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ECHO Cohort Study Finds Amount of Time Spent in Childcare Not Associated With Mental Health Risks in Young Children, Including Those Facing Family Challenges
Authors: Michelle Bosquet Enlow, et al.
Who sponsored this study?
The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.
Why was this study needed?
Children who face early life adversity—such as parental mental illness and household economic hardship—may be at a higher risk for mental health difficulties. Researchers in this study wanted to examine the extent to which attending out-of-home childcare might buffer or magnify the effects of those experiences.
In the U.S., many children under age 5 spend some time in nonparental childcare. However, previous findings on the role of childcare in child mental health have produced mixed results. While many studies highlight positive associations with attending childcare, some raise concerns that childcare may increase the risk for poor child developmental outcomes.
What were the study results?
The study found that children with higher exposure to factors such as family stress and mental illness were more likely to have higher levels of internalizing symptoms (such as anxiety or depression) and externalizing symptoms (such as aggression and hyperactivity), especially if their families also faced socioeconomic hardship. However, researchers also found that the number of hours in childcare did not seem to change the effects of these risks on children’s mental health, nor was childcare attendance significantly associated with improvement or worsening of their symptoms overall. This was true whether they looked at all types of non-parent childcare that were included in the study—including center-based care, home-based non-relative care, and care by a relative—or looked at just center-based care.
What was the study's impact?
The study found that the amount of time spent in childcare didn’t have a clear positive or negative effect on children’s mental health. The findings suggest that challenges like social or emotional stressors and financial hardships should be looked at separately to better understand the risks to children’s mental health in early life.
Who was involved?
The participants in the study were a diverse sample of 2,024 parent-child pairs from three ECHO Cohort Study Sites. Participants were recruited from hospitals in North Carolina, Pennsylvania, and Tennessee, as well as from U.S. adoption agencies across the United States.
What happened during the study?
The study collected data on the type and frequency of childcare attendance from birth to age 3 years. It also looked at early life challenges during that time, such as whether parents had experienced difficult childhood events, showed signs of depression, or had certain factors like age, education, or relationship status that could affect their child’s well-being. Between ages 3 and 5.5 years, the study evaluated children’s symptoms such as anxiety, depression, aggression, or hyperactivity. By following these children over time, researchers could explore the associations among early adversity, childcare attendance, and child mental health outcomes.
Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.
What happens next?
Future work could examine how and whether childcare quality is associated with child mental health, including whether high-quality care may be associated with a reduction of any adverse effects of early adversity on child outcomes.
Where can I learn more?
Access the full journal article titled “The Influence of Early Childhood Education and Care on the Relation between Early Life Social Adversity and Children’s Mental Health in the Environmental influences for Child Health Outcomes Program” in Development and Psychopathology.
The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Published December 2024
