A Primary Caregiving System for Infants and …...74 Young Children• March 2000 INFANTS AND...

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Jennifer L. BernhardtReprinted from the March 2000 edition of Young Children

A Primary Caregiving System for Infants and Toddlers: Best for Everyone Involved

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Social and Emotional Development Infants Toddlers

74 Young Children • March 2000

INFANTS AND TODDLERSINFANTS AND TODDLERSINFANTS AND TODDLERSINFANTS AND TODDLERSINFANTS AND TODDLERS

he term primar y caregiverhas long been used in re-search to describe the

most significant adult person in achild’s life, usually the mother. Asthe care of infants and toddlersoutside the home has increasedover the last three decades, the termprimary caregiving has evolved todescribe a model or system of caringfor children in groups.

Although primary caregiving hascaught on across the country—andexperts on quality care issues oftenimply a primary caregiving systemor even mention it by name in theirwriting—many caregivers workingin infant and toddler care settingsdon’t understand what it is, why itis done, or how to make it work. Orworse, staff mistakenly believe theyare working under the primarycaregiving model when they are

not. A thorough understanding ofprimary caregiving is important forall staff working directly or indirectlywith young children in groups.

In the primary caregiving model,each caregiver or teacher within alarger group is assigned primary re-sponsibility for a specific group ofchildren. For example, in an infant-care room with a ratio of three toone that serves 12 babies, eachcaregiver is responsible for thecare of the same three children ev-ery day. This does not mean thecaregiver cares exclusively for thesame three children; rather, thatshe has principal responsibility forthe few children in her direct care.

Teamwork among caregivers is ab-solutely essential for the system torun smoothly and effectively. This dif-fers from a group-coverage approachin which caregivers collectively carefor all children by assigning tasks—one caregiver changes all diapers inthe morning, another feeds all thechildren breakfast, and so on.

Advantages of primarycaregiving

The main advantage of primarycaregiving is the bond that formsbetween the child and adult throughconstant daily interactions. Accord-ing to Eriksonian theory, the first

component of a healthy personalityis a sense of trust, the foundationsof which develop during the first 18months of a child’s life. This senseof trusting the world is key to achild’s healthy psychological devel-opment (Erikson 1963). Of course,the parent-child relationship is farand away the most influential rela-tionship a young child has, but hisrelationship with his full-time childcare provider is very important too.

John Bowlby’s (1969) attachmenttheory tells us that infants internal-ize aspects of their self/caregiverrelationships. The models theybuild are unconscious, yet theyserve as models for other close re-lationships later (Honig 1993). If therelationship the child care providerbuilds with the young child affectshow he approaches all future rela-tionships, the provider has a re-sponsibility to work on developingthe most trustful and pleasurablerelationship she can.

The child and adult learn eachother’s rhythms and responsesthrough their daily interactions,and each becomes skilled at antici-pating the actions of the other.Knowing what to expect contrib-utes to the child’s feeling of secu-rity. Knowing how to elicit certainresponses from a caring adult givesher a sense of control over herworld. These factors all help a child

Jennifer L. Bernhardt

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Jennifer L. Bernhardt is a certified in-fant massage instructor, writer, adult edu-cator, and mother of two small children inVienna, Virginia. She has worked as aninfant/toddler caregiver, administrator,and consultant and has helped implementthe primary caregiving model in programsserving children birth to three.

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A Primary Caregiving Systemfor Infants and Toddlers:

Best for Everyone Involved

Young Children • March 2000 75

It’s important for an infant’s or toddler’s sense ofsecurity that, whenever possible, her parent beable to turn her over to her primary caregiver,not to another caregiver who may be present.

begin to feel a strong sense of self-worth and value.

A trusted caregiver serves as ahome base for her children. An in-fant or toddler who is confidentthat her caregiver is close by andavailable is willing to move out andexplore the world on her own. Thismay simply mean that a child feelssafe enough to crawl a few feetaway to examine a new toy becauseshe knows she will be able to gethelp from her special adult if sheneeds it. Very young children whodo not have a special, trustedcaregiver may become angry or ex-cessively clingy. But children whofeel close to a special adult learnthat it is safe to move away, explorefor a while, then come back to “re-fuel,” as Mahler, Pine, and Bergman(1975, 2) call it.

A sensitive caregiver observesher children’s interactions anddemonstrates positive interactionswith others. She is aware that ayoung child identifies with her andwith her behaviors and patternshis own behaviors after hers. Thecaregiver knows her children wellenough to know when to intervenein a difficult situation between twoor more of them. She helps her in-dividual children learn to negotiateand cooperate with one another, asmuch as their developmental levels

In a primary-care group in which achild shares a primary caregiver withtwo or three other children, the childoften forms a strong bond not justwith the primary caregiver but withthe other children in the group aswell. Such bonds mimic siblingbonds and may be especially reward-ing for children who do not have sib-lings at home. Two babies in my pri-mary care, for example, formed avery strong bond early on. The girlswere rarely more than a few feet fromeach other and often fell into thesame daily pattern of eating and nap-ping. For a time I even held both—one in my arm, the other in my lap—as they drank their morning bottles.The girls moved together throughthe center, supporting each otherand remaining fast friends. Thechild–child bond is an especiallyimportant one in a program inwhich children do not have thesame primary caregiver for the firstthree years of their lives—which,unfortunately, seems to be thenorm in many group-care settings.

Benefits are not onlyfor the child

The primary caregiving systemdoes not benefit only the children;it frequently has a positive effect onthe caregiver’s sense of value.

Employees whose supervisorshelp them develop skills and gradu-ally gain control over their work en-vironment are happier and moreproductive. The staff person in aprimary caregiving setting is re-sponsible for the daily care of herchildren. She plans for, observes,and evaluates them on an ongoingbasis, changing routines or theenvironment as they grow. Thecaregiver develops a sense of pride©

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allow, and helps them learn to besensitive to others’ needs.

Forging emotional bonds

Once an infant has developed ob-ject permanence (the realizationthat even when something is out ofreach, it still exists), he will oftencry in protest when his parentleaves him in the morning. Separa-tion can be sad and painful for bothchild and parent. Having a signifi-cant other there to hold him andget him involved in something thatinterests him eases the transitionfrom home to group care andmakes separation less traumaticand often as easy as a kiss good-byewhen Mom or Dad leaves. Even fora child who always has a hard timewith separations, the emotionalsupport the primary caregiver pro-vides is priceless.

What about a child who hasn’tformed a strong emotional bondwith a parent or other familymember? The caregiver may be the

only person the childcan fully trust anddepend on. This emo-tional bond becomesvital for the child’swell-being and servesas a protective fac-tor in his develop-ment (Wittmer 1995).It is all the more im-portant for any childat risk of being over-whelmed by stressfactors—and espe-cially children whoare separated fromtheir parents on aregular basis—to becared for by one lov-ing adult.



Many infant/toddler caregivers much prefer tohave their own little cluster of babies. Thecaregiver can delight in a baby’s preference forher over other caregivers in the room and cantake pride in knowing the little child so well.

and achievement, as well as a senseof importance to the group as awhole. The caregiver’s added respon-sibilities and chances to work moreclosely with her supervisor or men-tor that may arise from primarycaregiving are on-the-job training formore advanced teaching positions.

I have seen many center direc-tors struggle to increase moraleand find ways to enhance staff feel-ings of pride and ownership in thegroup. I have also noticed thatimplementing the primary caregiv-ing model increases staff morale al-most immediately!

Maybe even more important to thecaregiver than a sense of control inthe workplace is the daily re-ward of seeing the positiveeffect she has on the livesof her primary children.She sees them grow physi-cally, emotionally, intellectu-ally, and socially and knowsshe is playing a very im-portant role in their de-velopment. The ultimatereward is that many ofthe children’s smiles aremeant only for her!

Parents reap rewards too

Parents also reap the rewards ofa trusting relationship with thecaregiver. Having one adult primar-ily responsible for their child allday means that the parents have oneprimary contact with whom to com-municate and share information.

Imagine a parent who calls thecenter during his lunch break tofind out how his daughter’s morn-ing has been. A caregiver answers

the phone but knows only that hisdaughter had a bowel movementaround 9:00 A.M. That staff memberasks another caregiver nearby, butshe knows only that his daughterfinished her morning bottle andthat a third caregiver played withher outside for a while around10:30. However, the third caregiveris on her lunch break and won’t re-turn until the parent is in an after-noon meeting. Sadly, this is a com-mon scenario for parents whosechildren are in a setting that followsa task-assignment approach.

In the primary caregiving model,parents know whom to ask forwhen they call the center. They alsoknow the caregiver’s work sched-ule, so they can call before or afterher breaks. The caregiver in turnknows the parents well, havingformed a bond with them as well aswith their child. Together, theyshare information about the child’sdevelopment and needs and workto make positive decisions aboutthe child’s care.

Best of all, the parents feel com-fortable leaving their child incare. When I mentioned that thecaregiver eases the separationanxiety that often arises duringdrop-off times, I meant anxiety forthe parent too! Parents who areanxious and uneasy send out non-verbal—and sometimes verbal—cues to children. Even a very younginfant can sense a parent’s bodystiffening or other physical tensionin response to arriving at the caresite. If a child—even a very younginfant—repeatedly picks up nega-tive cues from a parent, she will be-gin to feel that this is not a safeplace. On the other hand, a confi-dent, happy parent gives the childthe message that her care is good

and safe, adding to thechild’s sense of comfortand security.

A parent who devel-ops a relationship withthe primary caregiveralso is more likely toshare important infor-mation about the child’shome life. Without thesingle direct contactthat primary caregiving

provides, the parent may not wantto share such personal informationfor the whole staff to know—and ofcourse there must also be confiden-tiality! But with one significantadult to share information with, theparent may give information or sug-gestions that help the caregiver un-derstand and more appropriatelyrespond to and nurture the child.

In turn, a primary caregiver whohas a strong bond with her familiescan advocate for needed changesor suggest new direction for growthin staff meetings, which high-qual-ity centers hold every week or twowith caregivers and administrators.As advocate the child care profes-sional has a wonderful opportunityto create centerwide change thatcan improve the relationship be-tween the center and all the fami-lies it serves.

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Many possibilities arise just bybuilding up trust in this triad ofrelationships!

Overcoming obstacles

Although a child care setting isideally limited to six children, witha ratio of three children to oneadult, this is not always a reality ingroup care. In one of my first group-care experiences, I worked in a cen-ter that served up to 23 infants andtoddlers in one large space. Thiswas far from ideal. There were toomany people “living” in this onearea, and it often became over-stimulating, even for me. The ad-ministration eventually limited thenumber of children to sixteen, witha 4:1 child-to-caregiver ratio, but itwas still a difficult situation. Pri-mary caregiving ameliorates the ef-fects of such a large group setting.

If staff members find themselvesin such undesirable circumstances,the most important thing to do islobby for fewersets of

infants or toddlers and caregiversper room. However, giving eachchild a primary caregiver can helpeveryone. Even in a room of sixchildren and two caregivers, all stillbenefit from primary caregiving.The children will most likely formbonds with both caregivers in the

small group, but routine consis-tency and knowing what to expectfrom one special adult are still es-sential to the child’s developmentof positive self-esteem.

In many group settings, a seniorteacher or caregiver is the leader

and supervisor of the other staffin the room. Primary care-

giving does not interruptthis staffing hierarchy.The senior teacher canbe a primary caregiver ifgroup numbers and ra-tios require it . Whenstaff members’ profes-sional preparation hasnot been optimal, the se-nior teacher should besomeone who can effec-tively help others de-velop caregiving in-sights and skills.

Some settings haveone more adult than is

needed to meet the ratio in thegroup. If this extra adult is an assis-tant or intern, the senior teachershould remain a primary caregiverand the extra staff person serve asa helper to all staff, interacting withall of the children. However, if allthe adults are qualified and can ef-fectively carry out the roles of a pri-mary caregiver, then all staff exceptthe senior teacher should be pri-mary caregivers, leaving the seniorteacher to help, supervise, andhave more flexibility to leave thecare room if necessary.

In any case, one extra adult servesan important role in the group-caresetting. She helps the other staffwhen more children need immediateattention than there are primarycaregivers and is the familiar personwho fills in the primary caregivingrole during a staff person’s absence.Prompt responsiveness to needybabies and one- and two-year-oldsis a hallmark of good care.

It should be the policy in anychild care setting to limit the totalnumber of adults who care for chil-dren under three years old. If thereare no extra staff or floaters in thecenter with whom the children canbecome familiar, administrators

When infants and toddlers are in child care together for two or three years, theyoften “grow up” as best friends and keep up the harmonious friendship later.

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should strive to use the same fewsubstitutes, so the children recog-nize them and the substitutes get toknow and understand the way thecenter works. It is also important tostagger staff working hours so allfamiliar people don’t vanish at acertain hour when a new shiftcomes in.

Getting the kinks out

Some benefits to primary caregiv-ing are not realized until the mechan-ics of the system work smoothly. Ittakes work to change to a primarycaregiving system. Making it workeffectively

takes dedication and the belief thatthe change is for the best.

I’ve gone through this changewith several centers and havefound that it takes much practiceand lots of communication betweenall parties involved to work out thekinks. But once the staff works un-der the primary caregiving model,it seems to become second nature.It is natural for adults who love chil-dren to want to bond with and pro-vide quality care for them.

To start, the senior teacher or ad-ministrator assigns children to pri-mary caregivers. In a setting inwhich all the adults have cared forthe children, she first assigns chil-dren to the adults they have al-ready formed a bond with. If a childhas not bonded with any particularadult or has bonded with more than

one adult, it makes sense tocompare children’s and care-giver’s schedules and matchthem as closely as possibleto maximize the time each

child spends in the careof one special adult. (Ihave noticed that thenatural bonds that formbefore primary caregiv-ing is implemented oftenare between adults andchildren who have simi-lar schedules.)

It also makes sense tomatch a caregiver witha family according toany special situations. Ifa caregiver previouslyformed a special bondwith a child’s older sib-ling and came to knowthe family well, it’s usu-

ally wise to match the younger childwith this caregiver. If a family is fromthe same culture or speaks the samelanguage as a particular caregiver,the family may feel more comfortablewith her. The senior teacher or ad-ministrator also should considerother unique circumstances.

An established program some-times has no choice in the pairing,as one caregiver will have an open-ing and the newest child will fill it.Only in extremely problematic situ-ations should a child switch fromone caregiver to another in thesame room once he has establisheda primary relationship. Ideally, ev-ery child should stay with the samecaregiver through the age of three.In any case, children should bemoved from caregiver to caregiveras infrequently as possible. Fre-quent changes are traumatic anddefeat some of the advantages ofthe primary caregiving model.

Knowing who’s responsible

Once children are assigned, eachstaff person should have a goodunderstanding of her daily dutiesand responsibilities. These include,but aren’t limited to, greeting eachof her primary care children, easingtransitions to and from the groupsetting as her work schedule al-lows, preparing food (being awareof any special diets or food aller-gies) and feeding the children,checking and changing diapers,putting children down for naps, su-pervising them at all times, andproviding a loving atmospherethroughout the day.

The caregiver also is responsiblefor documenting these activities ina written report that goes homewith each child’s parent at the endof the day. In addition, she talkswith the children’s parents at leastonce during each day.

The primary caregiver also ob-serves and documents the children’sgrowth and development, plans ap-propriate individual and group activi-ties, and works with the other staff©

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Most parents feel much better if they knowexactly who is taking care of their preciousinfant or toddler. Of course other caregivershelp out, but it’s good to know that bothparents and babies can count on one speciallycaring person.



and supervisors to add to or makechanges in the environment to matchchildren’s developmental needs.

As stated before, primary caregiv-ing does not mean that one personcares exclusively for an infant or tod-dler; there has to be teaming (Lally,Torres, & Phelps 1994). Each staffperson must remain flexible andcommitted to quality care for everychild in the program. A caregivermay be assigned to three children,but she must interact with others inthe group. The primary caregiving re-lationship should be viewed as pri-mary—not exclusive. This helps cre-ate other relationships that the infantcan fall back on when the primarycaregiver is unavailable (Lally 1995).

Staff members also must realizewhat a tremendous help they can beto one another. For example, Meesha,whose three children all arrive within15 minutes of each other, wants toindividually greet each child and par-ent, but her first arrival will be readyfor his bottle very soon. Paulina, asecond caregiver, is nearby andtwo of her children are sleeping.She helps Meesha by warming thebottle and holding one of the chil-dren whose parents have alreadygone. By pitching in and helpingeach other, everyone’s needs aremet and the children benefit.

When staff need immediate assis-tance and there is no time to askquestions, they should consult

other staff members, when possible,before presuming to help out withtheir children. Crucial informationmay have been passed by the par-ents to their child’s primarycaregiver. For example, considerJeanne, who is holding and calmingNancy, a six-month-old who is cut-ting two new teeth. Another ofJeanne’s assigned children, Dale, isready for breakfast. Sharon, an un-occupied staff member, decides tohelp Jeanne by preparing Dale’sfood. She goes to his cubby, gets twobaby-food containers, heats them,and begins to feed Dale. Sharonmeans to help, but she didn’t talk toJeanne to find out that Dale’s par-ents mentioned that they had leftyesterday’s food containers in hiscubby and the new ones were in hisdiaper bag. Sharon should haveconsulted Jeanne before helpingout.

Doing the dirty work

Very few of even the most dedi-cated child care professionals wantto change dirty diapers! A problemthat often creeps up in primary-caresettings is that a child stays in a dirtydiaper until his own caregiver is avail-able to change it because anothercaregiver states that “He’s not mychild!” A primary caregiver shouldroutinely change her own children’s

diapers, but no child should be leftunchanged when any adult is avail-able to change him. Teamwork notonly is a necessity but also a hall-

mark of a professional child careprovider.

To ensure consistent care dur-ing staff breaks, caregiversmay want to “partner up.”Each makes sure that theother’s children are cared forand that all interactions arerecorded on the child’sdaily sheet. This partneringworks even if a substitute isresponsible for the children.It helps the substitute andprovides a backup system toensure that all the children’s

routines are documented.Any time a staff member other than

a child’s primary caregiver performsa routine-care task with a child, sheshould record the appropriate infor-mation on the child’s sheet. Next tothe information she should place herinitials so that staff and parents knowwhom to contact if any questionsarise.

Every center has its own issues towork through. For this reason, cen-ters should hold frequent staff meet-ings to discuss these situations andwork out solutions.

A combination of care

With very young children spend-ing increasing amounts of time incare settings away from their par-ents, a caregiver must provide expe-riences and an environment thatpromote trust, security, and positiveself-esteem. Primary caregiving isone way to do this. The many ben-efits of this system can amelioratethe effects of less-than-perfect caresituations.

To provide maximum high-qualitycare, other policies should be usedin conjunction with a primary care-giving system, such as limited groupsizes and low staff–child ratios. Inaddition, child care staff and ad-ministrators should do everything

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possible to allow a child to stay inthe care of the same primary care-giver for the longest time possible—ideally, for the first three years. Onlyby implementing such policies canwe begin to ensure that our youngestchildren grow up in an environmentin which they feel safe and feel thatthey can trust the world.

References

Bowlby, J. 1969. Attachment and loss. Vol. 1:Attachment. New York: Basic.

Erikson, E.H. 1963. Childhood and society. 2ded. New York: Norton.

Honig, A.S. 1993. Mental health for babies:What do theory and research teach us?Young Children 48 (3): 69–76.

Lally, J.R. 1995. The impact of child-care poli-cies and practices on infant/toddler identityformation. Young Children 51 (1): 58–67.

Lally, J.R., Y.L. Torres, & P.C. Phelps. 1994.Caring for infants and toddlers in groups:Necessary considerations for emotional,social, and cognitive development. Zero toThree 14 (5): 1–8.

Mahler, M.S., F. Pine, & A. Bergman. 1975. Thepsychological birth of the human infant: Sym-biosis and individuation. New York: Basic.

Wittmer, D.S. 1995. “I want Mary.” Early Child-hood Today 10 (3): 30.

For further readingBalaban, N. 1992. The role of the child

care professional in caring for infants,toddlers, and their families. Young Chil-dren 47 (5): 66-71.

Cole, M.S., & S.R. Cole. 1989. The devel-opment of children. New York: ScientificAmerican.

Honig, A.S. 1993. Bonding with your ba-bies. Child Care Information Exchange50–52.

Honig, A.S. 1985. High quality infant/tod-dler care: Issues and dilemmas. YoungChildren 41 (1): 40–46.

Weiser, M.G. 1991. Infant/toddler care andeducation. New York: Merrill.

Copyright © 2000 by the National Associa-tion for the Education of Young Children.See “Permissions and Reprints” online atwww.naeyc.org/resources/journal.


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