Day Care as Germ Factory

by Mary Eberstadt

(Page 4 of 7)

The reason for beginning with institutional care, as opposed to other forms of substitute care, is simple: That is the chosen battleground of advocates who have argued over the years that such care is as good as or even better than maternal care or nonmaternal care in other forms - an older sibling or grandparent, a babysitter in the home, a turn-taking arrangement with the mother next door, and so on.

This ideological defense of mother-child separation is not new, of course. As Allan Carlson showed recently in an interesting essay on the history of such attempts, its pedigree stretches all the way back to Plato and includes many other thinkers through the centuries.4 In our own time such advocates generally have been dubbed "feminists." I will refer to their ideology instead as "separationism" and to its advocates as "separationists," for that is what they are - thinkers who urge institutional care not as an inevitable practical choice for some, but as a theoretical choice that allegedly advances higher personal or social goals. This is how institutional care has come to be rationalized and promoted.

One immediate harm of such care - or at least what some people would regard as harm - is familiar to all pediatricians and many parents. Day care centers literally make children sick, and they do so a lot more efficiently than care at home. The screaming toddler with whom I opened this chapter is not the exception but the norm; he is perhaps on the extreme end of pain (of course, not all children in day care spend their days this way), but it is the norm nonetheless. He represents the truth that just being in day care increases the likelihood of physical distress. That is because infections are more likely among babies or toddlers tended to in an institutional setting - for three rather obvious reasons. First, infants in full-time care are almost certainly not being breast-fed, or not much at any rate, so the immunological benefits of human milk are not being supplied to them. This raises the risks of their contracting ailments no matter where they are. Second, certain specific things about babies and toddlers, such as diaper-wearing and constant hand-to-mouth contact, make them germ carriers beyond compare, especially germs transmitted by saliva or feces. Third, the sheer number of children encountered every day in such institutions - which is far higher than for children at home even in large families - further and dramatically raises the likelihood of infection. It is like playing pathogen roulette with five bullets instead of two.

In a medical nutshell, and as parents who use day care already know, children in it tend to be sick more often than others. Consider the example of otitis media, commonly known as an ear infection and the single most common complaint that brings children to the doctor. Otitis media itself is not contagious but is caused by upper respiratory ailments (URAs) that are. Over the past couple of decades, as any pediatrician can tell you - to say nothing of those millions of parents still harboring a sticky pink bottle of antibiotic somewhere in the refrigerator - ear infections in children, especially young children, have risen dramatically. Why? For the same reason that Dr. Charles Bluestone, an otolaryngologist (ear, nose, and throat specialist), told one newspaper: "Virtually every study ever done on the increase in otitis media has shown that day care is the most important difference."

And otitis media is only the beginning. One current American Academy of Pediatrics fact sheet on "Controlling Illness in Child Care Programs" - the title is suggestive in itself - enumerates a number of other infections that are spread more easily in day care, from the common cold to gastrointestinal problems to any number of skin and eye infections (impetigo, lice, ringworm, scabies, cold sores, and conjunctivitis, or pinkeye). In fact, hepatitis A, which can be transmitted by contact with feces and is actually more serious for adults than for children, is such an issue in center-based care that this paper further recommends vaccines for "high-risk occupations" - that is, day care workers.

Medically speaking, the story of day care as germ central is relatively old news; it has been more than ten years since Pediatric Annals, an authoritative source for pediatricians, devoted a special issue to the subject - and titled its editorial "Day Care, Day Care: Mayday! Mayday!"6 But what has lagged in the popular understanding, at least to judge by the relative absence of writing on the subject, is what might be called the phenomenological face of all this - that is, what numbers like these mean in real life for people, including babies and toddlers.

Something like that need has lately been supplied by Harvard professor Jody Heymann who devotes considerable space to examining real-life case studies of contemporary family life in her 2000 book on inequality, The Widening Gap. (It was based on extended interviews with more than eight hundred individuals, including workers in the child care industry as well as parents.) The day care employees repeatedly emphasize the problems of having to work not only around sick babies and children, but also around desperate parents who drop off those babies and children at day care rather than miss a day of work. One center worker even coined the term "Tylenol signs" to describe what is evidently common practice: dosing a child with fever-lowering medicine at home or in the car just before drop-off, with the result that the caregivers do not realize the child has a fever until several hours later when the effects wear off and the child's temperature goes back up. Of course this is contrary to the rules of most centers; since fevers usually mean that kids are contagious, they are supposed to stay home when they have them - but this apparently is a rule parents frequently breach. In fact, on account of this "Tylenol" practice, some caregivers also routinely interrogate children about what happened at home - specifically, whether or not they have had any "pink medicine."

As anyone who has attended even one sick child can attest, the physical and emotional demands of several at once can strain many a "caregiver ratio" to the breaking point. "[M]any of the child-care providers we spoke with," Heymann summarizes, "described having received children whose acute health problems made it impossible to provide adequate care either for them or for the well children under the child-care provider's supervision" [emphasis added]. Problems arose, for example, because the child-care providers could not keep clean and well hydrated the sick children who were vomiting or had diarrhea, give sufficient attention to the sick children's other needs, and curb the spread of infectious diseases while also trying to care for the healthy children."

Moreover, many parents further confirmed these negative findings to the research team. "Overall," Heymann reports, "41 percent of the parents we interviewed extensively . . . said their working conditions had negatively affected their children's health in ways that ranged from children being unable to make needed doctors' appointments to children receiving inadequate early care, which resulted in their condition worsening."

Heymann's account, sad and all too real, is one of several in recent years to have drawn attention to the poor quality of care in many centers and to infer the need for some national "solution" (paradoxically, more and also better day care). Like most other such advocacy, Heymann's emphasizes how emotionally difficult it can be for the parents who must manage all these competing claims at once. And who cannot feel for a stressed-out mother torn between an unforgiving workplace on the one hand and a sick baby on the other? To avoid that, as discussed by Arlie Russell Hochschild in her book The Time Bind, increasing numbers of corporations have devised ways to keep parents at their desks, including flex time and other leave arrangements as well as in-house care centers.

Yet like most of the day care literature, Heymann's explains the sick child problem from the adult point of view - that is, the stress that a sick child adds to an already hectic schedule. As such, it is of limited moral utility. To get the full measure of the harm possibly transpiring, one must look at it from the point of view of the miserable ailing child in institutional care who is not only being deprived of the familiar people and things that might take the edge off his discomfort, but is also too young to understand where everyone else is and why he feels so bad. Shouldn't his unhappiness and confusion and lack of fulfillment count for something in the day care calculus, too? Life is indeed hard and misery abundant for all of us, and as some separationist literature reminds us, kids do have to get used to it. But why don't advocates answer this question: What age, if any, is too young for induction into the school of hard knocks?

© 2004 Penguin Group. All rights reserved.

About the Author

Mary Eberstadt is a part-time research fellow at Stanford University's Hoover Institution and consulting editor to Policy Review, the critically acclaimed journal of conservative thought. Her essays and reviews have also appeared in the Weekly Standard, The Wall Street Journal, and Commentary.