Unstable and Multiple Child Care Arrangements and Young Children's Behavior

Early Childhood Routines and Adolescent Health & Well-Being: Associations From a US Urban Cohort of Children With Socioeconomic Disadvantage

PURPOSE

To investigate longitudinal associations between the presence of early childhood routines- predictable and repeatable functional practices that promote healthy growth, development, and relationships - and adolescent health outcomes.

DESIGN

Secondary data analysis.

SETTING

20 large U.S. cities.

SUBJECTS

2943 children with socioeconomic disadvantage from the Future of Families cohort.

MEASURES

Routines at age 3 (shared family meals, bedtime routine, daily reading); outcomes later in the same children at age 15 (healthy routines, overall health, psychological well-being).

ANALYSIS

Descriptive statistics, regression analyses.

RESULTS

We detected longitudinal associations between early childhood routines and later adolescent routines (increased count of shared family meals by parent report [IRR 1.13, 95% CI: 1.03, 1.24, P = 0.007], bedtime routine and daily reading by adolescent report [aOR 1.34, 95% CI: 1.08, 1.67, P = 0.008; aOR 1.18, 95% CI: 1.01, 1.38, P = 0.04; respectively]). A bedtime routine in early childhood was associated with excellent health in adolescence (aOR 1.42, 95% CI: 1.12, 1.79, P = 0.004]. Adolescent routines were concurrently associated with overall health and psychological well-being. We also detected two longitudinal patterns of associations suggesting multiple mechanisms for how early childhood routines influence later health and well-being.

CONCLUSION

Early childhood routines predict adolescent routines, and may contribute to long term adolescent health outcomes. Future studies may promote childhood routines during critical developmental stages as a strength-based strategy to promote long-term health and well-being.

Childhood unpredictability research within the developmental psychopathology framework: Advances, implications, and future directions

Greater unpredictability in childhood from the level of the caregiver-child dyad to broader family, home, or environmental instability is consistently associated with disruptions in cognitive, socioemotional, behavioral, and biological development in humans. These findings are bolstered by experimental research in non-human animal models suggesting that early life unpredictability is an important environmental signal to the developing organism that shapes neurodevelopment and behavior. Research on childhood unpredictability has surged in the past several years, guided in part by theoretical grounding from the developmental psychopathology framework (shaped largely by Dr. Dante Cicchetti's innovative work). The current review focuses on future directions for unpredictability research, including probing intergenerational effects, the role of predictability in resilience, cultural and contextual considerations, and novel developmental outcomes that should be tested in relation to childhood unpredictability. We urge the integration of multidisciplinary perspectives and collaborations into future research on unpredictability. We also provide ideas for translating this research to real-world practice and policy and encourage high-quality research testing whether incorporating predictability into interventions and policy improves developmental outcomes, which would support further dissemination of these findings.

Childcare use and the social-emotional and behavioural outcomes of late-preterm and early-term born children at age 5: An analysis of the All Our Families longitudinal cohort

OBJECTIVES

Gestational age at birth (GA) shows an inverse gradient of risk with social-emotional and behavioural outcomes among children born late preterm (≥ 34 and < 37 weeks) and early term (≥ 37 and < 39 weeks). Childcare has the potential to influence this association. This study aimed to estimate the association between GA and social-emotional/behavioural problems among children born between ≥ 34 and < 41 weeks gestation, determine whether this association was modified by childcare use, and describe the relationship between childcare and behavioural and social-emotional functioning at age 5.

METHODS

Using data from the All Our Families cohort (n = 1324), logistic regression models were used to model the association between GA and social-emotional/behavioural problems (BASC-2 composite scales at age 5). Models were fit with interaction terms between GA and childcare variables (amount, multiplicity, and type of childcare at age 3) to assess effect modification.

RESULTS

GA showed no significant associations with social-emotional/behavioural problems at age 5, though the type of childcare significantly modified the association between GA and externalizing and internalizing problems. Neither the number of hours spent in childcare (amount) nor the number of childcare arrangements used (multiplicity) modified the association between GA and social-emotional/behavioural problems. However, multiplicity was associated with externalizing behavioural problems (aOR = 2.09, 95% CI 1.14‒3.83).

CONCLUSION

This study found no significant association between GA and social-emotional/behavioural problems at age 5, though childcare type modified this association. Factors such as using multiple childcare arrangements to meet families' childcare needs have the potential to influence a child's social-emotional and behavioural functioning at age 5.

Leveraging the science of early life predictability to inform policies promoting child health

Addressing the tremendous burden of early-life adversity requires constructive dialogues between scientists and policy makers to improve population health. Whereas dialogues focused on several aspects of early-life adversity have been initiated, discussion of an underrecognized form of adversity that has been observed across multiple contexts and cultures is only now emerging. Here we provide evidence for "why unpredictability?", including: 1. Evidence that exposures to unpredictability affect child neurodevelopment, with influences that persist into adulthood. 2. The existence of a translational non-human animal model of exposure to early life unpredictability that can be capitalized upon to causally probe neurobiological mechanisms. 3. Evidence that patterns of signals in the early environment promote brain maturation across species. 4. The uneven distribution of unpredictability across demographic populations that illuminates a possible focal point for enhancing health equity. We then outline the potential of unpredictability in terms of the "what"; that is, how might the concept of unpredictability be leveraged to inform policy? We emphasize the importance of interdisciplinary and community partnerships to the success of this work and describe our community-engaged research project. Finally, we highlight opportunities for the science of unpredictability to inform policies in areas such as screening, immigration, criminal justice, education, childcare, child welfare, employment, healthcare and housing.

Behavioral Outcomes of Children With In-Utero Opioid Exposure Age 2-7 and Parenting Self-Efficacy

BACKGROUND

The relationship between behavior difficulties and parenting self-efficacy in children with in-utero opioid exposure (IOE) remains a significant gap that needs to be addressed for providers to better understand the mental health trajectories of children with IOE and help these families.

AIMS

In this study, caregivers' perception of their child's behavior and potential relationships between parenting self-efficacy, child temperament, and behavior difficulties were investigated.

METHODS

A descriptive survey design with a convenience sample of 143 caregivers of 2- to 7-year-old children with IOE who had follow-up visits in a Neonatal Abstinence Syndrome (NAS) clinic was used for this study. Data were collected using a survey of demographics, the Children's Behavior Questionnaire, the Strengths and Difficulties Questionnaire, and the Parenting Sense of Competence Scale.

RESULTS

The overall sample scored in the average range of behavior difficulties, but a subgroup of children with very high difficulties was identified who exhibited a negative temperament, and caregivers reported a lower sense of parenting competence. There were no differences between groups on demographic variables.

CONCLUSIONS

High negative affect and low effortful control are predictive of later internalizing and externalizing problems, as well as broader problems in self-regulation, school readiness, and socioemotional competence. Thus, although a large percentage of children treated for NAS appear to be functioning at the same level as their peers, a subset of children appears to be at higher risk. Child behavior as well as caregiver self-efficacy should be assessed during all provider encounters.

Annual Research Review: The power of predictability - patterns of signals in early life shape neurodevelopment and mental health trajectories

The global burden of early life adversity (ELA) is profound. The World Health Organization has estimated that ELA accounts for almost 30% of all psychiatric cases. Yet, our ability to identify which individuals exposed to ELA will develop mental illness remains poor and there is a critical need to identify underlying pathways and mechanisms. This review proposes unpredictability as an understudied aspect of ELA that is tractable and presents a conceptual model that includes biologically plausible mechanistic pathways by which unpredictability impacts the developing brain. The model is supported by a synthesis of published and new data illustrating the significant impacts of patterns of signals on child development. We begin with an overview of the existing unpredictability literature, which has focused primarily on longer patterns of unpredictability (e.g. years, months, and days). We then describe our work testing the impact of patterns of parental signals on a moment-to-moment timescale, providing evidence that patterns of these signals during sensitive windows of development influence neurocircuit formation across species and thus may be an evolutionarily conserved process that shapes the developing brain. Next, attention is drawn to emerging themes which provide a framework for future directions of research including the evaluation of functions, such as effortful control, that may be particularly vulnerable to unpredictability, sensitive periods, sex differences, cross-cultural investigations, addressing causality, and unpredictability as a pathway by which other forms of ELA impact development. Finally, we provide suggestions for prevention and intervention, including the introduction of a screening instrument for the identification of children exposed to unpredictable experiences.

Early Childcare Precarity and Subsequent Maternal Health

PURPOSE

We examined prospective associations between early childcare precarity, or the security and reliability of childcare arrangements, and subsequent maternal health.

STUDY DESIGN

We conducted a secondary analysis of survey responses from mothers of 2,836 children in the Future of Families and Child Wellbeing study. We assessed the following childcare measures: insecure childcare, insecure childcare with missed work, inadequate childcare, and emergency childcare support. We used linear and logistic regression models with robust standard errors to examine associations between these measures when the index child was age 3 and maternal health outcomes (overall health, depression, and parenting stress) later when the child was age 9. We then examined additive experiences of childcare measures across child ages 1 and 3 on maternal health outcomes.

RESULTS

Early inadequate childcare was associated with higher odds of later poor maternal overall health (adjusted odds ratio [aOR], 1.64; 95% confidence interval [CI], 1.11-2.41). All early childcare precarity measures were associated with higher odds of maternal depression (insecure childcare [aOR, 1.64; 95% CI, 1.23-2.18]; insecure childcare with missed work [aOR, 1.58; 95% CI, 1.13-2.22]; and inadequate childcare [aOR, 1.75; 95% CI, 1.22-2.51]). Emergency childcare support was associated with lower odds of adverse maternal health outcomes (poor overall health [aOR, 0.65; 95% CI, 0.48 to 0.88]; depression [aOR, 0.73; 95% CI, 0.54 to 0.99]; and parenting stress [B -0.45; 95% CI, -0.80 to -0.10]). Prolonged experiences had stronger associations with maternal health than shorter experiences.

CONCLUSION

Early childcare precarity has long-term adverse associations with maternal health, and emergency childcare support seems to be favorable for maternal health. These findings highlight childcare precarity as a social determinant of women's health for researchers, clinicians, and decision-makers.

Growing up amid conflict: Implications of the Developmental Peacebuilding Model

Worldwide, 420 million children are affected by conflict and over half of all children experience violence every year. Thus, youth are unarguably affected by war and settings of persisting societal violence. Despite often being conceptualized as either powerless victims or violent perpetrators, recent advances in research and international policy recognize young people as key change agents in transforming adverse settings into positive environments. Framed by the Developmental Peacebuilding Model, this paper focuses on predictors, outcomes and intervention points within the family for youth peacebuilding. Recent advances of family-based interventions in diverse, non-WEIRD samples will be highlighted. Rooted in existing knowledge, we conclude with concrete suggestions on how to use secondary data to investigate youth peacebuilding across the globe.

Longitudinal associations between parental migration and children's psychological well-being in Southeast Asia: The roles of caregivers' mental health and caregiving quality

OBJECTIVE

This study investigates the longer-term effects of parental migration on the psychological well-being of children who stay behind in two major labor-sending countries in Southeast Asia, namely, Indonesia and the Philippines. Adopting the framework of the 'care triangle', we further examine how caregivers' mental health and caregiving quality moderate the associations between parental migration and children's psychological well-being.

METHODS

Using longitudinal data collected in 2008 and 2016/17, we assess children's psychological well-being during early childhood (aged 3-5 years) and again in adolescence (aged 11-13 years). We apply both fixed-effects and random-effects models, using the Hausman test to indicate the preferred model.

RESULTS

The findings indicate that there is no significant longer-term effect of parental migration on children's psychological well-being, but parental migration tends to show adverse effects on Filipino children's psychological well-being when they are cared for by a caregiver with poor mental health.

CONCLUSIONS

The two-country comparison demonstrates the complexities of understanding the gender-based influences of parental migration on children's psychological well-being. The findings also highlight the caregiver's role in maintaining frequent communications with migrant parents within the care triangle, which is crucial to children's well-being.

The Relationship between Childcare-Giving Arrangements and Children's Malnutrition Status in South Africa

Multiple caregiving arrangements have become common for childcare globally, and South Africa is no exception. Previous childcare studies mainly focused on the caregiver and household characteristics. Evidence on the influence of childcare on malnutrition is sparse. This study aimed to examine the relationship between exposure to secondary and multiple forms of care and child malnutrition, with a particular focus on child stunting and overweight among children. A cross-sectional study of a sample of 2966 dyads of mothers and children under five were analysed from the 2017 National Income Dynamics Study (NIDS) Wave 5. Descriptive and inferential statistics were used to analyse the data. The results indicated that 22.16% of the children were stunted and that 16.40% were overweight. Most children were mainly cared for at home (67.16%) during the day. Some results of the obtained multivariable analyses show that lack of being cared for in a crèche or school during the day was significantly associated with stunting (odds ratio (OR) 2; confidence interval (CI) 1.10-3.62, p < 0.05) and overweight (OR) 3.82; (CI) 1.60-9.08, p < 0.05). Furthermore, in this study, 69.88% of children who were cared for at home by the primary caregiver had no other forms of multiple care arrangements. The results showing high stunting and overweight rates among children cared for at home suggest that the government needs to look into supporting caregiver parenting. The high unemployment rates in the country highlight the importance of socioeconomic status in childcare and its implication for children's nutritional outcomes. The study's findings suggest the need for innovative strategies to address the challenges associated with multi-caregiving which negatively affects children's nutritional outcomes.

Trajectories and Associations Between Maternal Depressive Symptoms, Household Chaos and Children's Adjustment through the COVID-19 Pandemic: A Four-Wave Longitudinal Study

The COVID-19 pandemic and associated public health measures have adversely affected the lives of people worldwide, raising concern over the pandemic's mental health consequences. Guided by a systemic model of family functioning during the COVID-19 pandemic (Prime et al., 2020), the current study aimed to examine how caregiver well-being (i.e., maternal depressive symptoms) and family organization (i.e., household chaos) are related to longitudinal trajectories of children's emotional and behavioral problems. Data were collected at four time points during and after home lockdown periods. Mothers of children (N = 230; 55% male) between the ages of two to five years were asked to complete questionnaires via an Israeli online research platform. Results indicated that emotional and behavioral problems, household chaos, and maternal depressive symptoms were the highest during the first lockdown assessment and dropped in the post-lockdown periods. Multilevel models further revealed that at the between-participants level, maternal depressive symptoms and household chaos positively predicted children's emotional and behavioral problems. At the within-participants level, household chaos fluctuations positively predicted fluctuations in child behavioral but not emotional problems. Our findings suggest that lockdowns have adverse effects on both maternal and child mental health. Screening for depressive symptoms among mothers of young children and maintaining household structure are important targets for future interventions to assist parents in navigating the multiple challenges brought upon by the COVID-19 pandemic.

Who Cares if Parents have Unpredictable Work Schedules?: The Association between Just-in-Time Work Schedules and Child Care Arrangements

Working parents must arrange some type of care for their young children when they are away at work. For parents with unstable and unpredictable work schedules, the logistics of arranging care can be complex. In this paper, we use survey data from the Shift Project, collected in 2017 and 2018 from a sample of 3,653 parents who balance work in the retail and food service sector with parenting young children 0 to 9 years of age. Our results demonstrate that unstable and unpredictable work schedules have consequences for children's care arrangements. We find that parents' exposure to on-call work and last-minute shift changes are associated with more numerous care arrangements, with a reliance on informal care arrangements, with the use of siblings to provide care, and with young children being left alone without adult supervision. Given the well-established relationship between quality of care in the early years and child development, just-in-time scheduling practices are likely to have consequences for child development and safety and to contribute to the intergenerational transmission of disadvantage.

Heterogeneity in maternal and child mental health responses to the COVID-19 pandemic

We used latent profile analysis on a longitudinal dataset to examine changes in maternal and child mental health during COVID-19 and factors that may protect against declines in mental health. Participants were 183 low-income mothers (M = 36 years) with young children (M = 5.31 years) in the City of Toronto with data collected prior to and during the pandemic in 2020. Mothers reported on their own stress, anxiety and depression and their children's emotional, conduct, hyperactivity, peer, and prosocial problems at both timepoints. We found heterogeneity in mental health changes, with 5 distinct patterns of change for mothers, and 4 distinct patterns of change for children during COVID-19. The majority (83%) of mothers experienced significant declines in at least one aspect of mental health. In contrast, the majority of children (65%) experienced either no change or improvements in mental health. Interestingly, patterns of change across these groups were not differentiated by demographic characteristics such as income, education, and family composition. However, for mothers, a higher degree of satisfaction with social support was associated with membership in a profile with better mental health both prior to, and during the pandemic. For children, having a stable history of early childhood education, and care was associated with membership in a profile that showed improvements in mental health during the pandemic. We discuss how our results support the need for proactive and global interventions for at-risk families with raised mental health concerns, and the benefits that stable early childhood education and care may provide for young children.

Infant and Toddler Child-Care Quality and Stability in Relation to Proximal and Distal Academic and Social Outcomes

This study considered the quality and stability of infant and toddler nonparental child care from 6 to 36 months in relation to language, social, and academic skills measured proximally at 36 months and distally at kindergarten. Quality was measured separately as caregiver-child verbal interactions and caregiver sensitivity, and stability was measured as having fewer sequential child-care caregivers. This longitudinal examination involved a subsample (N = 1,055) from the Family Life Project, a representative sample of families living in rural counties in the United States. Structural equation modeling revealed that children who experienced more positive caregiver-child verbal interactions had higher 36-month language skills, which indirectly led to higher kindergarten academic and social skills. Children who experienced more caregiver stability had higher kindergarten social skills.

Heterogeneous treatment effects on Children's cognitive/non-cognitive skills: A reevaluation of an influential early childhood intervention

The 1962-67 High/Scope Perry Preschool Program, a well-known experimental early childhood intervention study that provided quality preschool education to disadvantaged children, has been shown to have had positive impacts on early child development and on a variety of adulthood outcomes. However, most previous analyses have only examined average treatment effects across all program participants without exploring possible effect heterogeneity by children's background characteristics. We investigated this question by first using the 1964-65 Current Population Survey data in combination with the Perry data to construct a scale of child socioeconomic status based on the estimated propensity for inclusion in the Perry program, then analyzing effect heterogeneity within the Perry sample by strata of our socioeconomic scale. We found that the treatment effects of enrollment in the Perry preschool on cognitive and non-cognitive skills were much larger and more persistent among the most disadvantaged children than among others in the Perry program. Furthermore, among the most disadvantaged children, the treatment (i.e., preschool enrollment) affects later outcomes through a reinforcement mechanism of skill development (i.e., early cognitive gain leads to a non-cognitive gain, which in turn leads to later cognitive gain) and a sequential improvement of cognitive skills over time. These findings have important implications for the evaluation of policy interventions in early child development using experimental data.

Migration and absent fathers: Impacts on the mental health of left-behind family members in Thailand

This paper examines whether children and main caregivers of overseas migrant fathers have fewer or more mental health symptoms compared to those of non-migrant fathers. The sample includes 997 households from the 2008 Child Health and Migrant Parents in South-East Asia project. The mental health measurements are the Strengths and Difficulties Questionnaire and the Self-Reporting Questionnaire. Compared to children of non-migrant fathers, those of migrant fathers are more likely to demonstrate conduct problems and hyperactivity/inattention. Factors which appear to impact a caregiver's mental health include the physical health status of children, caregiver's education level and household economic status. To reduce the risk of mental health problems on left-behind children, our findings imply the importance of encouraging and educating left-behind families to monitor the children's psychological well-being, especially those in father-migrant families.

Strengthening Social Programs to Promote Economic Stability during Childhood

Economic instability has increased in recent decades and is higher for families with low incomes and Black families. Such instability is thought to be driven primarily by precarious work and unstable family structure. In addition, the social safety net has become less of a stabilizing force for low‐income families, in part because benefits are often tied to employment and earnings. Too much change in economic circumstances may disrupt investments in children, parenting practices, and family routines—particularly if the economic changes are unpredictable, undesired, or not part of upward mobility. Given the considerable evidence that economic circumstances affect child health and development, economic stability can and should be an important goal of multiple policy domains. In this report, we describe economic instability, review the pertinent theories for considering how economic instability might matter to children, and describe ideas for policies that could reduce or moderate instability. We include policies that reduce instability in earnings, use public assistance to stabilize income or reduce material hardship, or enhance parents' capacity to deal with or avoid instability.

Childcare Instability and Maternal Depressive Symptoms: Exploring New Avenues for Supporting Maternal Mental Health

OBJECTIVE

We investigated links between childcare experiences-specifically, care instability and mothers' perceptions of care access-and maternal depressive symptoms in an effort to illuminate policy-amenable mechanisms through which childcare experiences can support maternal mental health.

METHODS

Data were taken from the nationally representative Early Childhood Longitudinal Study-Birth Cohort. We used regression models with lagged dependent variables to estimate associations between aspects of childcare instability and perceptions of care availability and maternal depressive symptoms. We did so on the full sample and then on subgroups of mothers for whom childcare instability may be especially distressing: mothers who are low income, working, single, or non-native speakers of English.

RESULTS

Childcare instability-length in months in the longest arrangement and number of arrangements-was not associated with maternal depressive symptoms. However, mothers' perceptions of having good choices for care were associated with a reduced likelihood of clinical depressive symptoms, even after controlling for prior depressive symptoms and concurrent parenting stress; this latter association was observed both in the full sample (adjusted odds ratio [AOR] = 0.77; 95% confidence interval [CI] = 0.63-0.96) and among subgroups of employed mothers (AOR = 0.71; CI = 0.57-0.87) and single mothers (AOR = 0.72; CI = 0.52-0.99).

CONCLUSIONS

Although dimensions of care instability did not associate with maternal depressive symptoms, mothers' perceptions of available care options did. If replicated, findings would highlight a previously unconsidered avenue-increasing care accessibility and awareness of available options-for promoting maternal mental health in a population likely to experience depression but unlikely to be treated.

Family Childcare Types and Conduct Problem Behaviors in Young Children: The Mediation Role of Caregiver-Child Interaction

Background: Previous studies have demonstrated the impacts of genetic, family, and community factors on child conduct problems (CPs). However, little is understood regarding the association between family childcare types and child conduct problem behaviors, as well as whether and to what extent caregiver-child interaction mediates the above association. Methods: 9,289 children first entering kindergartens in the Longhua New District of Shenzhen, China were enrolled in this cross-sectional study. Primary caregivers were invited to fulfill a self-administered structured questionnaire containing data regarding socio-demographics, family childcare types, caregiver-child interaction, and child conduct problem behaviors (measured by the Conners' Conduct Problem Subscale). A series of multiple logistic and linear regression models were employed to assess the associations among family childcare, caregiver-child interaction, and child conduct problem behaviors. Results: Family childcare types other than by parents together (i.e., mother alone, mother with others, grandparents, or changing caregivers) were all significantly associated with higher risks of conduct problem behaviors in young children (adjusted ORs ranged from 2.18 to 2.55, and adjusted βs ranged from 0.043 to 0.073; all p < 0.05), after adjusting for confounders including child age, gender, parental education level, parental age at pregnancy, marital status, and family income. The following family childcare types (mother alone, or grandparents, or changing caregivers) vs. the childcare by parents together showed significant relative indirect effects on conduct problem behaviors through caregiver-child interaction, indicating the significant mediation effect of caregiver-child interaction on the above associations. Mediation of caregiver-child interaction on the effect of being cared by mother with others relative to care by parents together on child conduct problem behaviors was yet non-significant. Conclusions: Family childcare types other than by parents together are associated with increased risks for conduct problem behaviors in young children. Caregiver-child interaction may function as a potential mediator for the above association.

Child-Care Instability and Behavior Problems: Does Parenting Stress Mediate the Relationship?

Child care instability is associated with more behavior problems in young children, but the mechanisms of this relationship are not well understood. Theoretically, this relationship is likely to emerge, at least in part, because care instability leads to increased parenting stress. Moreover, low socioeconomic status and single-mother families may be more vulnerable to the effects of instability. This study tested these hypotheses using data from the Fragile Families and Child Wellbeing study (n=1,675) and structural equation modeling. Three types of child care instability were examined: long-term instability, multiplicity, and needing to use back-up arrangements. Overall, findings showed little evidence that parenting stress mediated the associations between care instability and child behavior problems among the full sample. Among single-mother and low-income families, however, needing to use back-up arrangements had small positive associations with parenting stress, which partially mediated the relationship between that type of care instability and child externalizing behavior problems.

Rural Families' Use of Multiple Child Care Arrangements from 6 to 58 Months and Children's Kindergarten Behavioral and Academic Outcomes

Non-parental child care prior to kindergarten is a normative experience for the majority of children in the United States, with children commonly experiencing multiple arrangements, or more than one concurrent child care arrangement. The experience of multiple arrangements has predominantly been shown to be negatively related to young children's health and behavioral outcomes. The present study examined the use of multiple concurrent arrangements for children in the Family Life Project, a representative sample of families living in six high-poverty rural counties. Using the full sample of 1,292 children who were followed from six months to kindergarten, this study examined the associations between the number of child care arrangements averaged across six time points and children's behavioral and academic outcomes in kindergarten. After including a number of control variables, regression results suggested that a greater number of arrangements prior to kindergarten were related to higher levels of teacher-reported negative behaviors, but not positive behaviors, and letter-word decoding skills, but not mathematics skills, though effect sizes were small. Moderation analyses by child care type and quality were conducted, with no evidence emerging that findings varied by type or quality of care.