This article originally appeared in the January-February 2000 issue of the Children's Advocate newsmagazine, published by Action Alliance for Children.

Crisis in infant care

An interview with Ron Lally, co-director of the Center for Child and Family Studies at WestEd, on infant/toddler child care and mental health

By Fran Biderman

Children's Advocate (CA): Why are you so concerned about the care of very young children?

Lally: The reality of most infant and toddler care is that it is not designed for infants and toddlers but for older children. Most people do not have a clue about what infants need nor how to provide care for them in groups.

CA: Why is this such a big problem?

Lally: Well, we know from brain research that many problems begin in infancy. The number of children coming into child care at early ages is increasing. Never before have we had so many infants cared for by people other than family. The supports that used to be there-churches, neighborhoods, extended families-have eroded.

CA: What do young children need?

Lally: We have learned from the child abuse and neglect literature and from research on learning that very young children need seven essential supports at home and in child care: nurturance, support, security, predictability, focus, encouragement, and expansion.

Poor care threatens mental health

CA: Do all young children have "mental health" needs?

Lally: Often people say, "Aren't infants too young to have problems?" The answer is a resounding "no!" Infant "mental health needs" should be seen from two points of view, prevention and early intervention. True preventive mental health does not mean dealing with a child with problems, but setting the stage for positive social and emotional development through the provision of the seven supports. Early intervention means correcting problems that can start even before birth.

CA: How does inappropriate care affect children?

Lally: One example is fear. If children don't have a trusting and secure relationship with their caregiver during the first six months of life, their levels of anxiety and tension will be high. Later on, say from eight to 15 months, it is probable that they will not spend as much time exploring their environment and being curious. They will spend their time trying to establish trusting relationships or building emotional defenses.

Infants and toddlers need relationship-centered care

CA: What kind of care do infants and toddlers need?

Lally: Child care for children under three needs to be relationship-centered as opposed to curriculum-centered, and provided by knowledgeable, responsive caregivers. Caregivers need to observe the child and then figure out what to do, instead of having a pre-determined formula. For example, if caregivers observe that a child is temperamentally cautious, they will know to gradually woo the child to try something new. If a child is of relatively easy temperament the caregivers may have to pay extra attention to this child so he doesn't get lost in the hubbub of the group.

Good care takes its lead from the child. When children start to crawl and explore at around eight months, some untrained caregivers say, "Good, you are being independent," and feel they can then ignore the child. Others say "It's dangerous, don't hurt yourself." Either of these responses may frustrate the child. With a trained caregiver, children who are starting to crawl learn that it is all right to go out and explore because the caregiver is right there for them to crawl back to and get a hug.

CA: How do we establish relationship-centered care?

Lally: There are three policy foundations for relationship-based care for children under three:

1. Small groups.
2. The assignment of a primary caregiver to each child.
3. Continuity.

Small groups are important because you can't adequately observe and support young children in large groups. By assigning a primary caregiver you are in effect assigning a relationship. For the relationship to grow we need to keep caregivers with the child as long as possible. To cap it off, a fourth policy would be reflective supervision.

CA: What is reflective supervision?

Lally: This is a key element missing in child care in the United States. For example, in Italy there is a roving specialist who goes around and talks to child care providers about their children and their work practices. They get providers to step back and look at the impact of their work on the children and on themselves. They discuss possible strategies and approaches. Without this kind of assistance, even the best program will go off track. In some places in the U.S. mental health specialists and child care consultants are bringing this type of supervision to child care.

CA: How might a mental health specialist work with a particular child?

Lally: Let's take an example. Kadija Johnson, an infant mental health consultant from the University of California, San Francisco, observed a 20-month-old child hitting and kicking anyone who came near him in the child care center. She also observed the child at home and found he had two older brothers who constantly harassed him. She learned that his behavior at the center came from learning how to defend himself at home. As an intervention, she began by sitting next to this boy in child care and inviting easygoing children to sit on her other side. Slowly she helped the child see that he could interact with other children without needing to hit. This is an example of infant mental health work. If left unattended this issue could have snowballed into serious personality problems for this child at a later age.

Caregivers need special training and support

CA: Do caregivers need more training to work with very young children?

Lally: Absolutely. Most providers know how to work with preschool-age children, and often try to "force that type of care downwards." Babies can't sit in a 20-minute circle time or easily adjust to scheduled activities. Also, more and more children are coming to care at risk for emotional problems and need early intervention.

CA: How would you redesign the child care system to better meet the needs of infants and toddlers?

Lally: I would want to see children cared for in small groups that stayed together with the same caregivers for their first three years. I would require that each caregiver of infants and toddlers go through an intensive relationship-based training. I would place a full-time, child care mental health consultant in each resource and referral agency in the state. I would recommend that each child care program set aside time each week for reflective supervision. I would demand more compensation, ongoing training, and support for child care professionals.

I realize that all this costs money, but there is no investment with greater payback than investing in our youngest children.

The development and evaluation of several child care/mental health pilot projects is now underway, aiming to develop a statewide policy agenda on mental health support for child care. For information call Virginia Reynolds at WestEd, (916) 492-9999, or Marsha Sherman at the Child Care Health Program, (510) 839-1195.