Is Daycare Harmful?

The videos of children bursting into tears at daycare pickup are often followed by bold claims that daycare is harmful–or even traumatic. It’s enough to make any parent pause.

But those reunion tears? They don’t automatically mean distress, trauma, or that something’s wrong with daycare. They’re emotional, yes–but not necessarily a red flag. In fact, decades of research paints a more nuanced picture–one that highlights meaningful developmental benefits and offers real reassurance for families navigating this decision.

So, what does the research actually say about daycare, attachment, and child development? Why are experts so divided on this? And what matters most when choosing childcare for your family?

First, about those reunion tears…

Pickup time can be emotional. Many viral clips show a child happily playing–until they spot their parent. Then come the tears. And in that moment, it’s easy to wonder: Were they okay without me? Did something go wrong?

But those tears aren’t proof of harm. They’re a release. Crying at reunion is normal. It’s a sign of trust and secure attachment, not a warning flag. When a child sees their safe person, their guard drops. They let the big feelings out–not because something bad happened, but because they feel safe enough to do so.

This kind of emotional expression is part of healthy development–especially in toddlers and young children who are still learning how to manage their feelings. They don’t always have the words to explain how their day went, but they do know you’re their safe landing place. So they might cry, cling, or even act out a bit–not as a sign something is wrong, but as part of reconnecting.

And with time and consistent routines, those transitions often get easier.

What is attachment really about?

This is where a lot of the daycare debate begins–because the word attachment gets thrown around a lot but isn’t always used accurately.

Attachment isn’t about being with your child every second of the day. It’s about the quality of the relationship–how consistently a caregiver responds to a child’s needs with warmth, sensitivity, and reliability.

Decades of research shows that children can absolutely form secure attachments even if they spend time in childcare. In fact, many form multiple secure attachments–to parents, grandparents, and yes, daycare providers.

In one of the most comprehensive studies to date, the NICHD Study of Early Child Care and Youth Development followed over 1,000 children from birth through adolescence to explore how early experiences shaped development. When it came to attachment, their findings were clear: parental sensitivity–a parent’s ability to notice, interpret, and respond appropriately to their child’s cues–was the strongest predictor of secure attachment. Not the number of hours in care. Not the type of care. Not whether a parent stayed home or worked full-time.

A follow-up NICHD study at age 18 reinforced this: parental sensitivity remained a critical factor in long-term attachment security, while the quality and type of childcare did not significantly predict attachment outcomes. Interestingly, children who experienced higher-quality childcare in early life were more likely to show secure attachment representations in adolescence, even after controlling for parenting quality; however, the effect was small. Over the long term, the most meaningful influence on secure attachment remained the sensitivity and responsiveness of the child’s primary caregivers, especially parents.

Here’s what that means: 

• You can work full-time and have a securely attached child.

• A child can cry at pickup and still feel deeply safe and loved.

• Your child’s bond with you isn’t weakened by time apart–it’s shaped by how you show up when you’re together.

The study also noted that childcare quality matters, particularly in combination with the parent-child relationship. When low parental sensitivity and low-quality care were present, children were more likely to develop insecure attachment–something researchers refer to as a “dual-risk” scenario.

But when either relationship was strong–especially the one with the parent–the risk was dramatically reduced.

So, if you’re choosing daycare–or already using it– here’s your reassurance: you are still your child’s anchor. That doesn’t change just because someone else helps care for them during the day.

What does the research say about development?

Attachment isn’t the only thing parents wonder about when it comes to daycare. What about learning? Social skills? Emotional regulation?

The short answer: High-quality childcare can support a child’s development in meaningful ways.

Cognitive and language development: more talking, more learning

Children in high-quality childcare–especially center-based programs–tend to show small but measurable gains in language and cognitive skills. They’re exposed to new vocabulary, interactive storytelling, early problem-solving activities, and age-appropriate routines that build school readiness.

When thinking of high-quality childcare, the focus is on care that is consistent, emotionally supportive, and developmentally appropriate. That usually means low child-to-caregiver ratios, warm and responsive interactions, and environments where play, communication, and routines are thoughtfully supported.

In the NICHD study of children’s development prior to school entry, children in higher-quality care scored better on standardized assessments of language and academic abilities by preschool and early elementary school. These benefits were most consistently seen in environments where caregivers were warm, responsive, and trained in early childhood education.

The positive effects may last longer than many expect: in a follow-up study tracking children through adolescence, higher-quality early child care was associated with better academic outcomes in high school, including admission to more selective colleges. For girls in particular, early center-based care was also linked to improved impulse control, and fewer risk-taking behaviors in adolescence.

The takeaway? While these benefits won’t look the same for every child, the research shows that high-quality care can support important developmental skills–both now and down the road. It’s one of many reasons families can feel confident in making the childcare choice that works best for them.

Social development: practicing real-world skills with peers

Social development in early childhood is shaped through everyday experiences–and group childcare offers a lot of those. In these settings, children get daily chances to practice important skills like sharing, turn-taking, expressing their needs, working through disagreements, and building friendships.

These are real opportunities for kids to learn how to be part of a community. And caregivers play a key role, helping children navigate peer interactions, model kindness, and coach through tricky moments.

In the NICHD study evaluation of children’s peer interactions, children who experienced positive, responsive caregivers and regular interactions with other children–were linked to more skilled and positive peer play in group settings by age 3. While these effects were modest, the study suggests that both family dynamics and childcare quality contribute in different but complementary ways to early social development.

The takeaway? While every child is different, childcare can offer daily real-life practice for growing social confidence and communication skills.

Emotional development: building resilience

One of the biggest emotional skills toddlers and young children are working on is how to regulate big feelings–frustration, disappointment, excitement, fear. That regulation doesn’t happen overnight. It’s built through everyday moments where kids get to practice coping…with the support of a calm, trusted adult nearby.

In childcare, these moments come up naturally: waiting their turn and saying goodbye at drop-off. And when those experiences are met with patient, responsive caregiving, they become chances to build emotional resilience–not shutdowns.

Some research has found that cortisol levels (a stress hormone) can rise during daycare days, especially in toddlers. But it’s not the presence of stress that’s concerning–it’s how that stress is supported. In one study, toddlers showed an initial rise in cortisol during their first month in care–but by three months, levels had decreased, suggesting they adapted with time. Caregivers and parents described the transition as challenging at first but manageable with consistent routines and responsive care.

Another study on preschoolers found that children who had secure attachments to their caregivers were more likely to show decreasing cortisol levels over the course of the day. In other words, emotional support and strong caregiver-child relationships helped ease stress as the day went on.

The takeaway? Emotional ups and downs are part of the learning curve–and consistent, responsive caregiving (in or out of daycare) is what helps children manage them and feel safe doing so.

What about long hours in childcare?

This is a common concern: Is full-time daycare too much?

Research suggests that it’s not the sheer number of hours that matters the most–but rather the quality of care and the emotional climate at home.

In the NICHD study, longer hours in care were linked to slightly higher reports of behavior challenges in early childhood–but only when combined with lower-quality care and low parental sensitivity. This is another example of the “dual-risk” model: two less-than-ideal circumstances stacked together can increase risk, but when either the parent-child relationship or the childcare quality is strong, the concern significantly drops.

In other words, long hours alone aren’t the problem–it’s the context that matters.

If a child is in a warm, engaging, well-regulated environment during the day and reconnects with a responsive caregiver at home, they are not at risk simply because of how many hours they spent apart.

Why do some experts have divided opinions?

If you’ve heard people say things link, “Daycare leads to stress, disconnection, or long-term emotional issues,” you’re not alone. Experts like Dr. Gabor Maté and psychoanalyst Erica Komisar have raised concerns about early separation, especially when it comes to stress regulation and attachment.

Their perspective often comes from clinical experience and attachment theory–but it’s important to know that their interpretations don’t always align with what large-scale research studies have shown.

For example, Maté emphasizes how early stress can shape a child’s nervous system. That’s not wrong–but research also shows that when stress is buffered by warm, responsive caregiving, children are not harmed by short-term challenges like daycare transitions.

Similarly, Kosimar argues for at-home, full-time maternal care in the early years. She highlights the importance of the first three years, which, yes–these years are very important for development. But the reality is that this simply isn’t possible–or necessary–for many families. What is necessary? Emotionally present caregiving, strong relationships, and systems of support. That can happen at home. That can happen in childcare. It’s not one-size-fits-all.

These experts raise important questions, but their advice can sometimes leave parents feeling shame or fear. The truth is you can acknowledge the role of early experiences without assuming that working or using daycare causes harm.

And the research consistently supports that balanced view.

So, what to look for in childcare?

Whether you’re just starting the research or already in a childcare routine, it’s normal to wonder: Is this the right fit for my child?

The good news is there are some consistent signs of high-quality care that research and real-world experience agree on:

• Warm, responsive caregivers who engage with children at their level–talking, playing, comforting, and setting gentle limits.

• Low child-to-caregiver ratios so children can be seen, heard, and supported throughout the day.

• Consistency and routines that help children feel secure, especially during transitions like drop-off and pickup.

• Developmentally appropriate activities that support learning through play–think art, music, movement, storytelling, and sensory exploration.

• Open communication with parents so you feel informed and included in your child’s day.

And remember: a great childcare setting doesn’t have to look fancy. It has to be safe and the magic is in the relationships– how your child is cared for, how they’re comforted, and how they’re supported in exploring the world.

Want some more help making this decision? Download the free PedsDocTalk Childcare Guide for tips on what to ask during a tour, how to find a nanny that fits your family, and signs it might be time to switch.

A personal note from me–as a pediatrician and mom

I have two children, and their childcare journeys have been completely different–but equally beautiful in their own ways.

Our son started group childcare at 13 months old, three days a week. That quickly became five days a week because of the lack of other childcare options. He was a pandemic baby, and both my husband and I were working in healthcare. Some days, we were the first to drop him off and the last to pick him up.

And you know what? He thrived. He loved going. His speech took off, he developed socially, and most importantly, he remained securely and deeply connected to us. He is emotionally attuned, smart, and bonded–and those long days didn’t take that away.

Our daughter, on the other hand, has had a nanny and didn’t need group care early on. Thanks to that support, she’s had a stable routine, is meeting all her milestones, and she’s thriving, too. We’re just now starting her in group childcare two mornings a week at 24 months and plan to increase it slowly after she turns 3.

Despite the differences in their paths, I don’t see one as superior or inferior. They’re just different. And both are thriving–because they’ve had love, consistency, and connected time with us after our workdays. They’ve grown in our care and outside of it, and that’s a beautiful thing.

Final thoughts

There’s no one “right” way to raise a securely attached, emotionally thriving child. Whether you stay home, choose daycare, rely on grandparents, or hire a nanny–what matters most is the love, connection, and consistency your child feels from the people who care for them. 

Choosing childcare–or not–isn’t a measure of how much you love your child. It’s a personal decision shaped by your family’s needs, values, and circumstances. And that decision deserves support, not judgment.

Even with all the research, it’s just one piece of the puzzle. Every child is different. Every family is different. What’s best for one family, might not be best for another– it’s more about finding a rhythm that feels right for your child and sustainable for your family.

So let’s move the conversation away from shame or comparison–and toward what really helps families thrive–strong relationships, quality care, and support systems that make it possible to show up with love.

On The Podcast

Whether you’re preparing for birth or in the thick of postpartum recovery, this episode is packed with real talk and practical advice. We’re joined by Liesel from Mommy Labor Nurse (@mommy.labornurse) to answer some of the most common questions about labor, C-sections, vaginal delivery, and what actually happens after the baby is born.

We cover:

• How to advocate for yourself during labor (without conflict)

• Must-have items for C-section and vaginal birth recovery

• How to care for stitches and prevent infection

• What no one tells you about postpartum bleeding

• Pain management tips and why you shouldn’t try to be a hero

• Why stool softeners are your best friend (seriously)

There is a lot of terminology and misconceptions thrown around in the pediatric sleep world especially on social media. Can they self- settle? Are wake windows a real thing? And what about regressions?

I welcome back Sujay Kansagra who is a pediatric neurologist and sleep medicine physician at Duke who has dedicated his life to helping kids (and their parents) sleep better. He knows sleep and the importance of it. He was on my show before on an episode called Sleep-training: What the evidence does or doesn’t say.

He joins me to discuss:

• If genetics play a role in sleep and if there is such a thing as a “good” or “bad” sleeper

• If “wake-windows” are evidence-based

• If there’s a certain age we would expect a baby to “sleep through the night”

• The truth behind sleep regressions

On YouTube

Do vaccines cause SIDS? As a pediatrician and mom, I break down the facts, bust myths, and share what really helps keeps babies safe. The video covers:

• What is SIDS?

• Where did the vaccine and SIDS myth come from?

• VAERS and misinformation

• What vaccines do anti-vaxxers blame for SIDS?

• What do vaccine inserts say about SIDS?

• What does the science say?

• Vaccines do not cause SIDS

Ask Dr. Mona

An opportunity for YOU to ask Dr. Mona your parenting questions!

Dr. Mona will answer these questions in a future Sunday Morning Q&A email. Chances are if you have a parenting concern or question, another parent can relate. So let's figure this out together!