Maternal and non-maternal care in infancy and later child cognitive, language and motor development in Chile: Does type of care matter?

Early Childhood Research Quarterly 51 (2020) 204–214

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Early Childhood Research Quarterly

Maternal and non-maternal care in infancy and later child cognitive, language and motor development in Chile: Does type of care matter? Marigen Narea a,∗ , Claudio O. Toppelberg b , Matías Irarrázaval c,d,e , Jiali Xu f a School of Psychology, Pontificia Universidad Catolica de Chile and Center for Advanced Studies on Educational Justice (CJE), Av. Vicu˜ na Mackenna 4860, Macul, Santiago. Chile b Harvard Medical School, Judge Baker Children’s Center and Boston Children’s Hospital, Boston, MA, USA c Departamento de Psiquiatría, Facultad de Medicina Hospital Clínico Universidad de Chile, Santiago Chile d Millennium Institute for Research in Depression and Personality. Vicu˜ na Mackenna 4860, Macul, Santiago, Chile e Mental Health and Substance Use Unit, Pan American Health Organization/World Health Organization, Washington, DC, USA f Judge Baker Children’s Center, Boston, MA, USA

a r t i c l e

i n f o

Article history: Received 8 May 2018 Received in revised form 15 August 2019 Accepted 30 October 2019 Keywords: Non-maternal care Early childhood Infancy Child development Chile

a b s t r a c t Growing numbers of children across the world start non-maternal care in the first year of life. However, few studies have described how different infant care experiences may relate to later child cognitive, language and motor functioning, and most analyses have focused on samples from historically industrialized regions. Cognitive, language and motor subscores (TEPSI) and receptive vocabulary scores (TVIP) obtained through direct testing of 24-to-48-month-old children (n = 7564) from the Chilean Longitudinal Survey of Early Childhood were compared based on retrospective reports of care received as infants. Children who, as infants, had received one of four types of non-maternal care — center-based, grandparent, other relative, and non-relative care — were compared to those who had exclusively experienced maternal care (71.8%). Series of regressions with propensity score models (PSM) were performed. Compared to maternal care, children in center-based care and grandparent care had higher total TEPSI scores (d = .19, p < 0.05) (d = .19, p < 0.01) and TEPSI language subscores (d = .20, p < 0.05) (d = .20, p < 0.01), while those in grandparent care also had higher TEPSI motor subscores (d = .08, p < 0.05). In contrast, children in nonrelative care had lower TVIP receptive vocabulary scores (d = −.38, p < 0.01). These findings contribute to the debate on national policies supporting specific types of non-maternal care and their impact on child development. © 2019 Elsevier Inc. All rights reserved.

During the past decade, the collective evidence from neuroscience, developmental science, and cost-benefit analyses of early childhood programs underscores that the child’s first years of life present unique opportunities to promote healthy child development (Black et al., 2017; Fox, Levitt, & Nelson, 2010; Gaston, Edwards, & Tober, 2015). This early period is also one of considerable vulnerability in that adverse experiences may have lifelong consequences (Champagne, 2010; Shonkoff et al., 2012), with the child-rearing environment and quality of interactions playing a crucial role (Barros et al., 2016; Horm et al., 2018; Shonkoff et al., 2012; Thompson, 2016). With the continual increase in maternal employment, and the use of non-maternal care starting as early

∗ Corresponding author. Department of Psychology, Pontificia Universi˜ Mackenna 4860, Macul, Santiago, Chile. dad Catolica de Chile, Av. Vicuna Tel.: +56 2 354484. E-mail address: [email protected] (M. Narea). https://doi.org/10.1016/j.ecresq.2019.10.010 0885-2006/© 2019 Elsevier Inc. All rights reserved.

as infancy (Jaffee, Van Hulle, & Rodgers, 2011), there is a need to understand the impact different types of non-maternal care might have on developmental outcomes. Most studies on non-maternal care have focused on centerbased care. Centers that provide quality childcare can improve academic outcomes (McCoy et al., 2017) in addition to improving overall school readiness (Votruba-Drzal, Coley, Collins, & Miller, 2015). Children who attend high quality non-parental childcare have consistently been shown to experience gains in language and cognitive skills relative to children in maternal care (Bradley & Vandell, 2007; Côté, Doyle, Petitclerc, & Timmins, 2013; Dearing, Zachrisson, Mykletun, & Toppelberg, 2018), especially for children who are considered at risk (Burger, 2010). However, the care of very young children often occurs outside the child’s own home at the home of a caregiver, rather than at a childcare center (Adams, Tout, & Zaslow, 2007). The proportion of children under two who receive care under informal arrangements (involving grandparents, other relatives, or non-relatives) is 36% in

M. Narea et al. / Early Childhood Research Quarterly 51 (2020) 204–214

the USA and 34%, on average, in member countries of the Organisation for Economic Co-operation and Development (OECD Family Database, 2016). Despite their high prevalence, little is known about the effects of these types of informal care on young children’s development (Walker et al., 2007), as most studies have focused on children aged three and older (Gambaro, Stewart, & Waldfogel, 2014), living in industrialized regions, and attending center-based care (Bornstein et al., 2012). There is a critical need to extend studies to infancy (as non-maternal care often starts before age 1), focusing on (a) informal types of non-maternal care, as well as (b) center-based care, and (c) a much wider range of study populations, encompassing non-industrialized regions and Latin America. This study aims at extending the literature about childcare experience in infancy and later cognitive, language and motor functioning, by focusing on children in a wide range of non-maternal care settings, in Chile.

1. Type of non-maternal care and child development When analyzing the effects of non-maternal care on child development, it is important to consider the specific type of care (Gregg, Washbrook, Propper, & Burgess, 2005), given the different characteristics of center-based versus informal types of non-maternal care, offering a distinct set of experiences for the child. In general, informal settings provide higher quality care on some structural indicators (e.g. adult–child ratio) than formal settings, but formal settings such as center-based care tend to provide higher levels of caregiver training and education (Dowsett, Huston, & Imes, 2008). Regarding quality of processes, such as planning or communication with children, Bigras et al. (2010) found that quality was lower in relative care than in center-based care. Children in center-based care spent more time in structured, adult-directed activities than children in home-based care (Fuller, Kagan, Loeb, & Chang, 2004; NICHD Early Child Care Research Network, 2004). Past research on the association of non-maternal care during infancy and child development shows either neutral or positive results. In the previous two decades, the US-based National Institute of Child Health and Human Development (NICHD) Study of Early Childhood Care documented that children who participated in center-based care showed better cognitive and language development compared to children who spent an equivalent amount of time in home-based childcare or in relative care of comparable quality (Loeb, Fuller, Kagan, & Carrol, 2004; NICHD Early Child Care Research Network, 2002, 2004; NICHD National Early Child Care Research Network and Duncan, 2003). Similarly, Côté et al. (2013), studying a British cohort, found that attending center-based care at nine months (versus informal care such as family or neighbor care) was linked to better cognitive development at ages three and five. Sylva, Stein, Leach, Barnes, and Malmberg (2011), using data from the UK found that nursery attendance was associated with higher cognitive functioning at 18 months. Furthermore, Hansen and Hawkes (2009) using data from the Millennium Cohort Study, found that attending center-based care at age nine months was positively associated with school readiness. Compared to children in informal care, children who attend center-based care generally displayed better academic outcomes (Bradley & Vandell, 2007; Loeb, Bridges, Bassok, Fuller, & Rumberger, 2007). However, within informal care, studies on grandparent care have yielded mixed results. Hansen and Hawkes (2009) found that there was a positive association between grandparent care (compared to maternal care) and children’s vocabulary scores. Boca, Del Piazzalunga, and Pronzato, 2014, using data from the Millennium Cohort Study (UK) found that children cared for by grandparents (as well as parents) are better at naming objects, but worse at problem solving than children in center-based care.

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Of note, positive associations between grandparent care and child cognitive outcomes are stronger for children in more advantaged households, while negative associations appear only for children in more disadvantaged households, suggesting a moderating effect of being in a disadvantaged household. One hypothesis about the heterogeneity in the findings of the association between grandparent care and child development is the range of quality found in this type of care. In the “Growing Up” study in Australia grandparents reported better communication and overall relationship quality with the infant, relative to reports by caregivers at the center-based care (Gray, Misson, & Hayes, 2005), while data from the UK, Leach et al. (2008), found that grandparents offered 10-month-old infants fewer activities than center-based teachers. Of important note, most of these studies were conducted in industrialized regions focusing almost exclusively on children aged three or older in relation to center-based care. (Behrman, Cheng, & Todd, 2004; Berlinski, Galiani, & Gertler, 2009; Rosero, 2012; Rosero & Oosterbeek, 2011). To our knowledge, only two studies have evaluated the association of earlier non-maternal care experience (in both cases before age 2) and child development in Chile. In an observational study, Lira and Contreras (1999) found that children (n = 90) who stayed with their mothers were more likely to improve from a lagged to a normal level of development relative to children in grandparent or center-based care. In a more recent study, Noboa-Hidalgo and Urzua (2012), using a Chilean longitudinal dataset with 482 children younger than two years old, found that the expansion of publicly-funded center-based childcare had a positive association with reasoning, communication, fine and gross motor skills, but a small negative association with memory. Despite the growing use of center-based care, and other nonmaternal care, the evidence about the association between types of non-maternal care during a child’s first year of life and later cognitive, language and motor functioning is scarce in industrialized nations and even more limited in middle and low-income countries.

2. Household disadvantage as a moderator in the effect of different types of infant care on child development The association between non-maternal care and child development may vary as a function of family socioeconomic status (SES) (Côté et al., 2013; Geoffroy et al., 2007). A hypothesized mechanism that could explain the moderating role of household socioeconomic disadvantage on the effect of types of childcare on child development is that family income may be positively related with the level of stimulation that a child receives at home. In this sense, VotrubaDrzal (2012) concluded that the home environment in low income families is more sensitive to household income changes compared to wealthier families. Following this logic, for low-income children, it could be particularly beneficial to attend center-based care because formal care could potentially provide them with better learning opportunities compared to the learning opportunities at home (Geoffroy et al., 2010). Côté et al. (2013) further supported this theory with findings demonstrating an association between type of care and child cognitive outcomes for children whose mothers had low levels of education. In the present study, two variables reflecting socioeconomic risk were considered: low maternal education and low family income. It is important to test whether infants from disadvantaged households benefit more from formal (center-based) or informal non-maternal care than those from non-vulnerable families because national policy on early childhood education in Chile specifically targets households in the bottom 60 percent of the national socioeconomic distribution.

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Fig. 1. Distribution of type of care by child’s age.

3. Chilean context Overwhelmingly, extant studies are from industrialized nations and their findings are not always culturally transposable to the contexts of a nation such as Chile. While Chile recently reached developed nation status, marked socioeconomic disparities, social values, and culture-specific practices may contribute to differences in the association between non-maternal care and child development. Chile exhibits one of the highest rates of economic inequality in Latin America and is among the top 12% most economically unequal countries in the world (United Nations Development Programme, 2010). Also, often due to traditional patriarchal values and gender roles (Contreras & Plaza, 2010), women’s labor force participation in Chile (41% in 2017) is lower than in the United States (46%) and other Latin American countries such as Brazil (42%) and Colombia (42%) (ILOSTAT, 2017). In order to address the persistent economic inequality and to support maternal employment, in 2006, the Chilean government established an early childhood development policy. The main goal of the Chilean policy was to provide full center-based coverage of early childhood education for children up to age four for households in the bottom 60 percent of the national socioeconomic spectrum and for all children of working mothers (Ministerio de Educacion de Chile, 2014). Although enrollment in publicly funded early childhood care and education programs has increased substantially during the last ten years, Chile has less childcare coverage than the average OECD country (OECD, 2014). According to ELPI in analyses, 71.8% of Chilean infants ages 6–12 months were cared for exclusively by their mothers, while 28.2% attend non-maternal care, including 21.5% in informal and 6.7% in formal center-based care (see Fig. 1). While policies in Chile have favored center-based care in the first year of life over informal care, the use of informal care (by grandparents, other relatives, or nonrelatives) is more prevalent during this period than center-based care. As such, it is particularly important to understand the effects of informal types of care on child development in Chile in addition to center-based care. Based on developmental theory, important differential associations of these types of care on child cognitive, linguistic and motor development are quite possible, but any differences are not well documented in the empirical literature (Bradley & Vandell, 2007) as most studies have categorized different types of informal care under one category. For instance, most research have defined relative care as care provided by any family member (e.g., aunts and grandparents), however especially in the context of Chile, there is

a nuanced difference in the type of care provided by aunts, versus grandparents. In Chile, it is frequent for aunts to offer care for several children (nieces, nephews) in addition to their own, resulting in adult–child ratios that are typically higher than in grandparent care, where there is generally only one child per adult. In addition, as older people generally have better grammar and will take the time to speak more slowly relative to younger people (Griffin & Spieler, 2006), older caregivers may expose infants to larger vocabularies and more child-directed and contingent speech. In order to account for these differences, in the present analysis, grandparent care is distinguished from other relatives’ care (which focuses on care mostly provided by aunts).

4. Current study This study focuses in the national context of Chile, on children during their first year of life, a crucial but understudied period in childcare research. Given that Chile is heavily investing in the expansion of center-based care (Vargas-Barón, 2009), as opposed to looking at informal types of care like grandparents, relatives, and non-relative care, which is more prevalently used in infancy, there is a growing need to understand the association between different types of informal care, in addition to center based care and child development. In order to address this issues and investigate the extent of the association between attendance at different types of nonmaternal care, and maternal care during infancy on later child development, this study will focus on cognitive, language and motor outcomes from direct testing at 24–48 months relative to retrospective reports of care received as infants (e.g. maternal, center-based, grandparent, other relative, and non-relative care). The first and second aims of the study compare later child cognitive, linguistic and motor functioning of 24-to-48-month-olds, between children who, during infancy, were solely in maternal care versus those who experienced non-maternal childcare. In the first aim, maternal care is compared to any type of non-maternal care, while in the second aim, maternal care is compared more specifically to each type of non-maternal care — i.e., formal (centerbased) and informal (grandparent, other relative and non-relative). The third aim is to investigate the role of household disadvantage — low maternal education and household poverty — as a moderator of the association between type of non-maternal care experience in infancy and child cognitive, language and motor outcomes.

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Table 1 Maternal, child, and family characteristics for children (n = 7564) in different types of care at 6–12 months old. Maternal care N = 5521 % = 72.9

Center-based care N = 483 % = 6.4

Grandparent care N = 964 % = 12.7

Other relative care N = 291 % = 3.8

Non-relative care N = 305 % = 4.0

Obs. coverage N = 7564

R-squared

Maternal characteristics Age se Married (%) se Years of education se Mother low-educ se Teen mother (less than 20) (%) se Mother’s depression (%) se Mother’s WAISa digit score se Mother’s WAISa vocabulary score se Ethnicity se

29.7 (0.1) 0.733 (0.006) 11.03 (0.047) 0.397 (0.007) 0.082 (0.004) 0.105 (0.004) −0.061 (0.014) −0.075 (0.014) 0.088 (0.004)

31.2** (0.316) 0.662** (0.022) 1268** (0.152) 0.181** (0.017) 0.063** (0.011) 0.132** (0.015) 0.233** (0.049) 0.231** (0.061) 0.0823 (0.012)

28.6** (0.212) 0.547** (0.017) 12.95** (0.099) 0.162** (0.012) 0.083 (0.009) 0.127** (0.011) 0.140** (0.032) 0.207** (0.031) 0.0703** (0.008)

32.0** (0.413) 0.708** (0.027) 11.82** (0.205) 0.259** (0.026) 0.029** (0.0099) 0.151** (0.021) −0.00985 (0.062) 0.109** (0.061) 0.0904 (0.018)

34.3** (0.369) 0.796** (0.025) 14.49** (0.18) 0.100** (0.016) 0.002** (0.002) 0.147** (0.024) 0.543** (0.076) 0.860** (0.071) 0.0497 (0.013)

7448

0.949

7534

0.713

7370

0.928

7534

0.367

7534

0.08

7534

0.115

7531

0.022

7531

0.047

7418

0.084

Child characteristics Female (%) se Premature (%) se Older sibling (%) se

0.494 (0.007) 0.0746 (0.004) 0.556 (0.007)

0.498 (0.024) 0.0768 (0.012) 0.523 (0.024)

0.514 (0.017) 0.0563** (0.008) 0.372** (0.016)

0.473 (0.030) 0.0679 (0.015) 0.592 (0.029)

0.425 (0.033) 0.0580* (0.017) 0.550** (0.035)

7534

0.493

7534

0.072

7534

0.539

Family characteristics Family below poverty line (%) se Number of people in household se HOMEb score se TEPSIc score se TVIPd score se

0.485 (0.007) 4.911 (0.023) 14.23 (0.047) 3.580 (0.341) 0.444 (0.711)

0.293** (0.021) 4.485** (0.074) 15.06** (0.15) 3.780** (0.344) 0.65** (0.712)

0.297** (0.015) 4.924 (0.059) 14.95** (0.11) 3.808** (0.342) 0.667** (0.712)

0.332** (0.028) 4.814 (0.096) 14.54** (0.2) 3.658 (0.347) 0.563* (0.716)

0.109** (0.017) 4.381** (0.075) 16.03** (0.207) 3.819** (0.346) 0.838** (0.713)

7534

0.451

7534

0.899

7525

0.948

7453

0.027

5901

0.022

Variables

Notes: a Wechsler Adult Intelligence Scale. b Home Observation Measurement of the Environment Score. c Psychological and Motor Developmental Test (TEPSI). d Test de Vocabulario en Imagenes Peabody (TVIP), the Spanish version of the Peabody Picture Vocabulary Test. **p < 0.01, *p < 0.05, showing the significance of the difference between the category’s mean value and maternal care’s mean value. Robust standard errors in parentheses.

5. Method 5.1. Participants Our sample encompassed all 24-to-48-month-old children (n = 7564) and their families, which participated in the 2010 wave of Chile’s Longitudinal Survey of Early Childhood (ELPI). The ELPI is a nationally representative sample of 13,895 Chilean children who were six months to five years old (born between January 1st, 2006 and August 31st, 2009) at the time of the 2010 assessment. All analyses in this study focused on the complete sample of 24-to-48-month-olds. These analyses use retrospective information collected during the 2010 wave about childcare in infancy. Analyses were restricted to this age group: (a) to avoid possible confounding of the effects of school attendance and childcare for school-aged children (including 5-year-olds, the majority of whom attend kindergarten); and (b) due to the availability of childcare histories and development evaluations. The distributions of gender, ethnicity, family income, mother’s educational level and family composition are displayed in Table 1. In this study sample, most of the children (82.4%) were with their mothers before the age of six months. From ages 6 to 12 months,

there was more variability in the type of care received: while 71.8% of children were in maternal care, 28.2% were in non-maternal care. Within non-maternal care, 6.7% of children were in center-based care, 13.1% in grandparent care; 4.1% in other-relative care and 4.3% in non-relative care (see Fig. 1). 5.2. Procedure Children were recruited between March and June 2010. Data was collected by research assistants with a college degree in psychology or education and who received 14 h of training. The child and caregiver were assessed during two visits to the home when the children were between 24 and 48 months old. During the first visit, an interview was conducted with the main caregiver; during the second visit, the caregiver and child were both evaluated. An effort was made to provide a quiet environment for testing within the home, although this was not always entirely feasible. Primary caregivers (n = 7564) completed the interview during the first visit by the research team and 98.9% of children and their caregivers participated in developmental assessments during the second visit. There were a few differences across the variables of interest in the current study comparing fami-

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lies who completed both the interview and direct assessments (98.9% of our sample) with those who completed only the interview portion of the study (1.1% of our sample), suggesting lower risk in the complete assessment subgroup. Relative to individuals without interview or assessment data, children with both interview and assessment data (TEPSI and TVIP tests) have mothers who are older (M = 30.26, SD = 0.08; M = 28.14, SD = 0.09; p = <0.01, respectively), less likely to be depressed (M = 0.11, SD = 0.00; M = 0.17, SD = 0.00; p = <0.01, respectively), and less likely to have been teenage mothers (M = 5.99%, SD = 0.00; M = 15.29%, SD = 0.00; p < = 0.01, respectively), belong to households with fewer individuals (M = 4.85, SD = 0.02; M = 4.94, SD = 0.02; p ≤ 0.01; respectively), and are more likely to live in an urban area (M = 1.11, SD = 0.00; M = 1.09, SD = 0.00; p = 0.013; respectively) relative to children with only interview data. To manage the previously mentioned differences between interview and assessment data, we used weights to minimize any bias related to sample selection and missingness. 5.3. Measures 5.3.1. Dependent variables: TEPSI score and TEPSI cognitive, language and motor subscores, and TVIP scores The instrument used to measure child development was the TEPSI—for Test de Desarrollo Psicomotor, which roughly translates as “Psychological and Motor Development Test”. The TEPSI was developed in Chile based on the Denver Developmental Screening Test and other tests, as a simple, economical and accessible alternative widely used to screen for cognitive, language and motor skills among children 2–5 years old. The TEPSI comprises 52 task items and the tester scores the completion of each task by the child. TEPSI items were selected conceptually to assess three domains reflected in three corresponding subtest scores: coordinación in Spanish — referred to as the “cognition” subtest in this paper for reasons explained below —, language, and motor. Item content analysis reveals that the coordinación subtest is a measure of visuospatial ability, perception and integration, and hand-eye coordination. This subtest includes copying and drawing tasks similar to visual motor integration tests such as the Beery-Buktenica Developmental Test, and block tasks similar to the block design test part of the primary visual spatial index scale of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI, e.g., Fourth Edition), designed to measure spatial ability and spatial visualization. We thus concluded that the Spanish name coordinación does not correspond to its English cognate “coordination” and that this subtest is primarily, a cognitive test. Thus, throughout this study, we refer to this coordinación measure as the “cognitive” subtest of the TEPSI. The language subtest of the TEPSI examines expressive and receptive language, including the ability to follow commands, mastery of basic concepts, vocabulary knowledge, and the ability to describe and verbalize. The TEPSI motor subtest measures movement and body control in short and long actions, in motoric sequences and balance. Each subtest and the total score have a precalibrated standard to screen for developmental delays. The test has been standardized for the Chilean population. The concurrent validity is r = 0.73 (Stanford–Binet) and r = 0.92 (Denver Developmental Screening Test). The correlation between items and totals of the subtest is between 0.42 and 0.79, the internal consistency with the Kuder-Richardson coefficient is between 0.82 and 0.94; the agreement between evaluators with Pearson’s r is >0.9 and for the three subtests the agreement percentage per item is greater than 8 (Marchant & Haeussler, 2007). Receptive vocabulary, another domain of language functioning, was assessed with the untimed, norm-referenced Test de Vocabulario de Imágenes Peabody (TVIP), the Spanish counterpart of the Peabody Picture Vocabulary Test-Revised version (PPVT-R). The TVIP was implemented in Spanish speaking populations in the

1980s and has been found to be a valid and reliable measure of language skills in Chile (Strasser, Larrain, Lopez de Lerida, & Lissi, 2010). TVIP scores are highly correlated with verbal ability scores on the Spanish versions of the Wechsler Intelligence Scale for Children (WISC–III; r = .91) and Kaufman Brief Intelligence Test (K-BIT) Vocabulary test (r = .81). All TEPSI and TVIP test scores were transformed into Z scores (mean and standard deviation equal to zero and one, respectively), with higher scores indicating a higher level of functioning.

5.4. Independent variables: types of non-maternal care The ELPI survey collected information about the main care the child received between ages 0 and 5. Mothers were asked retrospectively about their children’s main care arrangements between the following intervals of their children’s first years: 0–3 months, 3–6 months, 6–12 months, 12–18 months, 18–24 months, 2–3 years, 3–4 years and 4–5 years old. Primary care arrangements in each period were categorized into five types: (a) exclusive maternal care, (b) center-based care, (c) grandparent care, (d) other relatives care (aunts and sisters), and (e) non-relative care (e.g. nannies). The detailed data about the specific types of care in the ELPI dataset enables us to analyze the association between child cognitive, language and motor functioning and earlier experiences of center-based care and different kinds of informal care (versus maternal care) between ages 6 and 12 months. Informal care was defined as non-maternal care in either the child’s home or elsewhere and provided by relatives or non-relatives such as friends, neighbors, babysitters, or nannies. Informal care is not regulated in Chile, as in other countries (Naumann, McLean, Koslowski, Tisdall, & Lloyd, 2013).

5.5. Variables that could influence childcare decisions The analysis included as covariates characteristics such as the child’s gender, their age at the time of the test (linear and quadratic terms), whether the child had an older sibling, childbirth weight (was coded as low if less than 2500 g or normal otherwise) and whether the child was premature. Maternal characteristics such as maternal age (log term), teenage mothers, maternal depression after birth, marital status, maternal level of education, ethnicity, whether the mother had worked before pregnancy, maternal income pre-birth (log term), and maternal cognitive ability (measured by digit span and vocabulary tests of Wechsler Adult Intelligence Scale test) were also included as covariates. Regarding family covariates, we included the number of people in the household, household income, family structure, and the quality of stimulation and support provided in the home environment. The latter variable was measured using the Home Observation for Measurement of the Environment (HOME), (Caldwell & Bradley, 1984), which is an assessment of the overall quality of the physical and social resources available to the child in the family context and the mother–child interaction score. The mother–child interaction score is based on a self-reported questionnaire with a series of questions regarding mother–child interactions such as ‘the mother reads to the child’, ‘the mother tells stories to the child’ or ‘the mother sings to the child’. In addition, the type of childcare received by the child after 12 months of age is added as a covariate. Control variables included the accessibility of center-based care, the household’s region of residence (15 regions) and whether the household was located in a rural area.

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5.6. Moderators of relations between type of care and child development Family income and maternal education are relevant moderators in the association between non-maternal care during infancy and child development. To test the effects of poverty on non-maternal care, household income per capita was dichotomized into poor and non-poor households. Poor households were defined as those with per capita family income below the Chilean poverty line (100 U.S. dollars per capita per month or 64,000 Chilean pesos). Using the previous criterion, 43.7% of households in the sample were classified as poor. Also, we tested whether non-maternal care is associated with child development in different magnitudes for children of mothers with low versus high levels of education. Low education level was defined as not having received a high school degree, i.e. less than 12 years of education. According to this criterion, 34.6% of mothers in the ELPI survey have a low level of education.

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beneficial for the outcomes of our interest when, in fact, the difference may likely reflect the effect of an unmeasured factor on the outcome. To deal with these potential sources of selection bias, we controlled for all theoretically relevant factors available in our dataset that could potentially introduce omitted variable bias. This strategy reduces the effect of social selection bias. Table 1 presents bivariate associations between potential confounders. These confounders have been controlled for in all models. 5.9. Missing data The amount of missing data was less than 10% for all variables except for maternal working status at the child’s birth and maternal income (missing 15%). Missing values were imputed on the potential confounding factors using multiple imputations. The statistical significance of the coefficients on the key variables did not change with the imputation analysis (see analysis without imputation on Appendix A, Table A1).

5.7. Data analysis 6. Results Two main sets of analyses were conducted. First, the cognitive, language and motor outcomes of children and vocabulary outcomes of children who received any type of non-maternal care 6–12 months after birth (28.2%) were compared with those children who experienced exclusively maternal care (71.8%). Second, children who experienced different types of non-maternal care (center-based, grandparent, other relative, and non-relative care) were compared with children who experienced only maternal care 6–12 months after birth. We ran a series of regressions to explore associations of types of early care (independent variables) on later child’s TEPSI and TVIP scores as dependent variables. To address the research questions, we used Propensity Score Matching (PSM); and also ordinary least squares (OLS) regression analyses of measures of child functioning on types of care and additional controls. To test whether potential moderators (maternal education and family income) were relevant, OLS analyses were run. We implemented PSM to address selection bias, using the same covariates mentioned below to predict the matching’s propensity score; similarly, these covariates were entered as controls in OLS models. We utilized PSM to estimate the average treatment effect on the treated (ATT) using nearest neighbor matching with robust standard errors clustered around the four nearest neighbors and using Imbens et al.’s (2014) ‘nnmatch’ command in Stata. To evaluate the degree of similarity between the treated and control (matched) samples a test of the balance of covariates was used in both samples. The advantage of PSM over OLS models is that the former imposes fewer assumptions on the relation between the covariates, the key variable and the dependent variable. Our sample is also adequate for PSM because of its large size. However, it is important to note that PSM (or OLS) models, unlike randomized controlled trials, do not control for unobservable characteristics. While RCTs may be ideal and minimize bias, quasi-experimental studies using PSM are feasible as they circumvent ethical obstacles, such as those that arise when a potentially beneficial intervention (for example, center-based childcare) is denied by random assignment. 5.8. Bias detection and correction Research shows that the higher the level of education and income of the mothers, the more likely children are to attend non-maternal care, especially center-based care (Huston, Chang, & Gennetian, 2002; Johnson, Martin, & Brooks-Gunn, 2011; Rose, Johnson, Muro, & Buckley, 2018). Therefore, a simple comparison of means between children who receive non-maternal care and those who do not could lead to the conclusion that non-maternal care is

6.1. Comparisons of maternal, child, and family characteristics for children in different types of care As shown in Table 1, mothers of children who were in maternal care during the 6–12 months period are more likely to be a teen mother, and less likely to present depression relative to mothers whose children were in non-maternal care during the same period. Also, these mothers have fewer years of education, lower digit and vocabulary scores, are more likely to be below the poverty line and have lower family income (maternal and non-maternal income) than mothers of children who were in non- maternal care during the 6–12 months after birth period. As such, these observable variables were controlled in the regression analysis and included in the propensity score in the PSM analyses. 6.2. Association between child development and non-maternal care during the second half of the first year Table 2 presents PSM analyses to address whether there is an association between non-maternal care received by a child in the second half of a child’s first year of life and child cognitive, language and motor outcomes (measured by the TEPSI and TVIP tests), compared with maternal care. After controlling for all covariates (child, maternal, and family characteristics), it can be seen that children who experienced non-maternal care between 6 and 12 months present lower child development functioning relative to children who only experienced maternal care. This association is statistically significant in one out of the three sub-areas measured by the TEPSI test and is not statistically significant in the TVIP measure. 6.3. Child cognitive, language and motor outcomes by type of non-maternal care during the second half of the first year Table 3 shows PSM with child development as the dependent variable (measured by the TEPSI and TVIP tests). The different types of non-maternal care 6–12 months after birth have different magnitudes of association with child development compared to children in exclusive maternal care. Controlling for all usual covariates, attendance at center-based care 6–12 months after birth showed a positive association with child development scores relative to exclusive maternal care. The previous difference is 8% of a standard deviation in the TEPSI Total score (Table 3) (d = .19, p < 0.05). Underlying the previous result is

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Table 2 Associations between any type of non-maternal care during the child’s first year of life and child functioning at age 24–48 months old compared to children in exclusive maternal care (with imputations); series of multiple regressions. TEPSI

Non-maternal care first year Obs.

TVIP

Total score PSM (1)

Cognitive subscore PSM (2)

Language subscore PSM (3)

Motor subscore PSM (4)

−0.119* (0.04) 6192

−0.086 (0.04) 6192

−0.134** (0.04) 6215

−0.05 (0.04) 6192

Score PSM (5) −0.017 (0.04) 4953

Notes: The dependent variable in columns (1) through (4) is the TEPSI test score and in column (5), the TVIP test score. The reference category is maternal care during the first year of life (between 6 and 12 months). PSM stands for Propensity Score Matching. **p < 0.01, *p < 0.05. Robust standard errors in parentheses.

Table 3 Associations between type of non-maternal care 6–12 months after birth and child functioning at age 24–48 months old compared to children in exclusive maternal care (with imputations); series of multiple regressions. Variable

Center-based care Observations Grandparents care Observations Other relative care Observations Non-relative care Observations

TEPSI

TVIP

Total score PSM

Cognitive subscore PSM

Language subscore PSM

Motor subscore PSM

Score PSM

0.080* (0.04) 4969 0.080** (0.03) 5338 −0.139** (0.04) 4806 −0.108 (0.07) 4801

0.008 (0.04) 4969 −0.004 (0.03) 5338 −0.067 (0.05) 4806 −0.067 (0.08) 4801

0.087* (0.04) 4986 0.087** (0.03) 5358 −0.130** (0.05) 4822 −0.124 (0.07) 4819

0.069 (0.05) 4969 0.067* (0.03) 5338 −0.085 (0.05) 4806 −0.055 (0.07) 4801

0.033 (0.04) 3916 0.019 (0.03) 4199 −0.07 (0.05) 3783 −0.207** (0.05) 3786

Notes. PSM stands for Propensity Score Matching. **p < 0.01, *p < 0.05. Robust standard errors in parentheses.

the fact that children who attended center-based care showed a higher score in TEPSI’s language domain. Also, children who experienced grandparent care 6–12 months after birth exhibited a higher child development score than children who stayed in maternal care during the same period. The previous difference is 8% of a standard deviation in the TEPSI Total score (Table 3) (d = .19, p < 0.01). The association between grandparent care 6–12 months after birth — relative to exclusive maternal care — and child development is driven by the TEPSI test’s language and motor domains, 9% and 7% of one standard deviation, respectively (d = .20, p < 0.01) (d = .08, p < 0.05). By contrast, the association between other relative care versus maternal care 6–12 months after birth and child development is negative. Controlling for the usual set of covariates, children in other relative care during the second half of the first year performed 14% of a standard deviation lower in TEPSI total score (d = 0.01, p < 0.01) relative to children in maternal care. This result is driven by the TEPSI test’s language domain. Children who attended other relative care at 6–12 months after birth performed 13% of a standard deviation lower in language skills at ages 24–48 months (0.06, p < 0.01), compared to children in exclusive maternal care. Also, there is a negative association between children attending non-relative care 6–12 months after birth and child vocabulary outcomes. Controlling for the usual set of covariates, attendance at non-relative care during the second half of the first year is negatively associated with language according to the TVIP score (21% of a standard deviation lower in language skills) (Table 3) (d = −.38, p < 0.01). Finally, we testing the difference between all type of care by changing the reference groups. The only significant difference was between grandparent care and other relative care where children in other relative care during the second half of the first year performed lower in TEPSI total score (24% of a standard deviation) and 20% of a standard deviation lower in vocabulary (TVIP) at ages

24–48 months, compared to children in grandparent care (For more information see Appendix B Table B1) 6.4. Moderators in the association between child development and types of care during the second half of the first year and child cognitive, language and motor outcomes We tested whether the associations of different types of care with levels of child cognitive, language and motor functioning varied across levels of family income and maternal education. We found that children who had attended center-based care in infancy had significantly lower receptive vocabulary if they came from households living under the poverty line or if they had mothers with lower education (see Tables 4 and 5). 7. Discussion In this study, we employed a nationally representative sample to examine the association between non-maternal care during the second half of the first year and child motor, cognitive and language outcomes. Overall, children who experienced non-maternal care 6–12 months after birth presented lower development relative to children who experienced maternal care during the same period. However, when we analyzed the association between each type of non-maternal care and child development outcomes, we found that the type of non-maternal care led to significant differences in later child outcomes. We found that attendance at center-based care 6–12 months after birth had a small positive association with child development compared with maternal care. Our results are consistent with previous research that found that attendance at center-based care during the first years of life is positively associated with child development (Abner, Gordon, Kaestner, & Korenman, 2013; Loeb et al., 2007; Sylva et al., 2011).

M. Narea et al. / Early Childhood Research Quarterly 51 (2020) 204–214 Table 4 Household poverty as moderator in the associations between type of care 6–12 months after birth and child development (with imputations); series of multiple regressions.

Center-based care Grandparent care Other relative care Non-relative care Center-based care × poor household Grandparent care × poor household Other-relative care × poor household Non-relative care × poor household Poor household Observations

TEPSI total score b/se

TVIP score b/se

0.055 (0.06) −0.004 (0.05) −0.067 (0.08) −0.104 (0.08) −0.167 (0.1) 0.113 (0.08) 0.022 (0.14) −0.345* (0.19) −0.048* (0.03) 6186

0.078 (0.07) 0.037 (0.06) 0.057 (0.09) −0.11 (0.1) −0.202* (0.11) −0.04 (0.09) −0.039 (0.15) −0.03 (0.19) −0.077** (0.03) 4896

Notes. The type of care reference category is maternal care, and the family’s income reference category is non-poor households. Low-income family means households with per capita income below the Chilean poverty line (110 dollars per capita per month or 72.000 Chilean pesos). Standard errors in parentheses. ***p < 0.01, **p < 0.05.

Table 5 Maternal Education as moderator in the associations between type of non-maternal care 6–12 months after birth and child development (with imputations); series of multiple regressions.

Center-based care Grandparent care Other-relative care Non-relative care Low maternal education × center-based care Low maternal education × grandparent care Low maternal education × other-relative care Low maternal education × non-relative care Low maternal education Observations

TEPSI total score b/se

TVIP score b/se

0.041 (0.05) 0.014 (0.04) −0.059 (0.08) −0.156** (0.08) −0.202 (0.14) 0.102 (0.09) −0.007 (0.16) 0.049 (0.2) −0.344 (0.24) 6186

0.077 (0.06) 0.022 (0.05) 0.089 (0.09) −0.121 (0.1) −0.322** (0.13) 0.015 (0.1) −0.174 (0.15) 0.048 (0.24) −0.254 (0.24) 4896

Notes: The type-of-care reference category is maternal care and maternal-education reference category is high maternal education. Low maternal education means mothers with high school degree or less. Standard errors in parentheses. **p < 0.01, *p < 0.05.

When compared to maternal care, center-based care for infants of mothers with a low level of education or from poor households was associated with lower linguistic functioning (vocabulary) at age 24–48 months than that of children of mothers with a high level of education or from households not in poverty. This finding supports previous studies, which found that while children from disadvantaged backgrounds did experience an improvement in cognitive abilities after attending center-based care, their performance was still lower relative to children from more advantaged households (Burger, 2010; Duncan & Magnuson, 2013; PeisnerFeinberg et al., 2001). Since the Chilean early childhood education policy seeks to create policies that address the needs of at least 60

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percent of vulnerable households, this finding should be investigated further. Regarding informal care settings, children in the care of other relatives (e.g., aunts) and non-relatives (maids or nannies) between ages 6 and 12 months performed lower, in child development and vocabulary tests at ages 24–48 months, compared to those in maternal care. The exception within informal care is grandparent care. Children in grandparent care during this early period, average an 8% of a standard deviation higher child development score at ages 24–48 months than children in maternal care. However, grandparent care was not associated with higher child vocabulary scores. It is difficult to contrast these results with the literature because very few studies have explored these associations with grandparent care. In one study by Hansen and Hawkes (2009) children in grandparent care at nine months had acquired 19% of a standard deviation more vocabulary when they were three years old compared to center-based care, but their findings were significant only for more advantaged groups. These included children whose mothers were highly educated, or were older, or who lived in two-parent families, or in households not claiming benefits. In the present study, none of these variables act as moderators in the association between child development and grandparent care compared to maternal care. First, grandparent care more often provides a one-to-one interaction. A higher child to adult ratio may be beneficial for child development (Ramírez-Esparza, García-Sierra, & Kuhl, 2015; Ramírez-Esparza, García-Sierra, & Kuhl, 2017). As a second explanation, because the higher child development score is driven by a higher score in the language domain of the TEPSI Test, we could say that older people may use grammar that is more complex and speak more slowly relative to younger caregivers, also facilitating language acquisition (Griffin & Spieler, 2006). Third, grandparent care is given in an environment familiar to the child facilitating a warm relationship with the caregiver. In contrast, care by other relatives is likely to be less individualized, as discussed in the introduction. 7.1. Policy implications The strongest positive association is between attendance at center-based care (relative to maternal care) during the second half of a child’s life and child cognitive development. However, in the present study, only 10 percent of children ages 6–12 months attend center-based care. On average, across OECD countries around 35% of children aged 0-to-2 participate in some form of childcare, which ranges from as low as just under 6% in the Czech Republic to as high as almost 66% in Denmark (OECD Family Database, 2016). Hence, a public education campaign could be considered to increase attendance at center-based care. Our findings raise the question of whether governments should invest resources not only in center-based care but also in other prevalent types of non-maternal care such as grandparent care. In Chile, the most prevalent type of non-maternal care 6–12 months after birth in ELPI’s sample is grandparent care (13%). Grandparent care, compared to maternal care, shows a moderate positive association with child functioning. Grandmothers can do a very good job of helping their grandchildren develop foundation skills. It is important to explore the quality of this type of care and mechanisms to support grandparent care. Also, it is important to include grandparents in discussions about activities they do with their grandchildren and share their ideas as a valuable resource. International experience legitimates grandparent care by supplying a support income, which is the case in Australia with the Grandparent Child Care Benefit (Australia Government, Department of Education and Training, 2016–2018) and the United States with multiples systems that provide aid to grandparents (Cox, 2009). Another way to support grandparents is to provide workshops specifically targeted

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to maximize the skills of grandparents as care providers. It is critical to attend to the implications related to this intergenerational dynamic from different dimensions. Grandparents could feel overwhelmed by looking after children due to the high physical and psychological demands associated with this role (Chan et al., 2018; Hayslip, Fruhauf, & Dolbin-MacNab, 2017; Tang, Jang, & Copeland, 2015). By contrast, looking after children implies positive rewards for caregivers like having a renewed purpose for living (Di Gessa, Glaser, & Tinker, 2016; Taylor, Marquis, Coall, & Werner, 2018). In extreme cases, when parents are incarcerated or unfit for child care, grandparent care may prevent the institutionalization of children (Seymour, 1998). There are a number of other reasons why grandparents may become care providers, such as parents needing someone they trust to take care of the children while they are trying to enter the workforce (Del Boca, Piazzalunga, & Pronzato, 2018), which is critical in the Chilean context where the data available shows that the rate of female labor participation in Chile is consistently lower than in other OECD countries between 1980 and 2006 (Contreras & Plaza, 2010). Policy discussions focus primarily on early childhood formal care access and quality, largely ignoring a potentially low quality of care in informal settings. With the exception of grandparent care, other informal non-maternal settings (other relatives, mostly aunts, and non-relatives like nannies) were associated with small and moderate negative association with cognitive and language skills, raising concerns about detrimental effects. More childcare research focused on these settings is critical. Because the association between type of non-maternal care and child outcomes is heterogeneous depending on the type of care, the creation of a regulatory system for informal care could be considered. There is a recognition that the provision of early childhood education has to be of high quality to exert its beneficial impact. Regulatory standards for all forms of provision therefore play an important role in shaping the development, provision, and evaluation of early childhood education services. To ensure quality, regulations and minimum standards should be defined and developed in a participatory and democratic process, involving different groups of stakeholders, such as children, parents, families, and professionals who work with children (OECD, 2012; Urban, Vandenbroeck, Lazzari, Van Laere, & Peeters, 2012). These regulations may meaningfully improve the quality of care available to infants and young children. 7.2. Strengths and limitations The strengths of the present study are: (a) this is the first study, to our knowledge, that explores the relationship between types of non-maternal care in the first year of life and child outcomes at 2to-4 years of age in Latin America; (b) the ELPI dataset is the first nationally representative sample in Chile, with a large sample size and concomitant statistical power which allows the exploration of higher-order, interactive relations and greater generalizability; (c) ELPI provides a rich set of child development outcomes and covariates that permit controlling for omitted variable bias; (d) ELPI allows us to detect heterogeneous associations between type of care and child cognitive and linguistic functioning in infancy. To our knowledge, the previously mentioned features of the ELPI dataset are unique in the context of Latin America and high socioeconomic inequalities. Some limitations should be noted. First, the TEPSI test, although based on well-known tests such as the Denver Developmental Screening Test and having the ecological validity benefits of a locally developed test with published psychometrics, is a national test not used internationally. Second, this study uses OLS regressions that deal with selection on observables (maternal, family, and child characteristics) and PSM analyses that are more robust than

OLS to misspecification. While we use OLS regression and PSM analyses that are comparatively robust to misspecification, these two methods are not robust to selection on unobservable and unobserved factors such as parental educational beliefs that could have influenced both the decision to use a certain type of childcare and child development, thereby biasing the results. Third, establishing the mechanisms by which childcare arrangement is linked to child development is critical to understanding the nature of the previously stated associations and for proposing welfare-enhancing policies. Specifically, understanding the role of quality and quantity in the relation between the type of care and child development is key. Unfortunately, the ELPI dataset does not have a measure of quality or intensity (regarding hours per week) for any type of non-maternal care. Hence, it cannot be tested whether the association between type of care and child development is heterogeneous depending on the quality of center-based care. If appropriate data were available in the future, studies could address the potentially mediating or moderating role of quality in the association of type of care and child development. Acknowledgements This research was supported by a fellowship awarded to the first author from Becas Chile. This work was done in partial fulfillment of the first author’s Doctorate’s Degree. We thank Kenzo Asahi who provided feedback on drafts of this manuscript, Kasim Allel who provided outstanding research assistance, three anonymous referees, and the editor, Maria Soledad Carlo, for their excellent suggestions. This article was funded by CONICYT PIA CIE160007. Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.ecresq.2019.10. 010. References Abner, K. S., Gordon, R. A., Kaestner, R., & Korenman, S. (2013). Does child-care quality mediate associations between type of care and development? Journal of Marriage and Family, 75(5), 1203–1217. http://dx.doi.org/10.1111/jomf.12055 Adams, G., Tout, K., & Zaslow, M. (2007). Early care and education for children in low-income families. Patterns of use, quality, and potential policy implications. (No. 4) Australia Government, Department of Education and Training (DET). (2018). Early childhood and child care in summary. Canberra, April: DET, Child Care in Australia, DET. Barros, S., Cadima, J., Bryant, D. M., Coelho, V., Pinto, A. I., Pessanha, M., & Peixoto, C. (2016). Infant child care quality in Portugal: Associations with structural characteristics. Early Childhood Research Quarterly, 37, 118–130. http://dx.doi. org/10.1016/j.ecresq.2016.05.003 Behrman, J. R., Cheng, Y., & Todd, P. E. (2004). Evaluating preschool programs when length of exposure to the program varies: A nonparametric approach. Review of Economics and Statistics, 86(1), 108–132. http://dx.doi.org/10.1162/ 003465304323023714 Berlinski, S., Galiani, S., & Gertler, P. (2009). The effect of pre-primary education on primary school performance. Journal of Public Economics, 93(1), 219–234. http://dx.doi.org/10.1016/j.jpubeco.2008.09.002 Bigras, N., Bouchard, C., Cantin, G., Brunson, L., Coutu, S., Lemay, L., & Charron, A. (2010). A comparative study of structural and process quality in center-based and family-based child care services. Child & Youth Care Forum, 39(3), 129–150. http://dx.doi.org/10.1007/s10566-009-9088-4 Black, M. M., Walker, S. P., Fernald, L. C. H., Andersen, C. T., DiGirolamo, A. M., Lu, C., . . ., & Grantham-McGregor, S. (2017). Early childhood development coming of age: Science through the life course. Lancet, http://dx.doi.org/10.1016/S01406736(16)31389-7 Boca, D., Del Piazzalunga, D., & Pronzato, C. (2014). . Early child care and child outcomes: The role of grandparents. Evidence from the Millennium Cohort Study (Vol. 20) (Families and Societies working paper series No 20). Bornstein, M. H., Britto, P. R., Nonoyama-Tarumi, Y., Ota, Y., Petrovic, O., & Putnick, D. L. (2012). Child development in developing countries: Introduction and methods. Child Development, 83(1), 16–31. http://dx.doi.org/10.1111/j.14678624.2011.01671.x

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