Yale Nursing Professor Leads National Effort to Provide Nursing Care to Every Child-care Center

Your child begins to cough and sneeze over the weekend. If you bring her to the daycare center on Monday morning, will she infect the other children? Chicken pox, strep, ear infections, head lice, diarrhea... the miseries of childhood can be passed from one sufferer to another. Who can say, for certain, when a child should be kept at home or allowed to join the group?

You drop your sleepy 6-month-old off at day care. Should he be placed on his back or his belly for a nap? Your 2-year-old is having difficulty adjusting to the group and is saying only a few distinguishable words. Could his slowness to speak be related to his frequent ear infections?

What kind of foods make the best mid-morning snack for 3-year-olds? What should be the hand-washing routine for toddlers who play indoors and out, use the toilet, and then eat lunch together? What toys develop their fine motor skills? What toys present safety hazards?

A lot of people deal with these issues everyday, and not all of them know the right answers. Currently, almost 60 percent of mothers with children under the age of 6 are in the workforce, and more than 40 percent of those children are cared for by non-relatives outside their homes (U.S. Department of Health and Human Services, 1997).

Angela Crowley, associate professor at the Yale School of Nursing, has devoted more than a decade to researching issues of child care and pediatric health. Her results argue strongly for the involvement of health care professionals in child care programs. The need is especially great for children and families with inadequate access to health services and those who experience multiple social and economic stresses.

Crowley developed and now co-chairs the 130-member Child Care (Special Interest Group, part of the National Association of Pediatric Nurse Associates and Practitioners (NAPNAP), a professional organization of 6,000 pediatric primary care nurse practitioners and advanced practice nurses. One of the group's current projects is "Adopt-a-Child Care Program." The goal is to link every NAPNAP member as a consultant to a child care center.

According to the "Cost, Quality, and Child Outcomes in Child Care Centers" study (1995) which was conducted in four states including Connecticut, only 8 percent of the infant-toddler rooms observed met the "good-quality level," considering health and safety among other criteria. Fully 40 percent were rated less than minimal. The Connecticut data, which were collected by researchers at Yale University's Bush Center, indicated that Connecticut scored highest, with 24 percent of the centers meeting good-quality standards. However, even here, 7 percent of the centers were rated poor and 69 percent were judged mediocre.

What can be done to change this situation and make child care safe, healthy and developmentally enriching?

In a recently completed study of health consultation to child care programs in Connecticut, Crowley found that when health professionals work with child care providers, they are able to solve problems jointly, offer health education, identify and make referrals for early intervention services, link children with primary care services and promote the quality of care by introducing healthy and safe practices.

Connecticut is currently the only state in the nation that requires -- at minimum -- weekly on-site visits by a registered nurse, physician or physician's assistant for programs that enroll children under 3 years of age. In Crowley's study of 133 child care centers, 99 percent of the health consultants were registered or advanced practice nurses. In addition, most of these programs have daily telephone access to their health consultants to discuss questions and concerns. Frequently, the nurse consultants are available to provide educational programs for parents, teachers and students.

In recent months, Crowley has been invited to the White House as an expert in health issues and child care. She attended the gathering at which President Clinton announced his $20-billion child-care initiative on Jan. 7, representing NAPNAP -- one of only two health professional organizations participating. The other organization was the American Academy of Pediatrics. Crowley was invited to speak at a one-day conference on child care, hosted by Hillary Rodham Clinton at Trinity College in Hartford on Jan. 28, sharing the podium with Ed Zigler, the Sterling Professor of Psychology at Yale and founder of Head Start; Joyce Thomas, commissioner of Connecticut's Department of Social Services; and other leaders in the field. In addition, she will participate in the U.S. Department of Health and Human Services Child Care Bureau Regional Conference on June 5 in Philadelphia, where she will speak on "Child Care Health Issues -- Nurse Consultants and Child Care."