Young children are happier and healthier when they are well cared for by loving, attentive adults. Sometimes that’s one parent alone, but more often it’s a village.
The child care crisis, however, has made that village much harder to find. The past five years have seen a decrease in the availability of child care programs. Over the past few decades, child care costs have risen at twice the pace of inflation. In 2023, the cost of care was higher than rent in all 50 states. A small number of lower-income families can secure existing subsidies, but the majority are left to pay their own way.
Meanwhile, child care worker wages remain stagnant, so it’s no wonder many educators exit the field. Availability further declines.
That’s why I wish presidential candidate Donald Trump had responded to a question about the ongoing child care crisis during the June 27 presidential debate. (He ignored the question.)
However, we do know the position of his vice-presidential choice, J.D. Vance, who articulated it clearly in an op-ed he co-authored, proclaiming that “Biden’s Daycare Plan Is Bad for Families” and noting that “Young children are clearly happier and healthier when they spend the day at home with a parent.”
Even though he’s the husband of an esteemed lawyer and father of three young children in nonparental care, Vance argues in the op-ed that child care leads to “negative effects on children’s emotional and social well-being.”
In his opinion, child care should not be subsidized for the middle class. As a pediatrician, I think Vance’s take is wrong.
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When high-quality care is impossible to find or afford, working parents have to make tough choices. Some drop out of the workforce altogether. Others attempt to juggle caring for their kids with nontraditional work schedules. Or they rely on relatives, neighbors or friends for informal care.
What often results is stressed caregivers who struggle to provide the basics — adequate sleep, nutritious food, play, attention and time outside.
When young children don’t have these needs met, their health and development suffer. The impact can be long-lasting. Children with lower physical activity are at higher risk for obesity, and 79 percent of 2-year-olds with severe obesity will remain obese into adulthood.
Children with poor sleep schedules can lack basic readiness for kindergarten and then perpetually struggle to catch up to their more prepared peers. Infants without adequate caregiver responsiveness are at higher risk for mental health problems later in life.
In turn, subpar care for toddlers has ripple effects that create strains on our healthcare, educational and criminal justice systems down the road.
But there is a solution: High-quality child care can make a meaningful difference in child health and development. A 2021 study demonstrated that states with larger child care investments had lower rates of child protective services calls, foster care placements and deaths by abuse or neglect.
Another study, in North Carolina, found that children who were randomly assigned to a high-quality child care program had better health outcomes at age 21 than their peers who didn’t get in.
A 2016 study found that infants in licensed care centers were at lower risk for obesity than those in informal care, and a 2022 study found that infants who attended an Oklahoma center had a wide range of academic advantages years later compared to their peers who didn’t get off the waitlist.
Daily, I see this play out in front of me. Take a 4-year-old patient I saw recently for a checkup.
One year ago, he had little speech, minimal social skills, explosive behavior and poor sleep. We started developmental evaluations. His mom, a medical assistant, explained to me that he was cared for by an overwhelmed neighbor who watched several children and relied heavily on screen time to keep the peace. She had considered sending him to a licensed child care facility, but waitlists were interminable and costs out of her reach.
Five months ago, her son enrolled in a Head Start program. He’s now talking in complete sentences, sleeping well and has marked behavioral changes. This is the power of good child care.
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The Presidential Transition Project — known as Project 2025 and designed for Donald Trump — calls for eliminating the Office of Head Start, which would lead to the closure of Head Start child care programs that serve about 833,000 low-income children each year.
My advice to our leaders like Vance? Keep Head Start and expand child care subsidies. Trust families to decide what’s best for their children.
Trust the providers currently working in this field and pay them more.
Allow parents using subsidies to choose between formal centers, private homes and faith-based institutions.
You’ll see more tax revenue from parents returning to the workforce. You might even lift millions of child care workers out of poverty. But most importantly, you’ll change the health and educational trajectories of millions of young children for the better.
Dr. Megan Prior is a pediatrician at a community health center in northern Virginia.
This story about the child care crisis was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for Hechinger’s weekly newsletter.
I am so happy to be able to write in my journal and tell how my day has been.
My deepest concern is getting enough rest at night.