Rx Lacking in Day-Care Dilemma : Health: Two new studies indicate there is still no consensus among pediatricians on how young children are affected by mother working.

Barbara Wirth had just completed her pediatric residency and was expecting her first baby when she was faced with the question of who would care for her infant while she and her husband pursued their careers.

But, as a pediatrician, Wirth was also worried about how to advise working parents on day-care issues. Like most pediatricians, she had no training in medical school on day-care issues and knew of few solid studies outlining the pros and cons of day care for young children.

Now two new studies, one that Wirth helped direct at the Thomas Jefferson University School of Medicine in Philadelphia, show health-care professionals are widely divided in their opinions on day care and its effects on young children.

The surveys--among the first to poll pediatricians on the issue--show many vital questions about day care and child development are unresolved, hampering physicians’ ability to advise parents on the best environments for children, Wirth said.

The Thomas Jefferson University study, released earlier this month at a meeting of pediatricians in Anaheim, polled 338 physicians. A joint study by the American Academy of Pediatricians and Working Mother magazine, also released earlier this month, surveyed 1,100 pediatricians. However, the surveys did turn up some trends in pediatricians’ views, including:

* A majority of them in both surveys think that day care for a child under the age of 6 months might be detrimental.

* The older the child, the less likely were the pediatricians to feel day care is harmful.

* Many are concerned about the general quality of day care in the United States.

The dearth of long-term, conclusive studies on day care has left pediatricians struggling for a base on which to form opinions--just when parents need their guidance the most, said Dr. Peter Scheidt, of the National Institute of Child Health and Human Development. According to government statistics, 75% of U.S. children under age 2 whose mothers are employed are cared for by someone other than a parent.

In an attempt to resolve many of the outstanding questions on day care, the National Institute of Child Health and Development this summer will launch the largest, longest study on the topic at 10 research institutions around the nation.

The five-year, $15-million study, called the National Study of Young Children’s Lives, will track a minimum of 1,200 children from diverse backgrounds and geographical locations to examine the effects of different types of day care.

Children will be recruited for the study at birth and will be monitored at various ages, from 1 month to 3, at home and at child development centers. The researchers will examine the child’s age, sex, health, birth order and temperament, home environment and family makeup. Details recorded on the family will include the family’s size, parents’ relationship, attitudes, education, income and race.

The study will attempt to answer such questions as: What long-term effects will day care have on the social, emotional and cognitive development of these children? Will they be more or less independent? How will day care affect the family relationships of the next generation of children?

“I don’t know of any study that, in a controlled way, looks at this detail for such a long period of time,” Scheidt said.

“Well over half of the families (in the U.S.) have both parents working full time and need child care. Within both the public and professional community there are many questions about what impact day care has on children. Not so much that it has a negative impact--it may have a positive impact--but it is a change.”

Concern over day care continues to be paramount among parents and child-development experts because of the few long-term studies on day care and the difficulty in finding quality care, said Alison Clarke-Stewart, a professor of social ecology at UC Irvine, where about 150 Orange County children will participate in the national study.

“It’s sort of surprising to me that it’s still as unsettled and as much of an issue as it was 15 years ago,” she said.

The study might help resolve one of the greatest reservations among pediatricians, apparent from the recent surveys: that mothers may return to work too soon after giving birth, said Dr. Antoinette Eaton, vice president of the American Academy of Pediatrics.

“I think the major gap in information is looking at the effect of day care on young infants,” Eaton said. “This is a topic of great interest, and I think we’ll see some answers on it from the national study.”

The AAP-Working Mother magazine poll showed that 68% of pediatricians said they thought mothers working full time might have a harmful effect upon children age 6 months and younger. Just over half thought it might be harmful for children 1 to 3 years old, and 35% thought it might be harmful for children 4 to 5 years old.

The Thomas Jefferson poll found 77% of doctors thought it best for infants under 6 months to be at home. That study did not poll physicians on their opinions about older children.

“Regarding infants, they overwhelmingly prefer one-to-one care with the baby at home,” said Dr. Cheryl Hausman, who co-authored the study with Wirth. “There may be some hints from other studies that it’s detrimental, but it’s still a strong bias that pediatricians are passing on to their patients.”

According to Eaton, too few long-term studies have been completed to indicate whether mothers working may be detrimental to an infant. But, she said, most studies of children older than 6 months have shown no difference in development between children in day care and children cared for by their mothers.

“I can say without hesitancy that there is no proof that the mother working outside the home has a deleterious effect,” Eaton said. “The real issue is that the environment must be one that is most conducive to the child’s development--whether it’s at home or a day-care center.”

Further questioning of the pediatricians polled by Working Mother revealed that many pediatricians do not think day care is harmful in itself but have doubts about the general quality of day care and how to best advise families, said Susan Seliger, deputy editor of the magazine.

“It was troubling to see the attitudes about mothers working,” Seliger said. “But the overwhelming response was they are concerned about the day-care situation in America. They feel the state of child care is just not so great. It’s not mothers working that is the issue. What’s important is that we can find decent child care.”

But pediatricians are increasingly asked to help parents locate and evaluate child care. Readers’ surveys show parents often rely on their pediatrician for advice on day-care issues, Seliger said.

“The bond between mothers and pediatricians is so strong and important,” she said. “Increasingly they have to turn to pediatricians because this is one of the few allies they have and one of the few people seemingly interested. Many pediatricians are not as well informed as they should be. But they see (guidance on child care) as part of their responsibility--to see that the child is brought up in the best environment possible.”

Wirth said the Thomas Jefferson University study indicated that pediatricians are not always comfortable giving advice.

For example, 39% felt uncomfortable discussing day-care issues, and a majority felt their training in the area was inadequate.

“What surprised me was that 85% said they felt they had inadequate training regarding day-care issues,” Wirth said. “And one-third had never discussed it with their patients. From our perspective, this is something that should be discussed.”

Even in the absence of conclusive studies on the effects of day care, pediatricians can help parents assess their individual circumstances in order to arrive at decisions on day care, said Dr. Peggy Goldenhersh, a Santa Monica pediatrician who specializes in pediatric and adult allergies. Goldenhersh is the mother of a 5-month-old child.

“I think pediatricians are interested in more hard-core data on day-care issues. But most pediatricians will tell you that it’s a very individualized decision,” said Goldenhersh.

Goldenhersh, who returned to her practice when her child was 2 months old, said she, too, struggled with uncertain feelings over what would be best for the child. She adopted a schedule that suited her career and allowed her to spend time with her child. Goldenhersh noted that each of her friends who are working mothers have adopted drastically different child-care arrangements to meet their needs.

“There is no question in my mind that the economic benefits of a mother’s working are going to help a child who might otherwise be raised in poverty,” Eaton said.

Hausman agrees that experts should help parents look at how day-care arrangements fit into their entire lives. Future studies might only reveal that the best day-care arrangements vary from family to family, she said.

“I think people look at day care and place too much emphasis on it as a separate entity,” Hausman said. “If the mother wants a career and is unhappy staying at home, what kind of effect will that have on a child?

“Family life, maternal attitude and the child’s temperament are factors that figure into the question. I think the National Institute of Child Health and Human Development study will look at those variables.”

LEAVING BABY BEHIND

Two recent surveys of pediatricians reveal mixed views on whether mothers of young children should work outside the home. The polls also showed the doctors are reluctant to advise parents on the subject.

Key findings of the American Academy of Pediatrics and Working Mother magazine poll of pediatricians:

* 68% thought it may be harmful for a child under 6 months of age if the mother worked outside the home.

* 61% thought it might be harmful if the child was 6 to 12 months old.

* 52% said they discussed finding child care with parents only if asked.

* 59% said they discussed choosing day-care environment only if asked.

Key findings of Thomas Jefferson University School of Medicine poll of pediatricians:

* 77% felt the best type of day-care arrangement for a 6-month-old was in-home care.

* 39% felt uncomfortable discussing day-care issues.

* 85% said their training on day-dare issues was inadequate.

* 43% never or rarely discussed day care during initial visit with parents.