CONTINUITY OF CARE

Having consistent primary caregivers who can provide continuity of care, especially in the early years (before three years old), helps the child develop secure attachments.

Practising

for a very young children involves having primary or main caregivers who do not change often and care for children with consistent caregiving routines.

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1. McMullen, M. B. (2017). Continuity of Care with Infants and Toddlers. Retrieved from Child Care Exchange website: www.ChildCareExchange.com

Having consistent primary caregivers impacts young children’s learning and development as children are more willing and able to explore their surroundings if they have a stable relationship with their caregivers. This is because children with their primary caregivers can use their caregivers as a secure base for exploration and as a haven for comfort when distressed.

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2. Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, NY: Basic Books.

In a US study of 11 to 27-month-old children during routine activities in day care centres, researchers found that infants and toddlers who were distressed were more likely to initiate greater closeness and comfort-seeking behaviours toward more consistent caregivers. Even in the absence of immediate distress, toddlers sought out the consistent caregivers more often, suggesting they were using the caregivers as a source of comfort and security.

Continuity of care recognises that secure attachments between babies and caregivers and their trusting relationships take time to develop and should last as long as possible.

Continuity of care involves ensuring individuals caring for the child are consistent for as long as possible to facilitate quality relationship-based experiences during the important first three years. Such consistent continuity of care has been recommended by nearly all major professional organisations that address infant-toddler practices. This is based upon attachment research that demonstrates the lifelong impact of supportive, stable relationships that begin at infancy.

Having familiar people to provide caregiving within the course of a day helps young children develop secure attachments with caregivers. A 1993 study of 106 children in infant day care settings showed that when children were younger than 30 months of age, a consistent relationship with one caregiver (who could also be an infant-care teacher) resulted in children developing secure attachments compared with children who had multiple changes of caregivers.

In addition, a study of 108 children between 6 to 30-months in 113 daycare centres in the Netherlands showed that young children who experience multiple caregivers or multiple childcare arrangements over a course of a day were at risk of more behavioural problems.

Other studies have found that it is not beneficial to have long term instability in caregivers. Instability refers to too many changes in non-parental caregivers over a period between birth and kindergarten entry. These changes may occur when a child leaves a childcare arrangement, for example, switching from one childcare centre to another or when a child changes too often to a new caregiver within the same setting. Multiplicity refers to experiencing multiple, concurrent childcare arrangements over the course of a single day or week on a regular basis.

Both long-term instability and multiplicity have each been associated with adverse effects on a range of socio-emotional outcomes in early childhood, including internalising and externalising behaviour problems and prosocial behaviours.

Not all changes in childcare providers or multiple, concurrent arrangements will be detrimental to children’s development. Changes that are planned and purposeful and that lead to higher quality or more developmentally appropriate care, such as transitioning from in-home care to centre-based care during the preschool years, may lead to more positive outcomes.

A study on infant caregiving arrangements carried out on 439 mother-child dyads on children at 4-months, 18-months and 3-years by a research team from the Singapore Children’s Society and the KK Women’s and Children’s Hospital also found that having the mother as the main caregiver was not associated with children being more securely attached to their mothers, or having better developmental outcomes at three years of age. The number of times children’s main caregiver was changed between birth and 3 years of age did not predict child temperament, mother-child attachment, or developmental outcomes at 3 years of age. What was more important was having consistent caregiving arrangements from caregivers who were responsive to the infants’ cues and needs, as this helped to ensure that the child developed more secure attachments and a better temperament.

Extensive neuroscience research incorporating 47 years of programme evaluation data and multiple meta-analyses, along with examining other literature review, carried out by the Harvard University Center on the Developing Child has shown that while attachments to their parents are primary, young children can also benefit significantly from relationships with other responsive caregivers both within and outside the family. Close relationships with other nurturing, reliable and available adults do not interfere with young children’s primary relationship with their parents. In fact, multiple caregivers can promote young children’s social and emotional development. That said, frequent disruptions in care and high staff turnover and poor-quality interactions in early childhood programme settings can undermine children’s ability to establish secure expectations about whether and how their needs will be met.

A study of 75 infants (mean age 15 months) in the Netherlands has shown that attachments do not need to be formed with just a mother. A stable network of adults (including educarers) can provide the same responsive care to help the child form secure attachments. Professional caregivers in this study did not have more insecure attachment relationships with the infants in their care than did parents. However, there must be enough time provided for the carer and infant to adapt to each other and to learn how to decode each other's signals and behaviours, so that the carer can sensitively respond to the infant.

A study on the primary caregiving system in two infantcare centres in Singapore also showed that having primary caregivers present when transitioning a child to another caregiver helped to keep the attachments secure when changing caregivers. Agreement on caregiving arrangements between all the main caregivers also helped maintain secure attachment relationships between children and all their caregivers.