987; Centers for Disease Control, 1985~. Such guidelines suggest the exclusion of infected children if they are not yet toilet trained, if they place hands or objects in their mouths, if they bite, or if they have oozing skin lesions. The guidelines are reactions to the extreme consequences of infection for a child and family rather than to the extremely limited risk of transmission by body fluids to peers. Retrospective research is clearly needed to evaluate the contacts of children who have been diagnosed with HIV infection to address public fears regarding peer transmission. Additional areas of concern include compliance with existing infection control recommendations (which reduce the risk to caregivers and to chil- dren with AIDS who have not yet been diagnosed) and the development of child care centers to serve children with AIDS. Viral Hepatitis Viral hepatitis presents a potentially substantial occupational health problem to child care workers, but a limited problem for child care chil- dren (Balistreri, 1988~. The limited research concerning viral hepatitis indicates that child care settings that cater to non-toilet-trained children are frequently a source of disease in attendees, adult caregivers, and house- hold contacts. Furthermore, although approximately 75 percent of infected children show very mild symptoms, 75 percent of infected adults develop a disabling illness lasting from 2 weeks to 2 months (Balistreri, 1988~. By far the most significant risk factor associated with an outbreak of viral

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112 WHO CARES FOR AMERICA'S CHILDREN? hepatitis in a child care center is the presence of children under 2 years of age (Hadler et al., 1982~. Fortunately, medical intervention can be highly effective in limiting the transmission of viral hepatitis. Specifically, public health experts rec- ommend that the identification of one or more cases in a child care center should be followed by immunoglobulin prophylaxis for all staff and children in the same room as the index case (Centers for Disease Control, 1981~. Although prophylaxis for household members has not been shown to be effective, it is recommended for parents of children who wear diapers in circumstances in which three or more families associated with a child care group show infection. Immunoglobulin prophylaxis can virtually eliminate the spread of viral hepatitis within a child care group. In addition to the use of immunoglobulin prophylaxis, other practices (hand washing, disinfection of diaper change surfaces and toys, segregation of children by age group) are recommended to curb the spread of any disease that is transmitted via the fecal-oral route, although their efficacy specifically for viral hepatitis has not been demonstrated. There has been some progress in the development of a hepatitis A vaccine for use in humans, but it is not ready for general use (McLean, 1986~. Cytomegalovirus Although cytomegalovirus (CMV) does not cause symptoms of acute infection in child care children (acute infection is generally asymptomatic), it can cause serious neurological damage to an embryo or fetus in utero if a pregnant woman experiences her first CMV infection during the first half of pregnancy (Conboy et al., 1987; Melish and Hanshaw, 1973; Pass et al., 1980; Stagno et al., 1986~. Therefore, there is potential risk to the fetus carried by the mother of an infected child in child care and to that of a pregnant child care worker (Adler, 1988b). Evidence indicates that CMV is excreted by approximately one-half of the children in centers with 50 or more children. Furthermore, children between 1 and 3 years of age do spread CMV to each other in child care settings. Children bring infections home to their parents and particularly to their mothers. And child care workers are at some risk of acquiring CMV, although less so than parents of child care children (Adler, 1986, 1988b; Pass and Hutto, 1986; Pass et al., 1987~. There are as yet no specific measures to control the risks of CMV infection, which remain low for any given pregnancy. CMV transmission in child care settings can be limited by standard hygienic practices because the virus is inactivated by soaps, detergents, and alcohols (Adler, 1988a).

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT Injury 113 Data on rates and severity of injuries to children in child care are limited. ~ date, there are no studies contrasting the incidence of injury among child care children and home-reared children. Nor has there been a prospective study with rigorous measurement procedures. Available in- formation concerning injury among children in child care thus rests on documentation of injury rates within centers and family day care homes. From the few studies that have examined injuries, it is clear that child care children show similar types of injuries to children reared at home, with the possible exception of bites from other children (Garrard et al., 1988~. A majority of injuries in child care settings occur on the playground and particularly on climbing equipment (Aronson, 1983; Elardo et al., 1987; Landman and Landman, 1987~. Minor injuries (e.g., abrasions) are common, but they are widespread among young children in general. The most important conclusion regarding injuries is the need for rigorous prospective studies that contrast children in family day care and center care with home-reared children and document the circumstances associated with injuries. Abuse and Neglect There is only one major study of sexual abuse in child care settings. A national survey of sexual abuse in child care (supported by the National Center on Child Abuse and Neglect and the National Institute of Mental Health) indicates that the risk of a child being sexually abused in child care (5.5/10,000 children) is significantly smaller than the risk of sexual abuse by a family member in a child's own home (8.9/10,000 children) (Finkelhor et al., 1988~. That study also found that the traditional indicators of quality of care (e.g., group size, ratio) did not predict low risk for sexual abuse. Abusers in child care settings rarely had previous histories of arrest for abuse (8 percent did), the majority had some college education, and most had at least 2 years of experience in child care. Sixty percent of the abusers were men; 40 percent were women. Only 35 percent of the abusers were employed in the centers as child care workers. Similarly, the evidence on physical abuse and neglect is scarce. A study in Kansas, a state with strict supervision and enforcement procedures, indicated reports of abuse and neglect in only 1.4 percent of all child care facilities (which were rapidly followed up by legal intervention) (Schloesser, 1986~. By contrast, in North Carolina during 1982-83 (at that time one of the least regulated and supervised states) 16.5 percent of complaints to the Office of Child Care Licensing involved abuse or neglect (Russell and Clifford, 1987~. Complaints were filed for 8.6 percent of centers and 2.3

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114 WHO CARES FOR AMERICA'S CHILDREN? percent of licensed family day care homes. This study indicated problems in the timing, quality, and rate of prosecution following complaints. There are no overall national figures for rates of physical abuse and neglect in child care. However, state-level data raise the possibility that supervision and enforcement mechanisms, which vary substantially by state, may be a factor associated with actual or possibly only reported rates of abuse and neglect. Exclusion Policy and Child Care for Sick Children There are substantial differences of opinion among parents, child care staff, and pediatricians about when it is appropriate to exclude a symp- tomatic child from a child care setting (Landis et al., 1988~. Furthermore, decision rules with a goal of limiting or preventing the spread of infection are often not based on sound scientific knowledge concerning transmis- sion, perhaps partly because the period or patterns of contagion and the appearance of symptoms often do not correspond closely. Jarman and Kohlenberg (1988) report that available medical evidence suggests several conclusions: 1. There is no evidence that excluding children with respiratory infec- tion changes the risk of disease for other children in child care or for their caregivers. 2. At present, available evidence does not justify policies that restrict child care attendance for all children with diarrhea! disease. Instead, exclusion is potentially valuable only in a small minority of cases, notably those marked by the presence of blood and mucus in the stools. 3. With the exception of children under age 2 (Klein, 1987), there is no evidence to suggest that fever itself merits exclusion from child care as a means of controlling infection (Shapiro et al., 1986~. Exclusion in such cases should be based on concerns for the comfort of the child, rather than the spread of infection. 4. In the case of hepatitis A, there is usually considerable spread of virus before the disease is detected. Prompt initiation of immunoglobulin prophylaxis once disease is detected generally eliminates the need for exclusion (Centers for Disease Control, 1981~. 5. Exclusion of a child with meningitis occurs automatically as a result of the usual need to hospitalize the ill youngster for appropriate therapy (see discussions of guidelines following identification of an index case, above). 6. The restrictive guidelines for exclusion of children diagnosed with HIV infection reflect the consequences associated with infection rather than the theoretical risk of transmission in child care settings (American Academy of Pediatrics, 1987; Centers for Disease Control, 1985~.

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 115 When children are ill, employed parents often lack options for their care. Stringent exclusion policies in many child care facilities have provided an impetus for the development of alternative models for child care for sick children. Four models for such care have been identified (Rodgers et al., 1986), though none is widely available: a "get-well room" within a child care center for a mildly ill child; a satellite family day care home to which a sick child is transferred; care in the child's own home by a trained worker from an agency or a caregiver from the child's own center; and an infirmary or independent facility that cares for mildly ill children. Given children's needs for psychological nurturing as well as physical care when they are ill, many professionals prefer care in the child's own home (Chang et al., 1978~. However, the feasibility of implementing this model is limited because the financial expense of hiring a trained professional to provide one-on-one care is beyond the means of many families. Summary and Implications for Practice Home-reared children and those in child care do not differ significantly in the kinds of diseases or injuries they experience. Differences that do occur are quantitative rather than qualitative. For example, there is a mild to moderate increase in the risk of a number of common infectious diseases for children in child care, but these generally do not entail long-term health consequences. Viral respiratory illnesses appear to be more common among child care children in the first 3 years; there are indications that they have fewer such illnesses in later years. The single longer term consequence of the common infections identified in this review is the possibility that more frequent middle-ear infections in early life may have lasting effects on hearing and language development. Children in child care also contract diarrhea! illnesses more frequently than children cared for at home, but these illnesses rarely have any long-term health consequences. Regarding rare but more serious infectious diseases, group child care does increase the risk for hepatitis A, CMV, and meningitis. There is no evidence of increased risk among child care children of HIV. From the perspective of children's health, it is only Hib disease (meningitis) that is of substantial concern. Children with hepatitis A or CMV are usually minimally symptomatic. Although primary as well as secondary infections with Hib disease are more frequent in child care settings, these account for very small percentages of child-care-related illnesses. Chemoprophylaxis diminishes the risk of secondary infections, and new vaccines may further diminish overall risk. Finally, there is no evidence to suggest that child care attendance is associated with increased risk of physical injury, sexual abuse, physical abuse, or neglect, although further study of these issues is needed. Thus,

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116 WHO CARES FOR AMERICA'S CHILDREN? despite significant increases in a host of minor infectious diseases, it is apparent from this review that child care attendance poses no major risks to the health status of young children in the United States. Existing scientific evidence and best professional practice from the fields of pediatrics and public health suggest a number of practices for safeguarding the health and safety of children in child care settings: limiting group size; separating groups of children according to age; strictly adhering to hand-washing practices particularly after dia- pering and before food preparation; regularly cleaning and disinfecting diaper changing surfaces and communal objects and toys; excluding children presenting with bloody stool and children youn- ger than age 2 with fever, as well as other selected infectious diseases; Rifampin therapy following the identification of an index case of Hib meningitis; and immunoglobulin prophylaxis following identification of an index case of viral hepatitis. There is little documentation of specific measures that can reduce injury, abuse, and neglect among children in child care. Some evidence in the research suggests, however, that instances of abuse and neglect can be diminished by strict supervision, enforcement, and prosecution of reported cases. PSYCHOLOGICAL DEVELOPMENT IN CHILD CARE The years when children may be participating in child care are years of rapid transition in several domains of development. At very young ages, children form their first attachment relationships with adults as well as their first friendships with peers. They extract the rules of language from the speech they hear, and they use increasingly complex speech. Children identify themselves as part of a cultural group and, surprisingly early, assess for themselves the way in which their group is seen. From their interactions with the physical and social world, young children are constantly developing their perceptual, reasoning, and problem-solving abilities. What specific child care practices support these developmental pro- cesses? In this section, we examine the existing knowledge of child care features and practices that are related to social development (relationships with adults, relationships with peers, and positive group identity in a mul- ticultural context) and cognitive development (language development and more broadly defined intellectual development).

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT Relationships With Adults 117 Research on children's relationships with adults has focused on two processes: the quality of attachment relationships and children's coopera- tiveness with adults. Although studies examining child care and attachment have traditionally emphasized implications for children's attachment to their mothers, recent evidence suggests the need for a broader perspective. The evidence is as yet limited, but there are indications that children's attach- ments to their caregivers are also important and, further, that development among children in child care can be best understood through simultaneous consideration of attachments to parents and to caregivers. Attachment to Mother As discussed in Chapter 3, the quality of children's attachments to their mothers has been considered a useful index of their overall emotional well-being (Ainsworth, 1985; Bretherton and Waters, 1985; Campos et al., 1983; Sroufe, 1985~. Factors influencing that attachment are also assumed to have importance for later development. Individual differences in chil- dren's attachments to their mothers have been found to be influenced by the mothers' sensitivity and responsiveness to a child's needs and commu- nicative behavior in its first year and related to the mothers' own emotional well-being and network of support, to the child's personality, and to the socioeconomic stresses experienced by the family (Bretherton and Waters, 1985; Campos et al., 1983; Crockenberg, 1981; Sroufe, 1985~. An issue that remains clouded with some uncertainty concerns the nature of the effects of full-time child care during the first year of life on infant-mother attach- ment. Although research has consistently shown that children of working mothers are attached to their mothers (Clarke-Stewart and Fein, 1983; see also Chapter 3), the question has been raised as to whether the quality of such attachments differs for children in full-time care during their first 12 months. As we discussed in Chapter 3, current assessments of infants' attach- ments to their mothers rest on a single laboratory assessment, the "strange situation" that places infants under the stress of separation from their moth- ers and observes their responses to both the separation and the reunion (Ainsworth et al., 1978~. Using this assessment, studies have shown that in- fants whose mothers work full time in the infants' first year are more likely to show a pattern of "anxious-avoidant" attachment than infants whose mothers do not (Barglow et al., 1987; Belsky, 1988; Belsky and Rovine, 1988; Schwarz, 1983~. Children who spent their first year in full-time child care were also found in some studies to be more aggressive and uncoop- erative, although this finding is not consistent (Barton and Schwarz, 1981;

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118 WHO CARES FOR AMERICA'S CHILDREN? Haskins, 1985; McCartney et al., 1982; Rubenstein and Howes, 1983; also see below). Although there is agreement about these research findings, their in- terpretation remains open. Some researchers argue that these findings indicate that babies whose mothers are absent for most of the day have missed experiences that are essential for the development of social rela- tionships outside the home, but this view has been criticized on several grounds: First, the validity of the laboratory situation as an assessment of the mother-child relationship for children accustomed to full-time child care has not been established. Second, it is not clear whether the observed associations are due to poor quality of care in infancy rather than to care per se, to continuity of poor care beyond infancy, or to differences in the families whose children are in full-time care in infancy from those whose children are not (Clarke-Stewart, 1989~. Further stringent monitoring of the implications of early full-time care and a broader based assessment of children's relationships with their mothers are clearly needed before the conflicting interpretations can be assessed. Attachment to Caregiver Recent research suggests that there may be important developmental implications of security of attachment not just to mothers but also to careg~vers. In addition, secure attachment to a caregiver may function to offset insecure infant-mother attachment (Howes et al., 1988~. Positive involvement with a particular caregiver in child care is associated with more exploratory behavior in children (Anderson et al., 1981~. Children with secure attachments to a caregiver also appear to spend more time engaged in activities with peers in child care (Howes et al., 1988~. Thus, a secure attachment to a caregiver may provide children with a "safe base" from which to explore both the physical and the social worlds. I-here are only a few indications from research of the child care cir- cumstances that foster the development of secure attachments to caregivers. Findings indicate that those attachments are more likely to occur in child care settings with fewer children per caregiver, in contexts in which children are less often ignored by caregivers (Howes et al., 1988), and when there is continuity for children in terms of the time they spend with a particular caregiver (Anderson et al., 1981~. These findings suggest that the precur- sors of secure attachment to mother and to a caregiver are similar: interest in, and availability for, interactions with the child.

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134 WHO CARES FOR AMERICA'S CHILDREN? experience of age appropriate activities . . . one would expect very different outcomes to be associated with it" (Vandell~ and Corasaniti, 1988:18~. Summary and Implications for Practice At present, there are few studies of child outcomes related to variations in after-school care. The picture that emerges from the limited data base is that school-age children benefit from communication between teachers or caregivers in different settings and from an after-school program that com- plements structured school programs through activity options and flexibility, the possibility of more sensory motor activity, and caregiver behavior that is somewhat warmer and more personally responsive in style than that of the regular classroom teacher. Studies are needed to replicate initial findings and extend them to community-based rather than model programs and to varying age and socioeconomic groups. Research examining a variety of approaches to closeness of supervision in comparison with child autonomy, and the nature of activities in after-school programs, would also be helpful. CONCLUSIONS As in the previous chapters, our review of the evidence points to gaps and flaws, but existing research findings also suggest several firm conclusions. The evidence on physical health and safety points to quantitative but not qualitative differences in the health status of children reared at home by parents and those who spend time in child care settings. Our assessment of the magnitude of these differences leads us to conclude that child care attendance does not involve a major risk to the health status of young children. At the same time, we call for continued empirical research, particularly on the developmental implications of middle-ear infections among children in child care and on practices to diminish the risk of bacterial meningitis among these youngsters. The organization of the settings and the guidance provided by care- givers can foster positive social and cognitive development among children in child care. Thus, for example, positive relations among peers and coop- erative behavior with adults are more likely to occur when children receive guidance in social relations from caregivers. Similarly, language develop- ment in child care can be fostered by particular kinds of verbal interactions between children and caregivers, namely, those that involve shared focus and informational content. Child care settings also present unique oppor- tunities to enhance particular aspects of social and cognitive development. For example, they can serve as a context for the affirmation of children's cultural, racial, or ethnic group identity.

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 135 The social development of children with developmental disabilities can be enhanced by participation in an integrated child care environment. However, benefits occur only when staff receive both initial and ongoing training and there is appropriate programming. Many children of employed parents are in self-care, and there is some evidence of problems among children in self-care after school. Determining the need for after-school care and those features of after-school child care that are important to the development of school-age children should become a priority. The limited evidence available indicates that high-quality after-school programs involve communication between teachers and after- school caregivers and after-school activities that complement the regular school curriculum. Child care settings were traditionally viewed as environments that, by comparison with children's own homes, were deficient as contexts for development This and the previous two chapters present a different pic- ture. Family day care and center care can be environments that effectively support children's health and development. They can also provide some unique opportunities for enhancing development (e.g., for peer interac- tions, cognitive interventions, cultural affirmation). Yet existing evidence from research and professional practice forces us to face an important caveat: child care supports healthy physical and psychological development only when it is of high quality. REFERENCES Aboud, F. 1988 Adler, S.P. 1986 Children and Prejudice. New York: Basil Blackwell. Molecular epidemiology of cytomegalovirus: Evidence for viral transmission to parents from children infected at a day care center. Pediatric Infectious Disease Journal 5:315-318. 1988a Molecular epidemiology of pytomegalovirus: Viral transmission among children attending a day care center, their parents, and caretakers. Joumal of Pediatrics 112:366-372. 1988b Cytomegalovirus transmission among children in day care, their mothers, and caretakers. Pediatric Infectious Disease Joumal 7:279-85. Ainsworth, M.D.S. 1985 Patterns of infant-mother attachments: Antecedents and effects on development. Bulletin of the New York Academy of Medicine 61:771-791. Ainsworth, M.D.S., M. Blehar, E. Waters, and S. Wall 1978 Pattenzs of Attachment: Observations in the Strange Situation and at Home. Hillsdale, N.J.: Erlbaum. American Academy of Pediatrics 1986 Report of the Committee on Infectious Diseases. Georges Peter, ea., 20th ed. Elk Grove Village, Ill.: American Academy of Pediatrics. 1987 Health guidelines for the attendance in day-care and foster-care settings of children infected with human immunodeficiency virus. Pediatrics 79:466-471.

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136 WHO CARES FOR AMERICA'S CHILDREN? Anderson, C.W., RJ. Nagle, W.^ Roberts, and J.W. Smith 1981 Attachment to substitute caregivers as a function of center quality and caregiver involvement. Child Development 52:53-61. Arenas, S. 1980 Innovations in bilingual/multi-cultural curriculum development. Children Today 9~3~:17-21. Aronson, S. 1983 Injuries in child care. Young Children 17:19-21. Au, KH., and C Jordan 1981 Caching reading to Hawaiian children: Finding a culturally appropriate solution. Pp. 139-152 in H. llueba, G.P. Guthrie, and KH. Au, eds., Culture and the Bdzng~al Classroom: Studies in Classroom Ethnography. Rowley, Mass.: NewbuIy House. Balistreri, W.F. 1988 Viral hepatitis. In S.L Kaplan, ea., New Topics in Pediatric Infectious Disease. Pediatric Clinics of North America 35~3~:637-639. Band, J.D., D.W. Fraser, and G. Ajello 1984 Prevention of Haemophilus znfluenzae type b disease. JAAL4 251:2381-2386. Barglow, P., B.E. Vaughn, and N. Molitor 1987 Effects of maternal absence due to employment on the quality of infant-mother attachment in a low-risk sample. Child Development 58:945-954. Bartlett, AV., M. Moore, G.W. Gary, KM. Starko, J.J. Erben, and B.A. Meredith 1985 Diarrheal illness among infants and toddlers in day care centers: 1. Epidemiology and pathogens. Joumal of Pediatrics 107:495-502. Barton, M., and J. Schwartz 1981 Day Care in the Middle Class: Effects in Elementary School. Paper presented at meeting of the American Psychological Association, Los Angeles. Belsly, J. 1988 The "effects" of infant daycare reconsidered. Early Childhood Research Quarterly 3:235-272. Belsly, J., and M. Rovine 1988 Nonmaternal care in the first year of life and infant-parent attachment security. Child Development 59:157-167. Blackman, J.^, and B.R. Appel 1987 Epidemiologic and legal considerations in the exclusion of children with acquired immunodeficiency syndrome, cytomegalovirus and herpes simples virus infection from group care. Pediatric Infectious Disease Joumal 6:1011-1015. Bretherton, I., and I. Waters 1985 Growing points of attachment theory and research. Monographs of the Society for Research in Child Development 50~1-2~:Serial No. 209. Brown, G., A. Anderson, R. Shillcock, and G. Yule 1984 Teaching Talk Strategies for Production and Assessment. Cambridge, England: Cambridge University Press. Bryant, D.M., and C.T. Ramey 1986 An analysis of the effectiveness of early intervention programs for high-risk children. Pp. 33-78 in M. Guralnick and C. Bennett, eds., Effectiveness of Early Intervention. New York: Academic Press. Campos, JJ., K.C. Barrett, M.E. Lamb, H.H. Goldsmith, and C. Stenberg 1983 Socioemotional development. In PH. Mussen, ea., Handbook of Child Psychology, Vot III. New York: Wiley.

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT Carew, J. 137 1980 Experience and the development of intelligence in young children at home and in day care. Monographs of the Society for Research ~ Child Development 45~6-7~:Serial No. 187. Centers for Disease Control 1981 Immune globulins for protection against viral hepatitis. MMWR 30:423-428, 433-435. 1985 Education and foster care of children infected with human T-lymphotropic virus type III/lymphadenopathy-associated virus infections. MMWR 34:517-521. Chang A., P. Armstrong, and G. Kelso 1978 Management of Day Care Children During Episodes of Illness: Parent Attitudes to a Sick Child Care Center. School of Public Health, University of California, Berkeley. Clarke-Stewart, K.A. 1989 Infant day care: Maligned or malignant? American Psychologist 44:266-274. Clarke-Stewart, K.A., and G. G. Fein 1983 Early childhood programs' Pp. 917-999 in P.H. Mussen, ea., Handbook of Child Psychology, VoL II. New York: Wiley. Cochi, S.L~, D.W. Fleming, A.W. Hightower, K. Limpakarnjanarat, R.R. Facklam, J.D. Smith, R.K Sikes, and CV. Broom 1986 Primary invasive H. azpuenzae type b disease: A population-based assessment of risk factors. Journal of Pediatncs 108:887-896. Comer, J. 1989 Racism and the education of young children. Teachers College Record 90:352-362. Conboy, T.J., R.F. Pass, S. Stagno, C.A Alford, G.J. Myers, W.J. Britt, F.P. McCollister, M.N. Summem, C.E. McFarland, and T.J. Boll 1987 Early clinical manifestations and intellectual outcome in children with symp- tomatic congenital cytomegalovirus. Joumal of Pediatncs 111:343-348. Crockenberg, S. 1981 Infant irritability, mother responsiveness, and social support influences on the security of infant-mother attachment. Child Development 52:857-865. Cummins, J. 1986 Empowering minority students: A framework for intervention. Harvard Educa- tional Review 56:18-36. Daly, K., G.S. Giebink, C.T. Le. B. Lindgren, P.B. Batalden, R.S. Anderson, and J.N. Russ 1988 Determining risk for chronic otitis media with effusion. Pediatric Infectious Disease Formal 7~7~:471-475. Denny, F., A. Collier, and F. Henderson 1986 Acute respiratory infections in day care. Reviews of Infectious Diseases 8:527-532. Devoney, C, M.J. Guralnick, and H. Rubin 1974 Integrating handicapped and nonhandicapped preschool children: Effects on social play. Childhood Education 50:360-364. Dingle, J.H., G.F. Badger, and W.S. Jordan 1964 napless in the Home. Cleveland, Ohio: Press of Western Reserve University. Doyle, A.B. 1976 Incidence of illness in early group and family day care. Pediatrics 58:607-613. Dyson, L^, and R.R. Fewell 1986 Stress and adaptation in parents of young handicapped and nonhandicapped children: A comparative study. Journal of the Division of Early Childhood 1~.25-35.

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138 WHO CARES FOR AMERICA'S CHILDREN? Ekanem, E.E., H.L. DuPont, L^K Pickering, B.J. Selwyn, and C.M. Hawkins 1983 Transmission dynamics of enteric bacteria in day care centers. American Joumal of Epidemiology 118:562-572. Elardo, R., H.C. Solomons, and B.C. Snider 1987 An analysis of accidents at a day care center. American Journal of Orthopsychiatry 57~1~:60-65. Field, T., N. Vega-Lahr, and S. Jagadish 1984 Separation stress of nursery school infants and toddlers graduating to new classes. Infant Behavior and Development 7:277-284. Filice, G.A., J.S. Andrews, M.P. Hudgins, and D.W. Fraser 1978 Spread of Haemophil~s infiEuenzae: Secondary illness in household contacts of patients with H. influenzas meningitis. American Journal of Diseases of Children 132:757-759. Fillmore, L.W., and S. Britsch 1988 Early Education for Children From Linguistic and Cultural Minority Families. Paper prepared for the Early Education Task Force of the National Association of State Boards of Education, Alexandria, Va. June. Fine, M.A., and C.F. Swift 1986 Young handicapped children: Their prevalence and experiences with early intervention services. Journal of the Dimension for Early Childhood 10:73-83. Fink, D.B. 1986 Latch-Key Children and School-Age Child Care: A Background Briefing. Paper prepared for the Appalachian Educational Laboratory School-Age Child Care Project, Center for Research for Women, Wellesley College. Finkelhor, D., L^M. Williams, N. Burns, et al. 1988 Sexual Abuse in Day Care: A National Study. Executive Summary. Family Research Laboratory, University of New Hampshire. Fleming, D.W., M.D. Leibenhaut, D. Albanes, S.L. Cochi, JEW. Hightower, S. Makintubee, S.D. Helgerson, and C.V. Broome 1985 Secondary Haemophilus influence type b in day care facilities: risk factors and prevention. JAM4 254:509-514. Fleming, D.W., S.L~ Cochi, AW. Hightower, and C.~. Broome 1987 Childhood upper respiratory tract infections: To what degree is incidence affected by day care attendance? Pediatrics 79~1~:55-60. Fredericks, H.D.B., V. Baldwin, D. Grove, W. Moore, C. Riggs, and B. Lyons 1978 Integrating the moderately and severely handicapped preschool child into a normal day care setting. Pp. 191-206 in M.J. Guralnick, ea., Early Intervention of Handicapped and Nonhandicapped Children. Baltimore, Md.: University Park Press. Garrard, J., N. Leland, and D.K. Smith 1988 Epidemiology of human bites to children in a day-care center. American Journal of Diseases of Children l 42:643-650. Gehlbach, S.H., J.N. MacCormack, B.M. Drake, and W.V. Thompson 1973 Spread of disease by fecal-oral route in day nurseries. Health Service Reports 88:320-322. Ginsburg, C.M., G.H. McCracken Jr., S. Rae, and J.C. Parke, Jr. 1977 Haemophi11ls znfluenzae type b: incidence in a day care center. JAAL4 238:604- 607.

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 139 Goelman, H. 1986 The language environments of family day care. Pp. 153-179 in S. Kilmer, ea., Advances in Day Care and Early Education, loot IV. Greenwich, Conn.: JAI Press. Goelman, H., and JAR. Pence 1987 Some aspects of the relationship between family structure and child language in three types of day care. Pp. 129-146 in D. Peters and S. Kontos, eds., Annual Advances in Applied Developmental Psychology, Vot II. Norwood, N.J.: Ablex Publishing Corp. Granoff, D.M., and M. Basden 1980 Haemophi1~s ingenue infections in Fresno County, California: A prospective study of the effects of age, race, and contact with a case on incidence of disease. Journal of Infectious Diseases 141:40 46. Guralnick, MJ. 1976 The value of integrating handicapped and nonhandicapped preschool children. 19~78 ~ _ , . American Journal of Orthopsychiatry 46:236-245. Integrated preschools as educational and therapeutic environments: Concepts, design, and analysis. Pp. 115-145 in M.J. Guralnick, ea., Early Intervention and the Integration of Handicapped and Nonhandicapped Children. Baltimore, Md.: University Park Press. Hadler, S. C, JJ. Erben, D.P. Francis, H.M. Webster, and J.E. Maynard 1982 Risk factors for hepatitis in day care centers. Joumal of Infectious Diseases 145:255-261. Hartup, SEW. 1983 Peer relations. Pp. 103-196 in P.H. Mussen, ea., Handbook of Child Psychology, Volume Id, 4th ed. New York: Wiley. Haskins, R. 1985 Public school aggression among children with varying day-care experience. Child Development 56:689-703. Haskins, R., and J. Kotch 1986 Day care and illness: Evidence, costs, and public policy. Pediatrics 77(supp.~:951- 982. Hauser-Cram, P., ~C. Upshur, M.W. Krauss, and J.P. Shonkoff 1988 Implications of Public Law 99-457 for early intervention services for infants and toddlers with disabilities. Social Policy Report of the Society for Research in Child Development 3(~3~. Hay, D. 1985 Learning to form relationships in infancy: Parallel attainments with parents and peers. Developmental Review 5:122-161. Henderson, F.W., and G.S. Giebink 1986 Otitis media among children in day care: Epidemiology and pathogenesis. Reviews of Infectious Diseases ~4~:533-538. Holliday, B.G. 1985 Toward a model of teacher-child transactional processes affecting black children's academic achievement. Pp. 117-130 in M.B. Spencer, G.K Brookins, and W.R. Allen, eds., Begynnzr'gs: The Social and Affective Development of Black Children. Hillsdale, NJ.: Erlbaum. Holloway, S.D., and M. Reichhart-Erickson 1988 The relationship of day-care quality to children's free play behavior and social problem solving skills. Early Childhood Research Quarterly 3:39-54.

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140 WHO CARES FOR AMERICA'S CHILDREN? Horaeek, HJ., C.T. Ramey, F.A. Campbell, KP. Hoffmann, and R.H. Fletcher 1987 Predicting school failure and assessing early intervention with high-risk children. Joumal of the American Academy of Child and Adolescent Psychiatry 26:758-763. Howes, C. 1987 Social competency with peers: Contributions from child care. Early Childhood Research Quarterly 2:155-167. 1988a Can Age of Entry and the Quality of Infant Child Care Predict Behaviors in Kindergarten? Paper presented at the International Conference of Infant Studies, Washington, D.C., April. 1988b Peer interaction of young children. Monographs of the Society for Research in Child Development 53~1~:Serial No. 217. Howes, C., and M. Olenick 1986 Family and child influences on toddlers' compliance. Child Development 57:202- 216. Howes, C., M. Olenick, and T. Der-Kiureghian 1987 After-school child care in an elementary school: Social development and continuity and complementarily of programs. The Elementary School Journal (September):93-103. Howes, C., C. Rodning, D.C. Galluzzo, and L. Myers 1988 Attachment and child care: Relationships with mother and earegiver. Early Childhood Research Quarterly 3:403-416. Ispa, J. 1981 Social interactions among teachem, handicapped children, and nonhandieapped children in a mainstreamed preschool. Joumal of Applied Developmental Psy cholo`~ 1:231-250. Istre, G.R., J.S. Conner, C.V. Broome, A. Hightower, and R.S. Hopkins 1985 Risk factors for primary invasive Haemophilus influence disease: Increased risk from day care attendance and school-aged household members. Journal of Pediames 106:190-195. Jarman, F.C., and T.M. Kohlenberg 1988 Health and Safety Implications of Day Care. Paper prepared for the Panel on Child Care Policy, Committee on Child Development Research and Public Policy, Commission on Behavioral and Social Sciences and Education, National Research Council, Washington, D.C Jones, S.N., and S.J. Meisels 1987 Training family day care providers to work with special needs children. Topics in Early Childhood Special Education 7:1-12. Klein, J.O. 1987 The febrile child and occult bacteremia. New England Joumal of Medicine 317:1219-1220. Klein, N., and R. Sheehan 1987 Stab development: A key issue in meeting the needs of young handicapped children in day care settings. Topics in Early Childhood Special Education 7:13-27. Landis, S.E., J.L. Earp, and M. Sharp 1988 Day-eare center exclusion of sick children: Comparison of opinions of day-eare staff, working mothers, and pediatricians. Pediatncs 81~5~:662-667. Landman, P.F., and G.B. Landman 1987 Accidental injuries in children in day-care centers. American Journal of Diseases of Children 141:292-293.

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 141 Lazar, I., R.B. Darlington, H. Murray, J. Royce, and A. Snipper 1982 Lasting effects of early education: A report of the Consortium for Longitudinal Studies. Monograms of the Society for Research in Child Development 47(~2- 3~:Serial No. 195. Lemp, G.F., WE. Woodward, and L^K. Pickenng, P.S. Sullivan, and H.L" DuPont 1984 The relationship of staff to the incidence of diarrhea in day care centers. American Journal of Epidemiology 120:750-758. Lewis, C.C. 1984 Cooperation and control in Japanese nursery schools. Comparative Education Review 28:69-84. Long, TO., and L" Long 1983 The Handbook for Latchkey Children and Their Parents. New York: Arbor House. McCartney, K. 1984 Eliect of quality of day care environment on children's language development. Developmental Psychology 20:244-260. McCartney, K., S. Scarr, D. Phillips, S. Grajek, and J.C. Schwarz 1982 Environmental differences among day care centers and their effects on children's development. Pp. 126-151 in E. Zigler and E. Gordon, eds., Day Care: Scientific and Social Policy Issues. Boston: Auburn House. McCartney, K., S. Scarr, D. Phillips, and S. Grajek 1985 Day care as intervention: Comparisons of varying quality programs. Journal of Applied Developmental Psychology 6:247-260. McLean, A.A. 1986 Development of vaccines against hepatitis A and hepatitis B. Reviews of Infectious Diseases 8~4~:591-598. Melish, M.E., and J.B. Hanshaw 1973 Congenital cytomegalovirus infections. American Joumal of Diseases of Children 126:190-194. National Head Start Multicultural Task Force 1987 Report for First Meeting. December 10-11. Administration for Children, Youth, and Families. Washington, D.C.: U.S. Department of Health and Human Services. Ogbu, J.U. 1986 Consequences of the American caste system. Pp. 19-56 in U. Neisser, ea., The School Achievement of Minority Children. Hillsdale, NJ.: Erlbaum. Osterholm, M.T, L.M. Pierson, HE. White, T.A. Libby, J.N. Kuritsky, and J.G. McCullough 1987 The risk of subsequent transmission of Haemophi~s influenzas type b disease among children in day care. New England Journal of Medicine 316:1-5. Pass, R.F., and C. Hutto 1986 Group day care and oytomegaloviral infections of mothers and children. Reviews of Infectious Diseases 8~4~:599-605. Pass, R.F., S. Stagno, ~J. Myers, and C.A. Alford 1980 Outcome of symptomatic congenital cytomegalovirus infection: Results of long- term longitudinal follow-up. Pediamcs 66:758-762. Pass, R.F., E.A. Little, S. Stagno, W.J. Britt, and C.A. Alford 1987 Young children as a probable source of maternal and congenital cytomegalovirus infection. New England Joumal of Medicine 316:136~1370. Phillips, C. 1989 Ann-Bi~s Curriculum. Washington, D.C.: National Association for the Education of Young Children.

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142 WHO CARES FOR AMERICA'S CHILDREN? Pickering, L^K., D.G. Evans, H.L~ Dupont, J.J. Vottet III, and D.J. Evans, Jr. 1981 Diarrhea caused by Shigella, Rotavirus, and Giardia in day care centers: Prospective study. Joumal of Pediatrics 99:51-56. Redmond, S.R., and M.E. Pichichero 1984 Haernophi~s ingenue type b disease: Epidemiologic study with special refer- ence to day care centers. JAMS 252:2581-2583. Reeves, R.R., A.L Morrow, A.L Bartlett, and UK Pickering 1988 A Case Control Study of Acute Diarrhea in Children in a Health Maintenance Organization (HMO): Risk Estimates Associated with Non Breast Feeding and Day Care. Paper presented at Society for Pediatric Research annual scientific meeting, Washington D.C. Richardson, J.L, K. Dwyer, K McGuigan, W.B. Hansen, C. Dent, C.A. Johnson, S.Y. Sussman, B. Brannon, and B. Flay 1989 Substance use among eighth-grade students who take care of themselves after school. Pediatrics 84:556-566. Rodgers, F.S., G. Morgan, and B.C Fredericks 1986 Caring for the ill child in day care. Journal of School Health 56~4~:131-133. Rodman, H., D.J. Pratto, and R.S. Nelson 1985 Child care arrangement and children's functioning: A comparison of self-care and adult-care children. Developmental Psychology 21:413-418. Rubenstein, J.L^, and C. Howes 1983 Social-emotional development of toddlers in day care: The role of peers and individual differences. In S. Kilmer, ea., Early Education and Day Care' Vot 3. Greenwich, Conn.: JAI Press. Rule, S., J. Killoran, J. Stowitschek, M. Innocenti, and S. Striefel 1985 Staining and support for mainstreaming day care staff. Early Child Development and Care 20:99-113. Ruopp, R., J. leavers, F. Glantz, and C. Coelen 1979 Children at the Center: Final Results of the National Day Care Study. Boston: Abt Associates. Russell, S.D., and R.M. Clifford 1987 Child abuse and neglect in North Carolina day care programs. Child Welfare 67~2~:149-163. Sale, J.S.S. 1986 Promoting creativity and independence in young children: A challenge for teachers and parents. Speech delivered at the Centennial Celebration of Japanese Christian Kindergartens, Kanazawa, Japan. Available from UCLA Child Care Services, Los Angeles, Calif. Schloesser, P.T. 1986 Children in day care: 26(5):21-24. A public health challenge. Public Health Currents Schwatz, J.C. 1983 Infant Day Care: Effects at 2, 4, and 8 Years. Paper presented at the meeting of the Society for Research in Child Development, Detroit. Schweinhart, LJ., D.P. Weikart, and M.B. Lamer 1986 Consequences of three preschool curriculum models through age 15. Early Childhood Research Quarterly 1:15-45. Seligson, M. 1988 Paper prepared for Workshop on the Developmental Implications of Child Care, Panel on Child Care Policy, Committee on Child Development Research and

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SUPPORTING PHYSICAL AND PSYCHOLOGICAL DEVELOPMENT 143 Public Policy, Commission on Behavioral and Social Sciences and Education, National Research Council, Washington, D.C. Shapiro, E.D., J. Kuritsy, and J. Potter 1986 Policies for the exclusion of ill children from group day care: An unresolved dilemma. Review of Infectious Diseases ~4~:622-625. Slaughter, D.T. 1983 Early intervention and its effects on maternal and child development. Mono- t~aphs of the Society for Research in Child Development 48~43:Serial No. 202. Smith, C., and M. Greenberg 1981 Step by step integration of handicapped preschool children in a day care center for nonhandicapped children. Journal of the Division for Early Childhood 2:96-101. Snyder, L^, T. Apolloni, and UP. Cooke 1977 Integrated settings at the early childhood level: The role of nonretarded peers. Exceptional Children 43:262-266. Spencer, M.B. 1985 Black children's race awareness, racial attitudes, and self-concept: A reinterpre tation. Joumal of Child Psychology and Psychiatry 25:433-441. 1986 Black children's ethnic identity formation: Risk and resilience of castelike minorities. Pp. 103-116 in J.S. Phinney and M.J. Rotheram, eds., Children's Ethnic Socialization: Pluralism and Development. Beverly Hills, Calif.: Sage. 1988 Cognition, Identity, and Social Development as Correlates of African Ameri can Children's Academic Skills. Invited lecture sponsored by the Center for Afroamerican and African Studies, University of Michigan, Ann Arbor, March. Spencer, M.B., S.R. Kim, and S. Marshall 1987 Double stratification and psychological risk: Adaptational processes and school achievement of black children. Formal of Nemo Education 56:77-87. Sroute, LA. 1985 Attachment classification from the perspective of infant caregiver relationships. Child Development 56:1-14. Stagno, S., R.F. Pass, G. Cloud, W.J. Britt, R.E. Henderson, P.D. Walton, D.A Veren, F. Page, and CA. Alford 1986 Primary cytomegalovirus infection in pregnancy. Incidence, transmission to fetus, and clinical outcome. JAAL4 256:1904-1908. Steinberg, ~ 1986 Latchkey children and susceptibility to peer pressure: An ecological analysis. Developmental Psychology 22:433439. Strangert, K 1976 Respiratory illness in preschool children with different forms of day care. Pediatrics 57~2~:191-196. Sullivan, P., WE. Woodward, L.K Pickering, and H.L" Dupont 1984 Longitudinal study of diarrhea! disease in day care centers. American Joumal of Public Health 74:987-991. UCLA Child Care Services 1989 UCLA Child Care Seances Philosophy Statement. Los Angeles, Calif.: UCLA Child Care Services. Vandell, D.L^, and M.^ Corasaniti 1988 The relation between third graders' after-school care and social, academic, and emotional functioning. Child Development 59:868-875.

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144 WHO CARES FOR AMERICA'S CHILDREN? Vandell, D.L~, and C.P. Powers 1983 Day care quality and children's free play activities. American Joumal of Orthopsychiatry 53:493-500. Vandell, D.L~, V.K Henderson, and K.S. Wilson 1988 A longitudinal study of children with day-care experiences of varying quality. Child Development 59:1286-1292. Wald, E.R., B. Dashefsly, C. Byers, N. Guerra, and F. Taylor 1988 Frequency and seventy of infections in day care. Journal of Pediatrics 112:540- 546 Ward, J.I., D.W Fraser, ID. Baraff, and B.D. Plikaytis 1979 Haemophi~s in~enzae meningitis: A national study of secondary spread in household contacts. New England Joumal of Medicine 301:122-126. Weissman, J.B., EJ. Gangorosa, A Schmerler, R.L" Marier, and J.N. Lewis 1975 Shigellosis in day care centers. Lancet i(7898~:88-90. Williams, L.R., and Y. DeGaetano 1985 Alerta: A Multicultural Bilingual Approach to Teaching Young Children. Menlo Park, Calif.: Addison-Wesley. Wood, D. 19~ How Children Think and Learn. Oxford: Basil Blackwell. Wood, D., L McMahon, and Y. Cranston 1980 Working With Under Fives. London: Grant McIntyre.