"...in the rush to improve and increase child care, we are ignoring a more fundamental reality: Much of the child care available for infants and toddlers in this country simply isn't good for them....rather than increase our reliance on day care, we should begin fundamentally rethinking the way we organize work and child care. 

"...I - and many other researchers - have identified the quantity and quality of experiences that babies and young children need to develop optimally. There are six stages that families who are emotionally and intellectually healthy provide to their children. A review of these six stages makes clear why most out-of-home care cannot provide a number of essential building blocks for a child's healthy mind and brain. Briefly, children need: 

An ongoing, loving and intimate relationship (lasting years, not months) with one or a few caregivers in order to develop caring, empathy, trust and relating. 

Sights, sounds, touches and other sensations tailored to the baby's unique nervous system in order to foster learning, language, awareness, attention and self-control. 

Interactions made up of long sequences of back-and-forth smiles, smirks, sounds, reaching and the like. The "emotional dialogue" between adults and babies fosters the beginnings of a sense of self, logical communications and the beginnings of purposefulness. 

Discussions without words - long negotiations with gestures to solve problems (such as when a toddler takes a caregiver to the fridge to get the juice) to foster early types of thinking and social skills. 

Shared use of creative ideas through pretend play between a caregiver and a child and creative negotiations of basic needs ("Juice!") in order to foster language and creativity. 

Logical use of ideas through a caregiver eliciting a child's opinion ("I like this because...") and debates in order to promote logical thinking, planning and readiness for reading and math. 

"These aren't interactions that can occur on the fly. Child care experts suggest that during the first two years of life, these types of experiences need to be available one-half or more of a baby's waking hours. Many parents provide these interactions during feeding, bathing and diaper changes. Yes, children get fed and get their diapers changed in day care, but even at excellent centers with outstanding, well-trained staff, there are significant limitations. Because day care workers are often caring for several infants, their interactions with each baby tend to be brief, which means the infants aren't getting the long interactive "dialogues" through words and gestures that many parents provide at home. 

"Even in good day care centers, we've seen many an eager, expectant eight-month-old baby give up and stare at the wall as his caregiver stops by his crib briefly but then hurries away to attend to a crying rival. 

"Even more important, day care workers don't get a chance to build long relationships with the children in their care because, at most centers, babies change caregivers each year as they move on to the toddler room. And in centers where there is less training, lower wages and high turnover, caregivers may change even more frequently. 

"In short, three of the six essential building blocks are compromised due to the very structure of center-based day care: ongoing, intimate relationships; interactions made up of lengthy, back-and-forth emotional dialogues; and long problem-solving discussions with gestures. 

"The other three components of good care - providing stimulation appropriate to the baby's nervous system; shared use of creative ideas; and logical use of ideas through eliciting opinions and debates - vary significantly, depending on the staff and the chemistry   between caregivers and the children. 

"There is some resistance to this idea. For example, the initial results of an ongoing day-care study conducted by the National Institute of Child Health and Development have been interpreted by many media outlets, including The Washington Post, CNN and popular parents' magazines, as "good news for parents." In fact, the news isn't quite as upbeat as all that. The study is finding that babies in relatively full-time day care have compromised attachments unless their parents were especially sensitive to their needs and adept at reading their emotional signals in the evenings – that is, providing the types of experiences missing in the day-care centers. 

"The child-care challenges we face cannot be dismissed. Current patterns of out-of-home child care have significant limitations that endanger the growing minds of future generations. An entirely new set of guiding assumptions is necessary. We need to re-evaluate the professed value we place on children. Children and the care of them must be elevated to a higher priority, both within families and society. This will be unrealistic for parents who, no matter how much they want to stay home, have no choice but to work. So we need to gradually bring about social arrangements which maximize at-home care of young infants by their parents." 

"For two-parent families and single-parent families where full-time work is essential to provide food, shelter and medical care, we must improve the quality of child care, including having caregivers stay with the same group of babies for three years or longer. 

"Impersonal child care is but the most obvious symptom of a society that is moving toward more impersonal modes of communication, education, and health and mental health care. Intimate ongoing interactions between children and their parents, we're learning, are essential for the proper growth of the brain and mind. These types of interactions also make for reflective citizens as well as a sense of cohesion that makes societies work." 

"In the end it's not the hours we work as pediatricians that are most critical. In the end it's the time that parents spend with their children, real time, not 'quality time.' And it's becoming increasingly clear that allowing even the best of child care programs to raise our offspring doesn't substitute for the time that children need from their mothers and fathers. 

"We hear a lot these days about children's rights, and while it's critical that we secure those for them, rarely discussed is their right to have parents who hold tightly to their absolute responsibility to raise their children. Having children implies this, and it is increasingly obvious that the "village" simply isn't a substitute. 

"By every measure our children are physically more healthy today than they have ever been. But their emotional health is poor and getting worse. That's reflected in the rising tide of substance abuse, violence, sexually transmitted diseases and teen-age pregnancies. 

"Several years ago, a periodic survey of our membership revealed that the majority of us thought it was important for a parent to be home with their (especially) younger children....

"Study after study in the medical and social sciences literature speaks to the importance of real parental involvement.... 

"Maybe that's how we need to spend our office time, counseling mothers and fathers about how important their time is to the well-being of their children. Perhaps as an organization we need to argue, not only for subsidization of out-of-home care, but perhaps even more for the adequate subsidization of families who would rather provide care for their children in person. Think about it and let me know."