Caring for Our Children (CFOC)

Chapter 1: Staffing

1.1 Child:Staff Ratio, Group Size, and Minimum Age

1.1.2 Minimum Age Minimum Age to Enter Child Care

Reader’s Note: This standard reflects a desirable goal when sufficient resources are available; it is understood that for some families, waiting until three months of age to enter their infant in child care may not be possible.

Healthy full-term infants can be enrolled in child care settings as early as three months of age. Premature infants or those with chronic health conditions should be evaluated by their primary care providers and developmental specialists to make an individual determination concerning the appropriate age for child care enrollment.

Brain anatomy, chemistry, and physiology undergo rapid development over the first ten to twelve weeks of life (1-6). Concurrently, and as a direct consequence of these shifts in central nervous system structure and function, infants demonstrate significant growth, irregularity, and eventually, organization of their behavior, physiology, and social responsiveness (1-3,5). Arousal responses to stimulation mature before the ability to self-regulate and control such responses in the first six to eight weeks of life causing infants to demonstrate an expanding range and fluctuation of behavioral state changes from quiet to alert to irritable (1-3,6). Infant behavior is most disorganized, most difficult to read and most frustrating to support at the six to eight week period (2,3). At approximately eight to twelve weeks after birth, full term infants typically undergo changes in brain function and behavior that helps caregivers/teachers understand and respond effectively to infants’ increasingly stable sleep-wake states, attention, self-calming efforts, feeding patterns and patterns of social engagement. Over the course of the third month, infants demonstrate an emerging capacity to sustain states of sleep and alert attention.

Infants, birth to three months of age, can become seriously ill very quickly without obvious signs (7). This increased risk to infants, birth to three months makes it important to minimize their exposure to children and adults outside their family, including exposures in child care (8). In addition, infants of mothers who return to work, particularly full-time, before twelve weeks of age, and are placed in group care may be at even greater risk for developing serious infectious diseases. These infants are less likely to receive recommended well-child care and immunizations and to be breastfed or are likely to have a shorter duration of breastfeeding (16,22).

Researchers report that breastfeeding duration was significantly higher in women with longer maternity leaves as compared to those with less than nine to twelve weeks leave (9,22). A leave of less than six weeks was associated with a much higher likelihood of stopping breastfeeding (10,22). Continuing breastfeeding after returning to work may be particularly difficult for lower income women who may have fewer support systems (11).

It takes women who have given birth about six weeks to return to the physical health they had prior to pregnancy (12). A significant portion of women reported child birth related symptoms five weeks after delivery (17). In contrast, women’s general mental health, vitality, and role function were improved with maternity leaves at twelve weeks or longer (13).

Birth of a child or adoption of a newborn, especially the first, requires significant transition in the family. First time parents/guardians are learning a new role and even with subsequent children, integration of the new family member requires several weeks of adaptation. Families need time to adjust physically and emotionally to the intense needs of a newborn (14,15).

In an analysis of twenty-one wealthy countries including Australia, New Zealand, Canada, United States, Japan, and several European countries, the U.S. ranked twentieth in terms of unpaid and paid parental leave available to two-parent families with the birth of their child (18,21). Although Switzerland ranked twenty-first with fourteen versus twenty-four weeks as compared to the U.S. for both parents/guardians, eleven weeks of leave are paid in Switzerland. In this study of twenty-one countries, only Australia and the U.S. do not provide for paid leave after the birth of a child (18).

Major social policies in the U.S. were established with the Social Security Act in 1935 at a time when the majority of women were not employed (19,20). The Family and Medical Leave Act (FMLA) of 1993, which allows twelve weeks of leave, established for the first time job protected maternity leave for qualifying employees (16,20). Despite the importance of FMLA, only about 60% of the women in the workforce are eligible for job protected maternity leave. FMLA does not provide paid leave, which may force many women to return to work sooner than preferred (18). FMLA is not transferable between parents/guardians. However, five U.S. states support five to six weeks of paid maternity leave and a few companies allow generous paid leaves for select employees (21).

In a nationally representative sample, 84% of women and 74% of men supported expansion of the FMLA; furthermore, 90% of women and 72% of men reported that employers and government should do more to support families (21).

Substantial evidence exists to strengthen social policies, specifically job protected paid leave for all families, for at least the first twelve weeks of life, in order to promote the health and development of children and families (22). Investing in families during an important life transition, the birth or adoption of a child, reflects a society’s values and may in fact contribute to a healthier and more productive work force.

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Helping Families Cope with Separation
  1. Staehelin, K., P. C. Bertea, E. Z. Stutz. 2007. Length of maternity leave and health of mother and child–a review. Int J Public Health 52:202-9.
  2. Guendelman, S., J. L. Kosc, M. Pearl, S. Graham, J. Goodman, M. Kharrazi. 2009. Juggling work and breastfeeding: Effects of maternity leave and occupational characteristics. Pediatrics 123: e38-e46.
  3. McGovern P., B. Dowd, D. Gjerdingen, I. Moscovice, L. Kochevar, W. Lohman. 1997. Time off work and the postpartum health of employed women. Medical Care 35:507-21.
  4. Cunningham, F. G., F. F. Gont, K. J. Leveno, L. C. Gilstrap, J. C. Hauth, K. D. Wenstrom. 2005. Williams obstretrics. 21st ed. New York: McGraw Hill.
  5. Kimbro, R. T. 2006. On-the-job moms: Work and breastfeeding initiation and duration for a sample of low-income women. Maternal Child Health J 10:19-26.
  6. Carter, B., M. McGoldrick, eds. 2005. The expanded family life cycle: Individual, family, and social perspectives. 3rd ed. New York: Allyn and Bacon Classics.
  7. Ishimine, P. 2006. Fever without source in children 0-36 months. Pediatric Clinics North Am 53:167.
  8. Harper, M. 2004. Update on the management of the febrile infant. Clin Pediatric Emerg Med 5:5-12.
  9. Carey, W. B., A. C. Crocker, E. R. Elias, H. M. Feldman, W. L. Coleman. 2009. Developmental-behavioral pediatrics. 4th ed. Philadelphia: W. B. Saunders.
  10. Parmelee, A. H. Jr, W. Weiner, H. Schultz. 1964. Infant sleep patterns: From birth to 16 weeks of age. J Pediatrics 65:576-82.
  11. Brazelton, T. B. 1962. Crying in infancy. Pediatrics 29:579-88.
  12. Huttenlocher, P. R., C. de Courten. 1987. The development of synapses in striate cortex of man. Human Neurobiology 6:1-9.
  13. Anders, T. F. 1992. Sleeping through the night: A developmental perspective. Pediatrics 90:554-60.
  14. Edelstein, S., J. Sharlin, S. Edelstein. 2008. Life cycle nutrition: An evidence-based approach. Boston: Jones and Bartlett.
  15. Robertson, S. S. 1987. Human cyclic motility: Fetal-newborn continuities and newborn state differences. Devel Psychobiology 20:425-42.
  16. Berger, L. M., J. Hill, J. Waldfogel. 2005. Maternity leave, early maternal employment and child health and development in the US. Economic J 115: F29-F47.
  17. McGovern, P., B. Dowd, D. Gjerdingen, C. R. Gross, S. Kenney, L. Ukestad, D. McCaffrey, U. Lundberg. 2006. Postpartum health of employed mothers 5 weeks after childbirth. Annals Fam Med 4:159-67.
  18. Ray, R., J. C. Gornick, J. Schmitt. 2009. Parental leave policies in 21 countries: Assessing generosity and gender equality. Rev. ed. Washington, DC: Center for Economic and Policy Research.
  19. Social Security Act. 1935. 42 USC 7.
  20. Family and Medical Leave Act. 1993. 29 USC 2601.
  21. Lovell, V., E. O’Neill, S. Olsen. 2007. Maternity leave in the United States: Paid parental leave is still not standard, even among the best U.S. employers. Washington, DC: Institute for Women’s Policy Research.
  22. Human Rights Watch. 2011. Failing its families: Lack of paid leave and work-family supports in the U.S.