Child Care Centers

Child analysts have long valued the way in which their profession affords them the opportunity to extend their knowledge of child development beyond the consultation or therapy room and into the community. At the Hanna Perkins Center for Child Development (HPC) our course in child psychoanalysis has provided training and experience in applied child analysis settings. Since the early 1950s, HPC child analysts have utilized the knowledge gained through experience and research at Hanna Perkins, our therapeutic preschool, and the HPC Clinic in our work with nursery school teachers and day care providers. The work has included the provision of extension courses, the facilitation of ongoing consultation groups, and the establishment of long-term consultative relationships with selected nursery schools and day care centers throughout the Greater Cleveland community

Our experience has repeatedly helped us know of two important factors involved in consulting in such settings. First, we are there not to teach or inform but to learn and understand so that we can think and work together with a director and staff that knows our respect for them as professionals. Second, it is vital that our commitment and involvement be understood as a long-term one that can enable the gradual fostering of a relationship that can become grounded in a sense of mutual trust and respect.

These concepts were central to our thinking in the fall of 1992 when we began discussions with representatives from the TRW Foundation, headquartered in Cleveland. Under the leadership of the CEO of TRW, Mr. Joseph Gorman, the Foundation has expressed an interest in supporting early child development, particularly with the goal of helping children reach school age with a readiness to learn.

Recognizing that most of the next generation of employees in business and industry were spending their preschool years in substitute forms of child care, we wondered how such children, with no consistent caregiver to invest in his or her activities, would be able to find pleasure in learning, play, or work. Child analysts have long understood that an enduring, consistent relationship with a primary caregiver is a crucial component in the child’s progression on the developmental line from play to work (E. Furman, 1990).

Realizing that conscience development can only occur in the context of a stable relationship (T. Barrett, 1992), we discussed our mutual concern regarding the development of empathy and kindness in children, who, as preschoolers, are asked to form relationships with multiple substitute caretakers.

Finally, acknowledging the central importance of mastery of self-care tasks in the development of a child’s self-esteem (E. Furman, 1992), we worried about the potentially detrimental impact of such multiple caregiver experiences on a child’s ability to master and find pleasure in such tasks as eating, dressing, and keeping himself clean and dry.

At first, the TRW Foundation representatives asked if we would provide training workshops to early childhood professionals from other communities where TRW has facilities. We expressed the concern that such an approach would be disrespectful in that it would be presumptuous and would not allow for the development of a relationship over time. We thought it would be more effective to arrange ongoing consultations designed to respond to the individual needs of the caregivers in other cities.

The Foundation representatives concurred and committed their resources to a ten year plan on behalf of children in day care centers in four pilot communities. These were identified as Detroit, Dallas, Huntsville, Alabama and San Bernadino, California. Through this joint effort, which was termed the Early Childhood Intervention Alliance (ECIA), TRW would support consultation services provided by a child analyst or child development specialist. When the project was inaugurated in January of 1993, four child analysts from Cleveland were paired with a business representative from each of the four sites. After visiting Cleveland to learn of the programs in place there, the business representative and the Cleveland consultants worked to identify child analysts or child development specialists in each of their respective communities who would be interested in participating. These professionals then came to Cleveland for a similar orientation and the next step was to select a day care center whose director and staff were interested in working with the consultants in the pilot program.

As the program evolved, the Cleveland consultants continued to provide consultation to the site city professionals in support of their forming and developing consultation relationships with the director and staffs at each of the four program locations. It was with these efforts that the project began to take on the individual community distinctions that had been anticipated, as differing child care centers and child mental health resources were brought together in each community.

The consultation model utilized for the project was based on that which had developed out of the consultations and outreach work in Cleveland. Consultants in each location would be available to their centers on a weekly basis. Initially, they would spend an hour to an hour-and-a-half a week meeting with the director to become acquainted and identify concerns. Staff would be included in meetings when appropriate, for instance to discuss specific children and concerns. As the relationships developed and the needs arose, the consultants would increase their hours to as much as four hours a week in order to be available to meet regularly with staff, observe children in their care rooms, and meet with parents.

The consultant’s role was to be that of a facilitator. She would respond to the questions brought by director and staff, assist them in better understanding the situations they found difficult, and participate with them in developing solutions to the problems. When cases were presented, the consultant would help staff find ways to intervene with children and parents long before agreeing to meet directly with parents. In working this way, the consultant would promote the professional growth of staff and help them develop a milieu where they could better attend to the needs of all the children in their care. This would include developing a day care system that would have the most potential for mitigating the stresses inherent in day care.

Put in other words, the goals of the consultation work would be: 1) to help caregivers form invested caring relationships with specific children; 2) to help caregivers form working relationships with parents and to bridge the gap for children between home and school; 3) to help caregivers and parents learn to understand the feelings children communicate through their behaviors and respond accordingly; and 4) to help caregivers and parents support the mastery of developmental tasks and facilitate the development of internal controls.

These goals, though clear in our minds, are as difficult to achieve as are the goals we have when working with patients. In order for caregivers to be in touch and effective with children under stress, they must first be aware of what the stresses are. They have many reasons to ward off such awareness, and we have found that helping them recognize, tolerate, and address these issues is one of the major challenges in the work we do.

In our work in day care centers, we encounter defenses against recognizing the inherent causes of stress on all levels. We see children who have retreated from the pain of separation by succumbing to a mechanical existence. We see caregivers who cannot hear the messages of distress of the children. They claim the children are managing just fine because they aren’t crying. They interpret a child’s restlessness as readiness to move on to the next group. We see parents who focus on the fact that their children are doing well because they’ve learned the ABCs. We see others who suspect that their child’s misbehavior was learned through imitation of another child at the center.

Child analysts have long understood the origins of the denial and sociological prejudices encountered in working on behalf of children. This is especially true with regard to preschool-aged children. Because parents, educators, caregivers, and even politicians and social planners cannot remember their own preschool years and, indeed, struggle to keep memories about them repressed, it is not surprising that there is such a strong impetus to deny and minimize the detrimental effects of day care stressors and experiences on young children. Moreover, there are unconscious processes at work that compel adults to tease, stress, and overwhelm young children whose anxious laughter, excited behavior, and defensive efforts to repeat are misunderstood as signs of pleasure. Sometimes adults with such unconscious needs are unfortunately drawn toward working with young children.

We would like to share with you a brief story written by Kara Richardson who was a caregiver in one of the ECIA sites. Mrs. Richardson has left the site to continue her formal education but remains in touch with the site consultant and recently sent her this story, explaining that it was inspired by a visit to a day care center. We were impressed by how eloquently Mrs. Richardson portrays the pain and stress felt by a child in day care, even as her parents and caregivers are less able to do so.

Jenny got to the day care center early this morning. She was tired before she got out of bed. After stopping at the burger place and getting milk at the grocery store, it was pretty late when she finally got home the night before. She had cuddled on the couch with Buddy Bear and watched TV. She really wanted to cuddle on Mom’s lap and look at a book, but Mom had to help Tommy with his homework and finish the load of laundry. Aunt Karen called on the phone and then Mom remembered she needed to call Mrs. Horton about the meeting tomorrow. Jenny thought about her day at the center:

Ricky kept yelling over play toys all morning, Miss Jane was too busy looking at papers and things and talking to Miss Lori to see that Beth kept taking away Buddy Bear and I had to pinch her so she’d give him back and then Miss Jane heard Beth crying and I had to put Buddy Bear in my cubby.

After play time it was group time and Miss Jane read us three books but I couldn’t see the pictures because I sat on the last carpet square in back of Billy and he kept “schooooching” all over the floor and Miss Jane had to stop to tell Billy to sit still. I don’t know what the stories were about.

Then Miss Lori let me do paint. I wanted to paint with black but Miss Lori told me I needed to put red and orange and yellow on my turkey. I wanted to paint black.

During play time again I built a great big castle with the blocks and I was the princess and no one else was. I put on the pretty purple dress and danced. I let Susie and Beth play too. They couldn’t be a princess but they were my friends and we had a picnic. Then Billy knocked my castle over. We were going to play again but it was time to go to Miss Deb’s room to practice our songs.

We sat on carpet squares and we were real quiet so we could sing songs about some people who ate turkeys and lived with Indians and liked to have picnics too. My mom is coming to hear me sing. Danny doesn’t like to sing and he keeps making funny noises and we have to stop and start all over again. We sang our songs a lot.

It was time to go to the bathroom so we could eat our lunch. My mom gives me good things in my lunch. At the big room where we eat I get my lunch out and Miss Lori opens my drink box and I eat some of my sandwich. Miss Lori says I have to have four bites cause I’m four. Then I eat my fruit snacks and my yogurt with sprinkles. I opened my yogurt all by myself and I still had a few sprinkles to put on.

Then we go to the bathroom so we can go outside. I like to go outside. I like to swing. I like to go on the slide. But I don’t like Ricky and Billy to chase me. They like to play chase. So I “screeeeeeeeam” at them to stop and then Miss Jane tells me to use my words and not scream but I don’t think Billy would hear me.

After outside time we go to the bathroom so we can have rest time. We lay down on our cots and I can have Buddy Bear. Sometimes Miss Lori rubs my back but today she had to sit next to Billy the whole time cause Billy kept sliding under his cot and made burping noises. Miss Lori kept telling me to close my eyes so they could rest but Buddy Bear kept talking to me.

After rest time, we go to the bathroom. Then we sing more songs on our carpet squares. I was pretty tired of songs.

I liked the peanut butter crackers for snack. Miss Lori said I could have three. Charlie spilled his juice all over the table. Miss Lori had to clean it up. She had to clean Charlie up too.

I played princess some more and then after the bathroom we went outside again. I really didn’t want to go outside. I wanted to play princess. I didn’t want to swing and Ricky and Billy wanted to play chase again and my eyes didn’t rest at nap.

When we came in, we went to the bathroom and played. I wanted to sit on Miss Jane’s lap and look at a book but Miss Jane had to talk to Billy’s mom about chase and then Beth’s mom came with her baby sister and Miss Jane had to get the paint ready for the turkeys tomorrow.

When Mommy picked me up we had to hurry because Tommy was waiting at school and Mommy was late and Tommy had to go sign up for basketball before we could go to the burger place.

Then it’s today and it’s time for group time and our carpet squares. Miss Lori is sick today so Miss Tina is here.

[Ms. Streeter speaks more directly to how denial is manifest in situations of substitute care.]

When I first began consulting to a day care, I was puzzled and distressed by the lack of communication among the caregivers and between the caregivers and parents. I was concerned, as well, by the director’s frustration in trying to assist the caregivers, who tended to maintain that everything was fine and that they didn’t need any assistance. Over time, I began to more clearly understand some of the reasons for the lack of communication.

A great number of children in the program came from single parent, low income families, for whom arriving at 7:00 a.m. and leaving at 5:30 p.m. was an economic necessity. The caregivers, both dedicated and underpaid, were doing their best to provide optimal environments for these children, often expecting more of themselves than is humanly possible. One simply cannot provide the kind of care a child needs when dealing with seven all at once. The result was that the caregivers found themselves feeling both inadequate for not being able to do what they imagined they should be able to do, and feeling “stressed out.” Because of this, they avoided engaging with others, fearing they would be exposed. Likewise, the parents, burdened by the demands on them, unable to be the wage earners, go to school, and be the kinds of parents they wished to be all at once, were feeling inadequate and stressed out. Consequently, the caregivers felt the parents “dumped” their children at the day care. They appeared to hope no one would ask more of them and that the caregivers would provide for the children whatever was lacking. When problems did arise, each blamed the other, unable to tolerate their own guilt.

The director, in turn, had to worry about managing the finances, “keeping the quota up” by shifting children to new levels when the numbers demanded it instead of when it was best for the child and the classrooms. She also had to see that all policies fit day care licensing laws, even when these interfered with the needs of an individual child. Work schedules had to fit union regulations even when that meant shifting caregivers more often than was best for the children. The director felt forced to carry out decisions that didn’t feel right to her. She struggled with her guilt, and tended to feel to blame for the difficulties that transpired between the frustrated caregivers and the guilt-ridden parents. In the face of all these demands and stresses, it is not surprising that communications had broken down or never developed in the first place. The sad part, of course, was that the children were not receiving the support they needed.

During the initial stages of the work, I found it hard to make myself go to the day care each week. I, myself, was stressed by observing the young toddlers wandering about aimlessly, the older toddlers being sent to time out after grabbing another’s toy, the three-year-olds made to eat their lunch in polite silence, the four-year-olds running wild, without the containment of a strong caregiver. I felt the caregivers’ hostility toward me. To them, I was the knowledgeable professional from the suburbs who they doubted could ever understand their situation. I felt the director’s desperation and felt at a loss to give her relief.

When we are under such stress, our impulse is often to become active -- to do something -- to make the pain go away. I wanted to be able to tell the caregivers what to do; I wanted to make the parents attend parent meetings; I wanted to get more money for the day care so that the director wouldn’t be under such pressure to move the children from level to level so precipitously; I wanted to punish all the fathers who were abusing the mothers whose children were acting out in the day care. I knew, however, that none of this would work. I knew that I could do all the telling I wanted and the caregivers would nod in polite silence and then either give lip service to my ideas by using the words without the music or simply go on about their business as they had before. I knew that to make a difference I had to help the caregivers come to their own understanding of children and, out of that, develop their own ways to respond in accord with these understandings. Just as I would do when working as a therapist, I had to sit with the feelings. I had to work gradually to understand the feelings before I could assist the director, caregivers, and parents in helping them find ways to help themselves with the problems they face. I knew, above all, that nothing could be effected until I had established trusting relationships with the director and caregivers and I knew, as well, that this would take a long time.

When we set up at the ECIA project, we were clear that the consultants would need time. We knew that the first year would involve the establishment of relationships, and, from our own experiences, we had certain ideas about how these relationships would best be established.

In beginning work in a day care center, we start at a respectful distance. We do not go into their classrooms to observe until they are clear that we are not there to judge them. When they bring us distressing situations with children and practically try to hand the child and parent directly over to us to solve the problem -- which they often do -- we refrain from biting the bait. We let them know that they know the children best and the children will be far more responsive to them than to us: The staff are the ones with whom the children have the relationship. Similarly, we let them know that they can work with the parents effectively themselves and that, in fact, the parents will only be able to utilize our assistance when the referral comes after they have already developed a respectful and trusting relationship with their child’s caregiver.

The director and staff at Greenhill Day Care Center were eager to have Mrs. Sender become involved as a consultant, but they had little idea as to what this entailed. Mrs. Jackson, the director of Greenhill Day Care, was a competent and energetic woman who had been quite successful in accessing funding and in recruiting a board for the support of her day care center. She believed that consideration for the feelings of young children is central to healthy emotional development, but had difficulty knowing how to effectively implement this perspective in the day care setting. Her personal style was one that focused on helping people feel good and she tried to avoid conflict. She later characterized her style as resulting from her wish to make the best of things and carry on cheerfully. When attempting to avoid inherent conflicts, the director had resorted to fostering a chummy relationship with staff and an efficient, cheerful, friendly and limited relationship with parents. Without the needed leadership and clear boundaries, staff, in turn, dealt with their stress by engaging in excited gossip with and about each other and making fun of parents’ and children’s idiosyncrasies. The children’s actual experience was assumed to be as positive as possible. Behavioral difficulties were generally tolerated in a benign, friendly way, with attempts to coax a child “back to normal.” Often, parents were not told of their children’s problems during the day, for fear of activating some punitive response after hours. Alternatively, when parents were informed, it was often in a way which conveyed the plea that the parents should “shape up” their children pretty quickly.

Early on, staff brought concerns about Kimberly, a child who was crying a lot and angrily refusing to participate in activities. They thought that maybe she was reacting to parental discord at home. They asked Mrs. Sender to observe Kimberly and suggested they could set it up so that Mrs. Sender could have a talk with Kimberly. Mrs. Sender pointed out to the caregivers that Kimberly didn’t know her, but knew them. Wouldn’t it make more sense for them to be the ones to talk with Kimberly? The caregivers didn’t know how. They worried Kimberly wouldn’t tell them anything or, conversely, that she might tell them something they’d be shocked to hear. And what if she did share her worries and they, in response, said the wrong thing? Mrs. Sender empathized with their feelings and helped them notice that they were feeling as helpless and anxious as Kimberly must feel at home. This allowed the caregivers to then use Mrs. Sender’s help in effectively providing containment and support for Kimberly, acknowledging her feelings and allowing her to talk -- without becoming too excitedly involved in the details of the home situation.

Simultaneously, Mrs. Sender worked with the director on handling the relationship with Kimberly’s mother and father. Here, the focus was on helping Mrs. Jackson gain a more neutral stance with the parents in order to communicate with them. Mrs. Jackson had joined the staff in their idea that the father was the frightening bad guy and she tried to avoid him when he dropped Kimberly off in the mornings. Mrs. Sender, who had heard a caregiver describe a nice interaction between the father and Kimberly, helped Mrs. Jackson note how important the father was to his daughter. If Kimberly perceived staff avoiding her father, how would she be able to keep her good feelings about him in his absence? How would that, in turn, affect her ability to sufficiently contain her anxiety and conflicts about the parents’ fights and impending divorce to enable her to engage in activities at the center? With this understanding, Mrs. Jackson found the strength to overcome her resistance to dealing with the situation and she spoke constructively with the father. Kimberly, in turn, became more relaxed and pleased to see her caregivers as she entered the center each morning.

As the work proceeded and Mrs. Sender carefully helped Mrs. Jackson and the staff become more aware of various children’s and parents’ feelings, Mrs. Jackson felt increasingly guilty for not following through with what she knew she needed to attend to -- in terms of contacts with parents, guidance of staff, and interventions with children. Her guilt was manifest in varying ways. Sometimes Mrs. Sender would arrive at the center at the scheduled time only to discover that Mrs. Jackson was away, tending to other matters. Other times, Mrs. Jackson talked of personal troubles instead of addressing the ongoing work. Eventually, however, as she integrated Mrs. Sender’s approach to problems, she became increasingly able to deal effectively with critical parents, acting out staff and problematic children. She was able to find sufficient satisfaction in her new found skills to tolerate the stresses she encountered.

It is noteworthy that after two years of work, she let Mrs. Sender know that she was beginning to realize that day care really isn’t good for children. She wondered if she felt right being in the business. She knew, however, that someone has to do the work. Better that it be someone, like her, who truly understands how the children feel. “There are some things I just don’t want to know and don’t want to deal with,” she said. “But then I think of you and the project and I move forward.”

Staffs often test a consultant initially by presenting their worst problems and seeing if she can magically make them disappear. Once they have learned that the consultant is only human, they become more available to think together with her. Often staffs are helped to extend their thinking by focusing on specific exchanges with children in the care rooms. The consultant helps by picking up on instances where staff can begin to notice and question more of the details surrounding each interaction with a child, and where they can recognize and use their feelings to understand the messages conveyed in children’s behavior.

One consultant described her work with a caregiver, Ms. Kent: “Ms. Kent told of her frustration with four-year-old Shelley who periodically became both defiant and tearful. She thought the girl was spoiled and mean-spirited. As I asked questions about what was going on when these episodes occurred, Ms. Kent realized that it was most often when the day care director had been in the room for a period of time and then left. Shelley had a close relationship with the director that had developed over the several years of her attendance at the center. At my suggestion, the director began speaking with Shelley each time she left the room, letting her know when she would return. Ms. Kent would then speak with Shelley about the director in her absence, suggesting, for instance, she might like to save her building to show it to the director. Shelley’s defiance and tears diminished significantly, proof to the caregiver and director that she had more feelings about the comings and goings of the director than they had realized. This helped them begin to appreciate the importance of relationships in a child’s experience. It also helped them become aware of the fact that behaviors can be generated by feelings -- feelings that can be generated internally as well as externally.”

Another consultant wrote: “Although it appeared that children didn’t always pay attention to things going on around them, I had stressed that they do and they have feelings about what they observe. One day a group of us visited a care room and the caregiver said, ‘Hello, Dr. Reston.’ Several hours later a little boy sympathetically asked his caregiver, ‘Are you sick?’ She was puzzled and replied, ‘No, but why do you ask?’ He said, ‘Because the doctor came to see you.’ This gave us a further opportunity to talk about how long children might wait to let you know what they are feeling and thinking and that behavior that seems to come out of nowhere, does, in fact, come from somewhere.”

Helping staff recognize and help with separation difficulties is often hard because of the caregivers’ need to deny the stress the children experience being away from their parents for so long. The following is a description of work with a staff around a child with separation difficulties. It was offered to us by Ms. Lerner, who has worked at the center described for over four years. In her preface to the vignette, she emphasized that the work was possible because of her well-established relationship with the director whose judgment and fairness had won the respect of the caregivers.

Ashley, a child in the toddler group, was refusing to eat, sleep, and interact with others. She spent a considerable portion of the day crying. This frustrated and angered the caregivers who, instead of providing comfort, had isolated Ashley and left her crying on the cot.

With help, the caregivers could acknowledge how helpless and angry they felt. They could then be helped to understand that these responses belonged to the mother and child and that Ashley’s behaviors were her ways of showing feelings about being separated from her mother whom she rarely saw, as mother worked weekends as well as weekdays. The refusals to eat or sleep and the crying were severe anxiety reactions to separation from her mother. The apparent manipulation and bossing of her mom when she came at the end of the day was another way to gain control of a mom whose leavings she could not control.

The understanding helped the caregivers realize that they did not cause the basic problem, but that their response to it was not a helpful one. They did not feel good about this and were glad to be assisted in making a plan that would be helpful to the child. The plan included bringing the mother back into the care room. Initially, her mother would be with Ashley during all activities. Then, as Ashley moved spontaneously from her mom and responded to her caregivers, the mother could sit by and watch from her chair. The eventual goal was for Ashley to be able to stay on her own, with the timing of this related as much to the work between the mother and child as mother’s work schedule would allow.

With Ms. Lerner’s assistance, the director worked with the mother to arrange for her participation in the plan. She learned that the mother, because of her own issues, had never let her daughter be alone with anyone other than herself or the maternal grandmother with whom she lived. In addition, she had made others seem scary. Then, with little preparation, Ashley was enrolled in full time day care ostensibly because the maternal grandmother felt she could no longer care for her all day. The mother wanted to help Ashley and agreed to the separation plan. In her need to ward off her own pain and Ashley’s distress, however, she tried to abort the plan by having an aunt bring Ashley. It was clear the work had to be done right or not at all and the mother tearfully said, “Help me,” and agreed to work with Ms. Lerner.

With Ms. Lerner’s help, the mother was better able to understand Ashley’s feelings and how it was for her to be in day care for so long each day. Mother could then agree to a shortened day for Ashley. Though the mother still could not bring herself to participate in a prolonged separation schedule, she was able to spend enough time in the care room to support the development of Ashley’s relationships with the caregivers. She talked with Ashley about the toddler group being a safe place and helped her to ask her caregiver for assistance. The mother discussed Ashley’s anger that she had to be gone so much and they made plans for what they would do when she came home after work. They made provisions to call one another if needed during the day. Ashley would announce to the caregivers upon arrival that her mom was going to pick her up and the caregivers always reassured her that this was so.

The caregivers came to see that when Ashley no longer felt torn from her mother, she could move away more independently on her own and begin to play. The idea of a mother being there to be left began to make sense to them (E. Furman, 1982). One of them said that she had to come to like the little girl and was surprised, but very glad, things had worked. She was also saying she liked herself better as she kindly met mother’s and child’s needs and mastered her own anger.

Essential in this intervention by Ms. Lerner was her simultaneous support of the staff in terms of acknowledging their frustration and concern, even as she helped them think of Ashley’s “misbehavior” as a communication, a cry for help.

As caregivers understand an individual child’s feelings about separation, they begin to see such feelings in all the children. They can then be helped to develop operating procedures that better support children’s mastery of separation. These include such things as prolonged separation schedules at the time a child begins attending day care and repeated reminders of the parents during the course of the day. As toddlers have not yet established the ability to maintain a mental image of the parents, mothers are encouraged to leave concrete reminders of themselves with their child -- such as a key ring from mother’s purse, or a sweater she has worn that smells of her. Preschoolers can use photos and notes as ways to maintain their relationships with parents.

One of the centers in the ECIA project specifically purchased cordless phones to help children and their parents keep in touch. The staff at this center became more aware of separation issues when working with three-year-old Brittany who had become quite aggressive, with episodes of hitting and biting the other children. Brittany had recently transferred from the nearby toddler program. The troubles had persisted over three weeks and nap time had been especially difficult as the child had refused to nap and had instead used this time to run about and disrupt the other children. When staff tried to contain her, she cried loudly.

The consultant, Dr. Prior, helped the staff think through what they knew about Brittany’s home life and her relationships with her parents. They reported that her father had confided that he hated to make his daughter cry, so he seldom made any demands of her. Bedtime patterns at home were also unclear and changing. The staff acknowledged further that all of the children who had transferred from the toddler to the three-year-old program were having a hard go, though Brittany had seemed the most troubled.

Dr. Prior then learned that Brittany had made the transition without her parents direct involvement in the move. She was simply dropped off as usual after having one brief visit in the program a few weeks earlier. Dr. Prior could then talk with the director about what the staff and center could do to make such a transition more manageable. Dr. Prior suggested that transferring children be invited to spend an hour with their mother present, followed by a full morning and lunch, and finally a full morning, lunch, and nap before making the final change. The director was enthusiastic about establishing a protocol to assist the staff in becoming familiar with the children as well. It was clear that the staff needed to be oriented to the children just as much as the children needed orientation. In the case of Brittany, there was no one around who really knew her and could help the staff cope with her behavior.

Transitions become all the more difficult for children struggling with upheavals in their home situations. When parents are receptive to working with the consultant, then consultant, parents, and caregivers can work conjointly to assist the child master his doubly stressful circumstances.

This is illustrated by work at another ECIA site where caregivers came to the consultant, Mrs. Hanna with concerns about Evert. Two-year-old Evert slapped, hit, and kicked his mother when she arrived to pick him up at the end of the day. He would refuse to leave with her. Parents were in the process of a divorce. Staff noted that Evert’s upsets increased particularly after weekends with his father and when there was a change in the schedule of which parent picked up. The parents met with Mrs. Hanna, to discuss how to help Evert with the changes. The father was relieved that Mrs. Hanna maintained a neutral position vis-à-vis the parents and custody issues and focused, instead, on how to help Evert with the transitions from being with his mother to visiting his father. With Mrs. Hanna’s help, parents and day care staff worked together to help Evert have a predictable routine for which he was prepared. Evert was helped tremendously when an arrangement was made for him to have a photograph of the parent who would be picking him up that day in his cubby. The parents were subsequently able to engage in individual and more in-depth work with Mrs. Hanna, each focusing on his or her own feelings and how these feelings affected their behavior with Evert. This could then allow them to focus more on Evert’s feelings and how best to help him.

Helping Caregivers Assist Children with Mastery and the Development of Internal Controls

Helping children with such things as self care, toilet mastery, and behavior management often comes naturally to parents who are able to “grow with” their child. Helpful assistance with developmental tasks comes less naturally to caregivers who do not work with the same children for more than a year at a time, who have to care for so many children at once, and who have received more training to be “teachers” than caregivers. Consultants can help caregivers tune in to the developmental needs of a child and respond in helpful ways.

One consultant helped caregivers support a three-year-old’s efforts to master toileting. Jason had entered the older class despite his questionable toilet mastery because of his chronological age and the center’s need to have an opening in the younger class. When the caregivers learned that Jason could not “pee” with accurate aim and often soiled his pants, they were angry at the director for deciding to let him move up despite his difficulties. They felt it wasn’t their job to help with toilet training and found themselves frustrated with Jason. They resorted to asking him every half hour if he needed to go to the bathroom. When he did soil, they often cleaned him up quickly to get back to their activities with the group, and once, finding no clean underpants, a caregiver put him in Pampers. The problem continued and they felt that nothing they did made a difference.

The consultant pointed out that the caregivers were doing Jason’s job for him instead of helping him take charge of himself. She assured them that there was a side of Jason that really wanted to be a bigger boy. The more they treated him as an older boy able to care for himself, the more he would do so. In response, the caregivers began to look for that “bigger boy side” of Jason. They turned the toileting job over to him, letting him be the one to note when he needed to go, and expecting him to be the one to clean up his own messes. They could share in his pleasure when he was successful in his use of the toilet without taking it on as their own accomplishment. Similarly, they could note that Jason must feel embarrassed and disappointed in himself when he failed -- without becoming punitive. With this kind of help, Jason was able to take charge of his toileting. Feeling more competent, he also took charge of himself in other ways and became more actively and appropriately involved in classroom activities.

In another center, a consultant helped a caregiver understand how to help a child lacking in internal controls. “Timmy was a vulnerable child who was alternately an endearing, infantile little boy and an out-of-control whirlwind who ran around the room, hurled invectives, and knocked down chairs. Though due to start kindergarten in the fall, he was neither academically nor emotionally ready to manage in a regular public school classroom.” The caregiver, Ms. Ali, reported that Timmy was fearless and destructive, unresponsive to her efforts to establish rewards and consequences for his behavior. He continued to be out-of-control, scaring not only the other children but her as well. The consultant suggested Timmy was giving others the feelings he felt on the inside -- that he, in fact, must be a very scared little boy. This made sense to Ms. Ali who began to look for ways to reassure Timmy and help him feel safe.

Once Timmy felt the caregiver understood how he felt and was his ally, he began to respond to her in more positive ways. The consultant could then help Ms. Ali find ways to support Timmy’s developing conscience. Ms. Ali noted times Timmy followed the rules of his own accord and helped him know he was using his inside voice as a helper -- to help him manage in a way that made him like himself. When he didn’t follow the rules, Ms. Ali helped him apologize and make right his wrongs. This helped Timmy regain his good feeling about himself.

Simultaneously, the consultant encouraged Ms. Ali to ask Timmy’s mother about his earlier experiences. In speaking with the mother, Ms. Ali learned that Timmy had been hospitalized for surgery during his second year. Ms. Ali wondered if this experience had interfered with Timmy’s development and could explain some of his scared feelings. She suggested the consultant might be able to assist mother in helping Timmy work through some of his feelings about his earlier experience. Because the caregiver presented the idea within a context that did not make the mother feel to blame for Timmy’s difficult behavior, she was able to follow through.

[Dr. Barrett describes ways staff can be helped to appreciate and incorporate their understanding into their daily functioning.]

As substitute caregivers overcome their need to minimize the stresses of day care, they can become more adept at helping to preserve a child’s primary relationship with his or her mother. The following is a description of a director’s insight learned from an experience with a mother and toddler:

Carol’s mother paused one Monday morning after settling Carol into the toddler room to tell the director of the center that Carol’s pediatrician had prescribed an antibiotic following a recent ear infection. The mother carefully explained the schedule for taking the medicine and the need to keep it refrigerated. She clarified that Carol was used to taking the required dose through an eye dropper, as they had been doing it that way over the weekend. Later in the morning the director, a person very familiar to Carol because of her frequent involvement in the toddler room, approached her to administer the medicine. Carol was frightened and cried, resisting and refusing. Fortunately, the sensitive director did not press the issue but telephoned Carol’s mother. The director recalled a recent consultation group discussion about the importance of young children being present and hearing communications between parents and caregivers. She arranged for Carol’s mother to stop in during her lunch hour. Mother then, in the presence of Carol, repeated the information she had given about the medicine and reassured Carol that the director not only had Mommy’s permission, but knew exactly how to help Carol take her medication. From that point on the process went smoothly.

This type of experience helps us appreciate how, regardless of multiple caregiving experiences, young children view their mothers as the ones to whom they turn for bodily care and comforting. Thus, it is crucial that young children participate in and listen to communications between parents and caregivers about such bodily care. In a similar way, information about the processes involved in efforts at toilet mastery should also be carefully shared and communicated in the presence of the child.

Often the work of a consultant involves helping a center director and staff think through the ways in which their policies and procedures may be refined or modified to be more in tune with the developmental needs and coping capacities of the young children in their charge. Sometimes routines such as using the bathroom as a group and allowing visitors to come and go from a care room without knocking are never thought about because they make things easier for the caregivers. We have found that caregivers often feel quite inspired and enthusiastic about the idea of trying to make a child’s experience in their centers be as much like home as possible. After all, it is often the case that children in day care spend most of their waking (and even many of their sleeping) hours in their day care center. If care- givers can begin to think this way it can follow logically that children feel better and can more easily attain a sense of mastery and control if bathroom privacy can be maintained and if visitors to a care room are required to knock and wait until the door is opened to them before entering. It works very well when the children can take turns having the assignment of being the one to answer the door for the day, with the younger children preferring to do this accompanied by one of the caregivers.

The celebration or observance of holidays can provide another important topic around which to discuss the developmental needs and capacities for managing stress in young children. Again, this is an area where adult denial can all too often play an important, undermining role. Because a sense of object constancy is not always solidified in a young child, because an ability to differentiate animate from inanimate and pretend from real is not yet autonomous, it is important that special care be taken to avoid overstimulating small children who are already stressed by the realities of the day care experience. It therefore becomes important to help parents and children plan carefully for how they might want to share their birthday celebrations with their peers. In a similar way thought must be given to how to celebrate such holidays as Halloween or Christmas. Dressing up in costumes should be especially avoided, both for the children and for adults coming into the care rooms. Alternative ways can be found, for example through the use of books or stories, to help children begin to understand holiday customs without causing them to feel confused or overwhelmed. Day care directors and staff can be helped by a consultant who can think through with them the ways in which young children can better integrate new experiences if they can have an active, rather than passive part in the process and when the process involves them in tasks and activities in which they are already at least partially familiar or proficient.

It is in this same vein that a consultant can help with the concept of preparation. The following vignette, which is a very sad one, helps to illustrate this important point:

When one of the ECIA consultants visited at the day care center, she was confronted with information about a tragedy that had occurred. When four-year-old Michael’s mother picked him up at the end of one day, she surprised Michael by having in the car with her the family’s new puppy. The puppy had been with the family for a few days but Mother had never before brought it along at pick-up time. Michael acted happy and excited. After Mother buckled him into his seatbelt, however, he impulsively reached out and pulled on the door handle causing it to open -- something he had never done before. In a flash, the puppy jumped out and ran into the nearby busy street where, in full view of Michael, his mother, and many of the other mothers and children, the puppy was quickly struck and killed by a passing car.

At first the staff wanted help thinking through with the consultant some of the ways in which they might respond to help Michael and the other children. They came up with many good ideas. One was to draw and laminate a picture of a dog that they presented to Michael. He could keep it in his cubby to bring out, sit with, or talk about with his caregivers and peers as needed. At group time all of the children were encouraged to talk about pets or relatives who had died, or dead birds or insects they had seen. In these ways the children were helped to be active in a way that could contribute to their efforts at mastery.

Later, the consultant was able to help in another important way. This sad experience opened up for the staff, who could then open it up with the parents, the whole notion of the importance of transition times, especially the transitions from home to day care and back to home again. How many times had it occurred that a grandparent or cousins or siblings arrived with a parent picking up a child at the end of the day, almost always without any preparation? The staff could easily recall how often it then occurred that the child would seem more excited or aggressive than on other days. Staff members were helped to share their observations that parents frequently had several errands to run or other things on their mind at this important transition of pick-up time.

When this was discussed at a group meeting of the directors and consultants from all of the ECIA cities, one of the directors had a helpful perspective to lend. She described how she had come to encourage the parents of the children in her center to think of giving themselves and their children what she called the “gift of the car ride home.” By phrasing it this way, she found that the parents could appreciate how important it was for their children and for them to have a circumscribed time together during which to reconnect. A time with no radios or tapes playing, with no interrupting errands, and especially with no surprise guests.

It is our hope that a consideration of vignettes will whet the appetite of other child analysts to become involved in similar consultation efforts. We feel it goes without saying that day care center consultation is a most appropriate activity for child analysts or child development specialists. We believe that, in addition to it being an important intervention, it is also an important effort at prevention, one aimed at helping to mitigate some of the stressors inherent in the day care experience.

Barrett, T. (1992). Supporting conscience development. Unpublished paper presented at the Hanna Perkins Annual Fall Workshop.

Furman, E. (1982). Mothers have to be there to be left. Psychoanalytic Study of the Child, 37, 15-28.

---- (1990). Play and work in early childhood. In Child Analysis: Clinical Theoretical, and Applied, 1, 60-76.

---- (1992). Toddlers and their mothers A study in early personality. Madison, CT: International Universities Press.

[1] T [1] This paper was first presented at a Colloquium on Day Care Care sponsored by the Philadelphia Psychoanalytic Society and the Margaret Mahler Foundation on November 18, 1995.

Send mail to ddewalt@hannaperkins.org with questions or comments about this web site. Copyright © 2007 The Hanna Perkins Center for Child Development Last modified: 12/13/05

Send mail to ddewalt@hannaperkins.org with questions or comments about this web site.
Copyright © 2007 The Hanna Perkins Center for Child Development
Last modified: 12/13/05