Navigating childcare: Nurseries and attachment theory.

16

14/12/2013 by RFB

The popular choice

There has always been a societal need for childcare during the early years. Traditionally it has been provided by parents, extended family, nannies, and child-minders, based in the home or a family-like setting. However, in recent years, not only has the number of young children in non-parental care increased rapidly (in 1981 76% of 1 year olds were being cared for by a parent, in 2010 it was only 24%) but there has also been a shift in provision. Group-settings such as nurseries have become the non-family childcare of choice; the 25 largest providers in the UK offer a total of 77,219 places. They have become the social norm, and are perceived as a safe and professional option for childcare. However, group childcare settings face a critical obstacle in their ability to meet the needs of babies and children, a factor that brings their suitability as institutions for the young into question: attachment theory.

What is ‘attachment theory’?

Attachment theory was pioneered by psychologists following the Second World War, most notably in the UK through the work of John Bowlby. He was interested in how important the bond between a child and their primary caregiver (usually but not necessarily the mother) was, during the early years, in determining the long-term psychological well being of children into adulthood. Through attachment theory we can understand how developing and sustaining secure attachment from birth has life long implications for how people relate to others, their ability to show empathetic behaviour, and their own mental health and well-being.

“A secure attachment is likely to develop when an adult is sensitive and attuned to the baby’s communications, and when the adult provides consistent and predicable care which meets the needs of the baby quickly and reliably.
An insecure attachment is likely to develop when the adult is insensitive and not well attuned to the baby’s communications, and when the care is inconsistent and unpredictable and does not satisfy the baby’s needs quickly or reliably.”

–       Sir Richard Bowbly, ‘Attachment, what it is, why it is important and what we can do about it to help young children acquire a secure attachment.’, European Parliament 2008.

For a secure attachment to exist, there must be a genuine mutual affection between the child and their caregiver, the caregiver must be consistently responsive, and the caregiver themself must be a consistent individual – this relationships is formed between two individuals not between the child and the setting. The pivotal period identified for secure attachment to be established and maintained is during the early years, from birth to age three to five (depending on the needs of the individual child).

Does attachment theory really matter?

The government thinks so – it has influenced NHS policies on hospital visiting regulations (particularly regarding neonatal and paediatric care), and social work practice. It has also informed the Early Years Foundations Stage guidelines which must be adhered to by all registered childcare providers, notably in the specification that childcare settings must have a ‘key person’ system in place. The intention of the ‘key person’ role is that the they form a secure secondary attachment (complimenting the primary one held between parent and child) with the young people in their care. This both preserves the quality of a child’s primary attachment, and serves to protect and meet the the child’s needs whilst in the setting.

Good practice is for people in key person roles to receive additional training in attachment theory with practical strategies that enable them to apply this understanding to their role. It is recommended that children self-select their key person based on whom they naturally warm to in order to increase the likelihood of a genuine bond developing. The key person must facilitate the child in feeling secure (within themself and the setting), and cared for whilst away from their primary care-giver (i.e. parent). For the role to be effective the relationship must be mutually affectionate and consistent.

“The KP [key person] is someone who has significance and meaning from the point of view of the child. It is the person who manages most of that child’s day to day care and who keeps the child in mind. It is the person with whom the child has a special relationship” – Peter Elfer, Principal Lecturer and Convenor, MA Early Childhood Studies – University of Roehampton, ‘Implementing the Key Person Approach’.

The challenge

Even with the best of intentions, it can be extremely difficult for group childcare providers to establish and maintain secure secondary attachments in their settings. This is due to a number of factors including the following:

  • The number of children in an key person’s care, the environment, and the practical demands on the nursery workers can make it extremely difficult to deliver consistent and tuned-in empathetic responses to the children in the setting.
  • Many settings do not have a thorough enough grasp of the importance of attachment theory, or a deep enough understanding of what appropriate delivery would look like in practice. This means that the ‘key person’ role can be misinterpreted or not applied effectively, therefore undermining the possibility for secure attachments to be formed.
  • Developing genuine bonds between children and non-related adults takes time and understanding, and adequate opportunity for this prior to and during their start at the setting is rarely provided. There is also the ongoing issue of staff absences and staff turnover, and the age related movement of children through the setting which can all have negative implications with attachments being compromised or broken.

Nurseries are businesses.

How have nurseries become seen as such a desirable option for childcare if it is so difficult for them to ensure quality secondary attachments and truly meet the needs of babies and young children? It is important to remember that the majority of group childcare settings are private businesses. Their priority is profitability, and marketing their provision to appeal to parents.

 “The children’s nursery sector has grown more than the economy over the past year and its overall value is now £4.6bn, according to Laing and Buisson’s annual market report, which highlighted that nursery groups are a driving force for growth in the sector.” – ‘Nursery Chains: League Tables – the Big Picture’, Catherine Gaunt, 6th November 2013, www.nurseryworld.co.uk

We cannot necessarily depend on nursery settings to share a full and unbiased account of their service. They are not impartial, they are businesses seeking to meet and profit from consumer demand. However, in accordance with the UN Convention on the Rights of the Child, anyone working with children has a duty to understand their needs and work in their best interests, and group childcare providers are neglecting to do this if they do not implement a robust system that reflects an understanding and respect for attachment theory.

“Article 3 (Best interests of the child): The best interests of children must be the primary concern in making decisions that may affect them. All adults should do what is best for children. When adults make decisions, they should think about how their decisions will affect children.” – UNICEF Convention on the Rights of the Child

Is it possible for group childcare to ensure secure attachment?

There are proven examples where secure attachments have been achieved and maintained in a group childcare setting. Pioneering a successful approach was Emmi Pikler, a Hungarian paediatrician who developed a model for the care of babies and young children. Pikler’s model prioritises the children’s physical and mental wellbeing, by creating an optimal environment for their development and ensuring the establishment of mutually respectful and affectionate relationships with their caregivers. Her work was so successful in doing this that it enabled institutionalised orphans to experience an upbringing that could be compared in quality and future outcomes to that of an average family life. In order to achieve this, there were key principles that gave the foundation to the provision that she offered:

  • The caregiver must acknowledge the child (from birth) as a free and equal human being, and as an equal partner in the relationship.
  • The caregiver does things with the child, not to the child.
  • Care giving moments such as nappy changes, dressing, feeding and sleeping are entered into respectfully, and are seen as opportunities for bonding not as tasks.
  • Children and babies have freedom of movement so that their development can unfold in due course.
  • Children and babies are cared for in groups of eight, by four adults. The children stay with each other and the same four caregivers the entire time they are at the residential nursery (which caters for 0 to 3 years old).
  • Children and babies are properly supported in forming a secure attachment to their secondary caregiver.

In the Pikler model the ‘settling-in’ process is granted a minimum time scale of two weeks for each child, but is facilitated for as long as is necessary for them to establish a secure secondary attachment to their caregiver in the setting, before they remain there without their parent. It allows for a gradual and authentic development of trust between the primary caregiver (parent), secondary caregiver, and the child.

“Over this period a very very close relationship is being built between the Mother and the caregiver. In the emotional safety of this growing relationship the child “gets to learn the habits of the daycare with the Mother’s help, [and] the child’s trust can be earned, which is indispensible for him to have a good time with us.” – Dr Gabriella Püspöki (Emmi Pikler Institute), key note address at the New Zealand Childcare Association – Te Tari Puna Ora Conference, Auckland, 12th July 2009.

Adopting a Pikler approach can side-step the potential negative impact of insecure attachments that was identified by John Bowlby, enabling young children to establish healthy attachment in a childcare setting.

“Day care can be made much better all over the world if we learned from the experiment of Lóczy[the Institute led by Pikler]. At most day-care centers, children are cared for randomly, picked up by one person and fed by another.  Children are cared for as objects.  What the child needs is relationships with the least possible number of stable adults.” – words of Magda Gerber from ‘Respect is Key To Development’ by Joy Horowitz.

Advice for navigating childcare:

1)   When considering a group childcare setting for your child make it a priority to ask them about their understanding of attachment theory and how this is reflected in their approaches to childcare provision. Areas for particular consideration are the settling in process, allocation of the key person and establishment of the relationship with the child, drop off and pick up, and caring moments such as nappy changes, feeding and sleeping. Ask if the staff have a thorough understanding of attachment theory. Be aware that nurseries are in the majority private businesses seeking to appeal to parents. Hold in the forefront of your mind that above all else the most important thing for a child’s development and well being in the early years is the responsive and empathetic care from a consistent individual with whom they share an authentic bond. This should be your guide to assess the setting.

2)   Seek childcare arrangements that offer a better opportunity to form a secure secondary attachment, where the child receives consistent care from an individual in a home-type setting, such as a child-minder, family member, nanny or nanny share. These providers should also demonstrate an understanding of and appreciation for attachment theory, formally or informally.

3)   Parents as primary care givers for children aged one and older has become the minority choice, however parental care gives the best opportunity for children to form long lasting, strong and healthy attachments and it should not be underestimated for its potential benefits.  Parental care in the early years is the most preferable option in regards to the long-term well-being of children.

For more information:

The Origins of Attachment Theory, by Inge Bretherton, Developmental Psychology (1992):

http://www.psychology.sunysb.edu/attachment/online/inge_origins.pdf

Attachment, what it is, why it is important and what we can do about it to help young children acquire a secure attachment, by Sir Richard Bowlby, Alliance For Childhood European Network Group.

http://www.allianceforchildhood.eu/files/QOC%20Sig%204.pdf

Early Years Foundation Stage (EYFS) 2012:

http://media.education.gov.uk/assets/files/pdf/eyfs%20statutory%20framework%20march%202012.pdf

Implementing the Key Person Approach – Peter Elfer, Principal Lecturer and Convenor, MA Early Childhood Studies – University of Roehampton 

Key Person Approach

The Pikler Collection – central resource on Pikler’s work.

http://thepiklercollection.weebly.com

Getting to Know You – Dr Gabriella Püspöki’s key note address at the New Zealand Childcare Association – Te Tari Puna Ora Conference, Auckland, 12th July 2009, transcribed by Pennie Brownlee

http://thepiklercollection.weebly.com/uploads/9/4/5/3/9453622/settling_at_pikler_daycare_budapest.pdf

Interview with Emmi Pikler: ‘Respect is key to baby development’.

http://littleriverschool.wordpress.com/2011/03/04/respect-is-key-to-baby-development/

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16 thoughts on “Navigating childcare: Nurseries and attachment theory.

  1. Would you please look at my UK based website http://www.freerangechildcare.com and concider adding a link to the above post?
    And/or possible write an article about the website?
    Thank you
    Annelize Cruz
    Attachment parent, attachment childminder and business owner of Free Range Childcare

    • schristophy says:

      Hi Annalize, come and find me on Facebook at Respected from Birth, I would be very interested to hear how you apply attachment theory in your setting.

  2. janeevansparenting says:

    Fantastic piece I found myself cheering along too!

    All such essential information for parents and carers of children. I deliver Attachment Theory in Practice Training to early years staff and am amazed that some have little if any knowledge about it. It should be a firm foundation for anyone involved the lives of children whatever their role but most especially if they are providing and attachment figure to a young child.

    Keep on writing about this crucial issue.

  3. David Wright says:

    I also agree with the need for the importance of attachment to be promoted and understood within daycare settings. As a nursery provider, may I just defend some of us a bit and say that not everyone is driven purely by profit? Yes, there is a need to cover outgoings (nb wages) and make a living but not at the cost of poor care. Our motto of ‘Love, Laughter and Learning’ makes explicit our primary focus on children’s physical, social and emotional well being.We work very hard to ensure our staff provide effective attachment to the children we care for within our settings. I know of many other providers who are equally concerned that we get it right for our children. We also need to be realistic about what is feasible – staff do not work 10 hours a day, 5 days a week and therefore the same person may not always be available to greet, care for and wave goodbye. Not many of our children attend all day every day either. It’s about doing the best within each and every context, given the constraints.

    • schristophy says:

      Thanks for your comment David. Can you share how your setting ensures secure attachment? If a setting can not do so it is not protecting the mental health of the children and so should not be responsible for their care. It’s a bit like a nursery having a hole in the fence, but about mental well being rather than physical wellbeing.

      • AlejandraP says:

        That’s a very hostile response. Do you think ANY nurseries provide care high enough to meet your standards? It’s clearly not something you’d ever choose for your own children so do you really think you should be the one to dictate what nursery care should look like?

        Also, care to show the evidence of how poor quality nursery care in this country is damaging the mental health of children? Because from what I’ve read (not on blogs, by the way) the evidence is ambiguous and patchy – it’s hardly a public health crisis in the making.

      • schristophy says:

        The key person system is a non-negotiable part of the EYFS. For more information please follow the Peter Elfer link at the bottom of the post.

  4. Great blog! Will share on my travels.. 🙂

  5. Becky Wood says:

    A very interesting post & I share your concern about childcare arrangements for the very young. My view is that ideally, a child should be looked after predominantly by a parent or a close family member until the age of about three. I also agree with you about childcare settings being businesses and I’m sure you know that very few offer the ideal model of care that you describe in your post. But the reality is that many families have few options other than to place their children in these settings: single parents, those under financial constraint (that is surely the main reason why these settings are chosen, as well as a concern about ‘socialisation’), with no family support, with a disabled child/children, little access to good transport, having to work long hours etc., to name but some reasons. Also, the fact is that some children are actually better off in these settings than at home. Having said this, I have been shocked when some of my friends have placed their very young children/babies in childcare for lengthy periods without any question, and this continues into school, with breakfast clubs and after-school clubs…making a very long school day. As a wise family friend once said to me: “The best thing you can give your children is your time. You might be just doing the ironing while they are watching the telly, but you are there.”

    • schristophy says:

      Hi Becky thank you for your comments. I would advocate a good childminder over a nursery, but as you said for some families it may be the only option This is which why it is so important that all nurseries make raising awareness of attachment theory amongst their staff and the parents a priority. It has to be something approached as a collaborative effort between the nursery and the family. Their can be no excuses, and is especially important for nurseries caring for children who might be coming from unstable home lives. It must be a non negotiable base line standard.

  6. […] This is a very good article…Is group care best for effective attachments? Apparently not…..this is one area where training should be compulsory…available at all levels and revisited regularly Navigating childcare: Nurseries and attachment theory. | Respected from Birth […]

  7. I agree with David’s comments. The majority of providers do their best for children. The important thing is raising awareness about attachments and the key person approach. I have written two blogs on this subject.

    http://laurachildcare.wordpress.com/2013/01/15/elephants-never-forget-attachment-and-loss/

    http://laurachildcare.wordpress.com/2011/10/07/practitioner-and-child-positive-or-personal-relationships/

    • schristophy says:

      Hi Laura thank you for your comments. An full and practical understanding of the key person approach re: attachment theory must be a basic minimum requirement for early years settings. Without it a setting is compromised in its ability to care for the children that attend. There may be challenges in achieving this but those challenges must be overcome in all group childcare settings. This isn’t to say that people working in early years settings who aren’t aware of the importance attachment don’t care about the children, they just don’t have the information that they need to fulfil their role properly. Thank you for your blog links – I can see that we agree on lots of points. Elephants are a great example of attachment theory, and emphasise how important it is to establish secondary attachment with a key person gradually and BEFORE a child is left by the parent in a new setting, therefore massively reducing the anxiety and upset.

  8. Leah Jones says:

    Hi I have a brilliant ofsted outstanding childminder my child is goes to 2 mornings a week. But the only way she would do settling in was him being pulled off me into her arms. Yes to be comforted at all times, yes we met once, then i left for half an hour, then 2 hours etc. He even got hysterical going in his car seat at all. I was going to pack it in then he just was fine. I think it was a few weeks at least. He went into her arms without crying. He was one. Apparently this approach is best practice and if I was there it would have upset the other kids. I would never do it again and never have. Thank you. Brilliant and informative article.

  9. ELloyd says:

    Very interesting article. As a parent whose child attends nursery 8.45am-5.30pm four days per week I am obviously concerned about continuity of care and attachments with staff and other children. I have been very happy with the care and education my child has received (though not without expense). She is thriving, confident and healthy.

    Of course I would like to spend more time with her but without any other family members around to help, and given our jobs, we have to manage in the best way we can. I’m actually happy she is in nursery now rather than with a childminder- the environment is stimulating and she has lots of friends as well as bonds with staff (especially the manager who she has known since eleven months old), although I did question our choice when she was very young. Now I know for sure she is happy because she can tell me so!

    I personally feel there needs to be a massive culture shift around childcare in UK. It should not be seen as the obligation of the mother to stay at home with the children (so I do sort of object to ‘the best setting for the child is at home with a parent’ line as that parent tends to be the mother as she is usually the lower earner). If our work and income allowed it, it would have been better for us both to work part time so that we could both spend more time with our child and also work for the long term benefit and security of our family. Fathers and mothers both should have the opportunity to bond with and learn with their children where possible and where it is in the child’s best interests.

    Working parents – mothers especially- feel much guilt about leaving their children with someone else so I’d like to see more people standing up for us, recognising we are doing the best in our given circumstances, acknowledging that we are being good role models and recognising that just because we don’t spend all day with our children it doesn’t mean we don’t want the absolute best for them, or that we have impoverished relationships with our children as a result.

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