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| |    Continuity of Care: Why It's So Important by Robert Needlman, M.D., F.A.A.P. reviewed by Robert Needlman, M.D., F.A.A.P. In thinking about child-care arrangements for your baby, one of the very most important considerations is continuity of care: having the same one or two people look after your baby month after month, and year after year if at all possible. Why is continuity so important? From the age of a few months, babies come to love, count on, and get their security from the one or two people who handle the major part of their care. Reactions to broken continuity By four months of age, babies will become seriously depressed--losing their smile, their appetite, and their interest in things and people--if the parent who has cared for them disappears. There will be a depression, lesser in degree, if the person who assists the parent on a regular basis leaves. Small children who have been moved from one foster home to another several times may lose some of their capacity to love or trust deeply, as if they never really learned how to attach to just one or two people and as if it's too painful to be disappointed again and again. So it's crucial that the parent or other caregiver not give up during the first two or three years, or give up only after a substitute has very gradually taken over. And it's important to be as sure as possible that the substitute plans to stick with the job. Continuity in group child care It's important, in the group care of babies, that every child is assigned to one particular staff person so that there will be a relationship more like that of child and parent. This close relationship between caregiver and child in no way undermines or takes away from the child's primary love of his parents! Babies can easily come to trust two, three, or four people, as long as they are consistently there for the baby. It is when people pop in and out that babies experience the loss of a trusted adult--and with it grief and a lessening of their ability to trust in other people. An expensive effort If you can't rely on a grandparent or other close relative to provide child care, you will have to pay for it. Continuity of care, while extremely important, can also be expensive. Child-care workers are usually paid very little, and so the temptation to move on to better-paying jobs is great. High job turnover among child-care center workers is a very serious problem because is undermines continuity of care. If you choose to get your child care from a center, be sure to ask about the steps that they take to increase continuity of care and decrease their turnover rate. If you hire a sitter or nanny in your home, pay them as much as you can possibly afford so that they will want to stay with your family for a long, long time. The importance of this investment to your child's long-term mental health is hard to overstate. Talk about:
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