20.1: Introduction

Introduction to Primary Care

High quality care and education for infants and toddlers begins with relationship-based care (Mangione, 2006). Primary caregiving is a relationship-based practice and is the practice of assigning each child (and family) to a caregiver who will serve as the primary source of information and care for the child. Primary caregiving enables caregivers to develop deep relationships with children and their families and offers opportunities to provide individualized care and interactions during daily routines and experiences. This focused care by a familiar adult can provide infants and toddlers with a sense of predictability and security that comes with knowing each child’s unique needs and preferences. ^[1]

Figure \(\PageIndex{1}\): Focused care is a benefit of a primary care system. (Image from “Individualizing care for infants and toddlers - part 1” from Head Start ECLKC is in the public domain.)

Primary caregiving does not mean that caregivers care only for their small group of children to the exclusion of the other children in the group. Rather, it means that each caregiver, to the extent possible and practical in a group care situation, cares for and responds to children’s routine care needs (e.g., eating, toileting, diapering, sleeping) who are assigned to them. However, caregivers also work as a team and rely on each other as backup when they are not able to work directly with their particular children. For example, if a caregiver is busy changing one child’s diaper, the other caregivers in the room still continue to provide care for the other children until their primary caregiver returns. Another reason why primary caregiving should be conceptualized as a team effort rather than exclusive care, is when a primary caregiver is not able to work (e.g., sickness, vacation, etc.,). It is imperative for all the caregivers to have respectful relationships and establish trust with all of the children, even those children outside of their primary care assignment. Of equal importance, parents and other family members know who has primary responsibility for their child; this can strengthen the parent-caregiver relationship and communication between home and the childcare program. ^[3]

Caregiver Spotlight: Magnia Family Childcare

Interestingly, years ago someone mentioned I was good at “mothering,” and I should consider making a “business” of this skill. I could not imagine what this person meant! Then, I heard of “licensed family childcare.” After interviewing someone in this career, I investigated more thoroughly what was necessary to become licensed. I went through the California Community Care licensing process and learned what I needed to provide early care and education to children in my program. After meeting all safety and licensing standards, my home was issued a license to care for children from ages 0 to 18 years of age. Our program served primarily infants, toddlers, and preschoolers.

Figure \(\PageIndex{2}\): Albert and Martha Magnia with some of the children from their family childcare (CC BY; Martha Magnia)

Our program began enrolling infants when the current families “grew” with the addition of their new babies. I recall interviews with prospective families whose babies were not yet born. They wanted to look ahead and plan for their future childcare needs. My philosophy in caring for infants and toddlers is simple: to establish warm, loving, and nurturing relationships. Once relationships are established, infants and toddlers can develop trust in their caregivers. We were the adults they could turn to for comfort when they missed their parents, or when they needed a cuddle because they felt tired.

In my program, I did not separate the infants and toddlers from the other children. Of course, these little ones had their own schedules for feedings and naps; but during their waking hours, they were part of the “group.” They were outdoors during outdoor play, they were present for story time, and they joined the other children for wagon rides through the neighborhood. I enjoyed most the loving relationships my husband and I created with the infants and toddlers in our care. We were the primary caregivers of these children while they were in our program. Our home served as an extension of their families; providing warm hugs, the little kisses on their heads, and the snuggles, too. They learned from the stories we read to them, the things they saw on their wagon rides, and the songs we sang with them. As these children grew to preschoolers, they had the necessary skills needed for learning by the early enrichment of our program.

I would like students to know licensed family childcare is a viable career in early care and education. Infants and toddlers need small groups, individualized care, nurturing environments, and consistent caregivers. Center-based early care and education programs have rotation of staff. Whereas family childcare offers families the consistency of the same caregivers to provide care for their children.

On an anecdotal note, my husband and I are proud to have had the most loving and caring families in our program throughout 23 years. It was an honor to have had their trust in us to care for their precious babies. As our reward, we have witnessed these babies become amazing people. Through the years we saw them as kindergarteners, eighth-graders, high school graduates, and college graduates. Some of these children have married and had babies of their own. Our “circle” is complete, and we could not have had a more enriching and rewarding career in having a small part in the lives of these children’s development.

- Martha and Albert Magnia

While primary caregiving is a common practice in the U.S., it is not a commonly implemented practice worldwide, even in highly-developed countries. In Singapore, for example, primary caregiving is not frequently practiced with infants and toddlers (Ebbeck et al., 2015). However, in a different study with parents of children under three years of age in Singapore, most parents expressed wanting to have their child cared for by the same caregiver and parents in programs that did implement primary caregiving reported high levels of satisfaction with the practice (Ebbeck, Yim, Ho & Sharma, 2022).

Despite the strong recognition of the importance of primary caregiving from organizations such as Zero to Three, the Program for Infant and Toddler Care (PITC) and the National Association for the Education of Young Children (NAEYC), there is very little empirical evidence directly investigating primary caregiving as a practice (Lee, Shin & Recchia, 2016). The research that is used to justify the importance of primary caregiving comes mainly from empirical explorations into the development of attachment. Since primary caregiving is a practice that encourages the development of a secure attachment between caregivers and children, it is often assumed that primary caregiving would also support the positive developmental outcomes associated with secure attachment (Bernhardt, 2000; Lally & Mangione, 2017).

Figure \(\PageIndex{3}\): Primary Care allows for focused care. (Individualizing care for infants and toddlers - part 1” from Head Start ECLKC is in the public domain.)