Chapter twenty-nine Child Care Laura Stout Sosinsky and Walter S. Gilliam

Chapter twenty-nine Child Care Laura Stout Sosinsky and Walter S. Gilliam

Child care impacts the health and development of children and the economic stability of families. For too many young children and their families, affordable high-quality child care is not accessible. Pediatricians have a role in helping children receive safe, enriching care in high-quality early childhood education settings that allows parents to be able to work.

As an environment in which children learn, grow, and play, child care is a component of the social determinants of health. The majority of young children regularly spend time in at least one nonparental child care arrangement. Routine exposure to high-quality child care provides an opportunity for early education in language, early literacy, math, and social skills, as well as for teaching children health-promoting behaviors and for identifying early signs of delays or special needs. Inadequate child care supply and poor availability block these opportunities for many children, disproportionately those from low-resourced families. Instead, many young children are exposed to a patchwork of child care arrangements that are unstable, unaffordable, and often poorly resourced, adding stress that harms child and family well-being.

Child care provision is affected by many factors, derived from family demand, child care supply, and child/family policy. With increasing movement of mothers into the workplace across the globe, the prime reason most families use child care is to support employment of both parents. After childbirth, unpaid maternity leave is the typical situation among U.S. mothers. The U.S. federal leave program allows for twelve weeks of unpaid job-protected leave during pregnancy or after childbirth, but only covers approximately fifty percent of the workforce because companies with less than fifty employees, with part-time employees, and those working in informal labor markets are exempt. Several states and cities have passed paid family leave laws.

In part because of the financial burden of an unpaid maternity leave, many mothers return to work, and their children may begin child care in the first few weeks after birth. In a two thousand Family and Medical Leave Act survey, only ten percent of respondents reported taking more than sixty days for maternity leave. Approximately forty-four percent of mothers in two thousand five to two thousand seven were working by the time their first child was three to four months of age, and approximately sixty-three percent of mothers were working by the time their first child was twelve months. Some mothers face work requirements if they are receiving public benefits because of the reforms to welfare passed by the U.S. Congress in nineteen ninety-six. Many mothers feel strong financial motivation or even pressure to work, especially in single-parent households, or have strong incentive to work for short- and long-term financial security. Employment is not the only factor driving child care use; young children of unemployed mothers spend on average twenty-one hours per week in child care. Many parents want their children to have child care experiences for the potential benefits that early learning environments can give to their children. Given these realities, child care quality is of great concern, yet the quality of child care and early education environments varies widely, and the supply of high-quality child care is largely deemed inadequate.

The COVID-nineteen pandemic revealed the fragility of America's child care system. Relative to adults, young children have been far less likely to suffer severe medical complications from coronavirus infection, and rates of transmission in child care facilities that followed mitigation protocols have been low. However, the downstream effects of the pandemic on young children have been acute. Burdensome child care cost and access barriers became exaggerated. Parents of young children report significant concerns about their children's safety and education during the pandemic and describe significant disruptions and impacts on families' well-being. Estimates indicate that one in every five hundred

Chapter twenty-nine Child Care

U.S. children have experienced COVID-nineteen orphanhood or the loss of a caregiving grandparent, further highlighting a crisis in early childhood caregiving.