Infant Care:

What you want to see

Group size is limited to no more than eight babies, with at least one caregiver for every three babies. Each infant is able to form a bond with a primary caregiver.

In the Little Live Wires Child Development Center at the Los Angeles Department of Water & Power, children remain with one primary caregiver from the time they enter the program—as young as six weeks—until they enter preschool at 30 to 36 months, says Judy Hamilton, center director. "We believe continuity of care is very important, so the children stay in the same groups, and we always have the same teacher who puts them down for a nap there when the children wake up."

Kathy Zetes, Child Development Specialist at Children's Council of San Francisco, is a board member of the Infant Toddler Consortium. While it's important for a child to have one primary caregiver, she says, the baby should also be comfortable with other caregivers. Then the child is not devastated when the primary caregiver is sick or on vacation.

Caregivers show warmth and support to infants throughout the day, making eye contact and talking to them about what is going on.

"Talking to them is very important," says Rebecca Reid, lead teacher in the infant room at Kinderhaven Children's Center in San Francisco. "Also watching what they are doing so that you are always supporting their language development. For instance, I might see that Tony is playing with a ball. I will say, 'Oh Tony, you're rolling the ball. Can you go get the ball, Tony?' He looks from me to the ball and back to me. I nod and he goes after the ball. When the adults are occupied and I hear a child crying, I speak to that child, saying, 'I hear you're crying and you want your bottle. I will get it for you in just a minute.' The child knows I'm paying attention and that's important."

Alert to babies' cues, adults hold infants or move them to a new place or position, giving them variety in what they are able to look at and do. Caregivers can see and hear infants at all times.

"I don't carry them a lot. I hold them on my lap when I'm feeding. I give cuddles during the day, but I encourage time on the floor so they get those physical skills they need. When they get bored or frustrated—especially when they are on their tummies and just learning to hold their heads up, they get tired—I put them in the swing, prop them up on a pillow or hold them for a minute," says Reid.

Caregivers pay close attention and talk to children during routines such as feeding and changing diapers or clothes.

"It's important to make a connection with the child during the care process, so he doesn't feel like it's being done to him," says Reid. "When I change a child's diaper I might say something like, ?I'm taking off this wet, yucky diaper. I'm putting on a clean diaper. Doesn't that feel better?' If the child is old enough, I let him hold the clean diaper. If the child is objecting to having his diapers changed, I acknowledge that by saying, ?I'm doing this as fast as I can. I know you don't want to be up here.' I always give a hug and kiss when I'm done."

Babies eat and sleep when they are most comfortable doing so. Caregivers consider infants' individual preferences for food and styles of eating.

"With infants, it's usually on-demand scheduling," says Reid. "I offer food and change a diaper every two hours, but I really try to follow the individual's cues for eating and sleeping."

Caregivers follow standards for health and safety, including proper handwashing to limit the spread of infectious disease.

"You see a lot of cracked hands in child care," says Zetes. "There is handwashing after diapering and wiping noses and before preparing food. Many places have a bucket of soap and water into which the caregivers can toss toys that a child has mouthed, so they're not lying around for some other child to chomp on."

Parents and caregivers share babies' activities and development on a daily basis, building a mutual understanding and trust.

"Having a parent-centered room is as important as having an infant-centered room," says Reid. At Kinderhaven, both parent and child are greeted personally in the morning. The parents are asked to fill out the top portion of a daily record, outlining things like when the child woke up, what she ate that morning and any special needs such as medications. During the day the caregiver records feedings, naps, and anecdotes.

"I use the bottom portion of the form to record development," says Reid, "like, ?For the first time today, Tony climbed to the top of the climbing cushions.' This allows parents to feel more a part of their child's progress."

At Little Live Wires, an on-site employer-sponsored center, parents often join their children for lunch. Breast-feeding moms are given flexible breaks to go to the center.

Toddler care:

What you want to see

Children remain with a primary caregiver over time so they can form a strong relationship. The caregiver learns to respond to the toddler's individual temperament and cues and builds strong communication with the child's family.

"If parents don't volunteer information when they drop their kid off in the morning, I ask questions. I ask them about how they slept, have they tried any new foods, is there anything new going on at home. I also let them know when they pick their child up what went on during the day," says Ruby Mayfield, owner of Little Bits Family Day Care in San Francisco. "It helps us all."

Caregivers praise children for their accomplishments and help them to get more confident and in control of themselves.

"It's important for caregivers to tell children what they can do rather than what they can't do," says Zetes. "If a caregiver sees a toddler who is capable of being rough heading for another toddler, she will start coaching immediately by saying, ?Oh, I see you want to play with Bobby.' Then she will give him positive play options and coach him through the interaction to avoid possible trouble. By helping to facilitate success and complimenting appropriate behavior, she will foster confidence."

Caregivers, recognizing that toddlers are not yet able to communicate their needs through language, promptly respond to children's cries or other signs of distress.

"I have one two-year-old little boy who is usually feisty and a lot of fun," says Mayfield. "One day he came in and I noticed he was not his bubbly self. I knew that he was distressed even though he wasn't crying, just playing quietly by himself. He is not that verbal yet, so asking questions isn't going to help. I got down on the floor with him and hugged him and played with him. After about five minutes of that support, he returned naturally to his old self. You just have to really know your kids."

Caregivers communicate warmth through pats on the back and hugs or holding toddlers in their laps.

"Jason had just arrived at the center and mom was saying goodbye as she handed him over to me," recalls Marge Mendoza, Head Infant Teacher at Little Live Wires. "He cried, he reached out with both arms for one last hug from mom. I allowed him to watch until his mother was out of sight, then I said, ?Mom will be back soon, Jason. I know it's so hard to see her leave.' Jason sucked his thumb and stroked my hair, and we moved to a part of the room where we could sit together looking at books. Jason was soon calm and moved off on his own to play with other children."

Caregivers set good examples for children by treating others with kindness and respect. As children gain in language ability, adults encourage them to resolve differences with words.

Mendoza remembers one day when "Harrison was scooping sand into a pile. Kathy stopped to watch him a minute, then reached out to take the shovel. Harrison let out a yell. He held tightly to the shovel with one hand and lifted his other to hit Kathy. I gently interceded. Taking hold of the hand Harrison had intended to use to hit Kathy, I softly placed it on Kathy's shoulder, saying, ?Use gentle touches with your friend, Harrison. Tell Kathy, "This is my shovel.' " Harrison did, and another pail and shovel were produced for Kathy's use. Then I encouraged and praised both children for working and playing together, saying, ?Let's fill up both buckets, friends…Good job!' "

Recognizing that frequent testing of limits and saying No! is part of a toddler's healthy development, caregivers minimize their restrictions unless children are in physical or emotional danger. Rather than merely refusing and restraining children, caregivers offer a few options and emphasize what children are allowed to do.

"There should only be a few firm and clear restrictions," says Zetes. "Don't ask yes or no questions like, ?Do you want to go to the playground now?' Ask choice questions like, ?What toy do you want to bring out to the playground?' Giving choices allows the toddler to feel like a big kid instead of someone who gets orders all the time."

The setting is "inclusive," that is, physical space and activities allow all children to participate. For example, a child with a physical disability eats at the table with other children.

Zetes acknowledges that "it's rare to find a child in a center or family care with a disability." More often "you may find children with health problems, such as asthma. To include them in activities, such as long walks and playing at the park—which may cause them to become short of breath—monitor them carefully and bring a carriage or wagon for them to ride in. Take toys to focus their energy so they can sit and play. Other children will likely join them."

Caregivers frequently read to toddlers, do finger plays, and act out simple stories as children actively participate.

"Start reading to children when they are five months old," says Zetes. "It's a cozy and warm thing to do. It's a great thing to do with toddlers because it's face-to-face and one-on-one. As you read books, the children get involved, picking up repetitions and movements."

Sturdy picture books in the child care setting depict people of different ages, racial and cultural groups, family types, and abilities or disabilities.

In addition to books, the children's own families can represent a great deal of human diversity, says Hamilton. "At our center we get family photos, which we enlarge and copy. Then we tape those pictures to the floor for the crawling infants and the toddlers."

Everyday tasks such as eating, toileting, and dressing are opportunities for toddlers to learn new skills and better control their own behavior. Caregivers support toddlers' attempts to take care of themselves and provide items that are easy for toddlers to use.

"While children are eating they should be sitting in a comfortable place where their feet are not dangling and they're physically able to reach the table," says Zetes. "Give them implements that are easy to use, like bowls with non-skid bottoms, and opportunities to practice with a spoon early on.

"Undressing is easier than dressing, so loosen their shoes and let them pull them off or lift a shirt part way and let them finish pulling it off."

Children have many opportunities for active, large-muscle play. Play equipment is safe and challenging for toddlers.

"Most playground equipment is not made for toddlers. There is some manufactured play equipment that is low to the ground—but you don't always have to buy equipment to achieve large-muscle exercise," says Zetes. "Music and dance provide great movement. So does jumping in place. You can also just pile up lots of padding and pillows to jump and roll around in."

Just when children are most powerfully affected by their surroundings, they are most likely to experience poor quality child care. In the past five years, widely reported new research has shown how experiences affect brain development from birth to three years. Meanwhile, national studies of child care have consistently found that most infant and toddler care fails to promote—or actually harms—healthy development. Welfare reform, by pushing mothers to get jobs, will mean more babies and toddlers spending more time in out-of-home care.

Fortunately, excellent materials and programs on quality infant and toddler care are available from several sources:

• The Infant Toddler Consortium, (510) 658-9189, is an organization of child care professionals and organizations in the Bay Area. It supports quality infant/toddler care through training opportunities, peer support, and advocacy. Contact: Eleanor Davis.
  
  
• WestEd, (415) 331-5277, in collaboration with the California Department of Education, has created a Program for Infant/Toddler Caregivers, which provides detailed training through a series of videotapes and booklets. Contact: Terry DeMartini.
  
  
• The National Association for the Education of Young Children (NAEYC), (800) 424-2460, publishes numerous books and pamphlets describing quality, developmentally appropriate care.

In addition, many child care resource and referral organizations have training programs in quality infant/toddler care.

Two of the NAEYC's pamphlets tell parents "what you want to see" to find "a caring place" for infants and toddlers. Here are some of their tips, with explanations by infant/toddler caregivers and the people who train them.

More essentials of quality toddler care:

Adults follow health and safety procedures, including proper handwashing methods. Each area has clearly written procedures for waste disposal.

Caregivers directly supervise toddlers by sight and sound, even when they are sleeping.

Caregivers see parents as the primary source of affection and care for children. Parents are always welcome in the home or center.

Caregivers have training in child development or early education specific to toddlers. They are warm and responsive to children's needs and patient in supporting children as they become more independent.

Maximum group size of 12, with one adult for no more than six toddlers, preferably fewer, allows for the intimate atmosphere and high level of supervision that toddlers require.

The staffing schedule allows each toddler to develop a close relationship with a primary caregiver. Toddlers stay in the same group for many months and from year to year if possible, to ensure close relationships.