Original Article| Volume 23, ISSUE 2, P387-395, March 2023

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Type of Child Care Setting Is Associated With Child Care Constraints and Food Insecurity Among Families With Low-Incomes



      High quality child care positively affects long-term development in children and is a necessary support for parents who work or are in school. We assessed the association between child care setting and parents’ report of difficulties with ability to work and/or further their education (“child care constraints”) or material hardships among families with low incomes.


      Cross-sectional data were analyzed from families in Minneapolis, MN with children aged six weeks to 48 months in child care from 2004 to 2017. Associations between child care setting (formal, informal relative, informal non-relative) and child care constraints or material hardships (household/child food insecurity, housing instability, energy instability) were examined.


      Among 1580 families, 73.8% used informal care. Child care subsidy and public assistance program participation were higher among families utilizing formal care. Compared to formal care, families using informal relative or non-relative care had 2.44 and 4.18 greater adjusted odds of child care constraints, respectively. Families with children in informal non-relative care had 1.51 greater adjusted odds of household food insecurity. There were no statistically significant associations between informal relative care and household or child food insecurity, and no associations between child care setting and housing instability or energy insecurity.


      Informal care settings–relative and non-relative–were associated with child care constraints, and informal non-relative care with household food insecurity. Investment to expand equitable access to affordable, high-quality child care is necessary to enable parents to pursue desired employment and education and reduce food insecurity.


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        • Camilli G
        • Vargas S
        • Ryan S
        • et al.
        Meta-analysis of the effects of early education interventions on cognitive and social development.
        Teach Coll Rec. 2010; 112: 579-620
        • Laurin JC
        • Geoffroy M-C
        • Boivin M
        • et al.
        Child care services, socioeconomic inequalities, and academic performance.
        Pediatrics. 2015; 136: 1112-1124
        • Black MM
        • Walker SP
        • Fernald LC
        • et al.
        Advancing early childhood development: from Science to Scale 1: early childhood development coming of age: science through the life course.
        Lancet. 2017; 389: 77-90
      1. Olivetti C, Petronlogo B. The economic consequences of family policies: lessons from a century of legislation in high-income countries. Published January 2017. Accessed February 9, 2019.

      2. Susman-Stillman A, Banghart P. Demographics of family, friend, and neighbor child care in the United States. Published August 2008. Accessed February 4, 2019.

      3. Child Care Aware of America. The US and the high cost of childcare: an examination of a broken system. Published 2019. Accessed June 17, 2021.

      4. Congressional Budget Office. Factors affecting the labor force participation of people ages 25 to 54. Published February 2018. Accessed June 17, 2021.

      5. Gould E, Cooke T. High quality child care is out of reach for working families. Published October 6, 2015. Accessed March 6, 2019.

      6. Bruce C, Bovell-Ammon A, Ettinger de Cuba S, et al. Access to high-quality, affordable child care: strategies to improve health. Published April 2020. Accessed May 28, 2020.

        • Coleman-Jensen AJ.
        Working for peanuts: nonstandard work and food insecurity across household structure.
        J Fam Econ Issues. 2011; 32: 84-97
        • Sandel M
        • Sheward R
        • Ettinger de Cuba S
        • et al.
        Unstable housing and caregiver and child health in renter families.
        Pediatrics. 2018; 141e20172199
      7. Minnesota Department of Human Services. Do you need help paying for child care? Accessed February 4, 2019.

      8. Coleman-Jensen A, Rabbitt MP, Gregory C, et al. Household food security in the United States in 2018. Published September 2019. Accessed January 2, 2020.

        • Cook JT
        • Frank DA
        • Casey PH
        • et al.
        A brief indicator of household energy security: associations with food security, child health, and child development in US infants and toddlers.
        Pediatrics. 2008; 122: e867-e875
        • Batan M
        • Li R
        • Scanlon K.
        Association of child care providers breastfeeding support with breastfeeding duration at 6 months.
        Matern Child Health J. 2013; 17: 708-713
        • Mirkovic KR
        • Perrine CG
        • Scanlon KS
        • et al.
        Maternity leave duration and full-time/part-time work status are associated with US mothers’ ability to meet breastfeeding intentions.
        J Hum Lact. 2014; 30: 416-419
        • National Survey of Early Care and Education Project Team
        Fact sheet: provision of early care and education during non-standard hours.
        2015 (Published AprilAccessed November 2, 2021)
      9. Butcher KF, Schanzenbach DW. Most workers in low-wage labor market work substantial hours, in volatile jobs. Published July 24, 2018. Accessed January 28, 2021.

      10. Golden L. Irregular work and its consequences. Published April 9, 2015. Accessed April 1, 2021.

      11. Centers for Disease Control and Prevention. Strategy 6. Fact sheet: support for breastfeeding in early care and education. Published January 2019. Accessed June 22, 2022.

        • Schafer EJ
        • Livingston TA
        • Roig-Romero RM
        • et al.
        Breast Is Best, But…” according to childcare administrators, not best for the childcare environment.
        Breastfeed Med. 2021; 16: 21-28
        • Lee R
        • Zhai F
        • Han W-J
        • et al.
        Head Start and children's nutrition, weight, and health care receipt.
        Early Child Res Q. 2013; 28: 723-733
        • Giles LC
        • Davies MJ
        • Whitrow MJ
        • et al.
        Maternal depressive symptoms and child care during toddlerhood relate to child behavior at age 5 years.
        Pediatrics. 2011; 128: e78-e84
        • Herba CM
        • Tremblay RE
        • Boivin M
        • et al.
        Maternal depressive symptoms and children's emotional problems: can early child care help children of depressed mothers?.
        JAMA Psychiatry. 2013; 70: 830-838
      12. The US Government Accountability Office. Child care: subsidy eligibility and receipt, and wait lists. Published February 18, 2021. Accessed November 2, 2021.

        • Blau D
        • Tekin E.
        The determinants and consequences of child care subsidies for single mothers in the USA.
        J Popul Econ. 2007; 20: 719-741
        • Forry ND
        • Hofferth SL.
        Maintaining work: the influence of child care subsidies on child care-related work disruptions.
        J Fam Issues. 2011; 32: 346-368
        • Rose-Jacobs R
        • Black MM
        • Casey PH
        • et al.
        Household food insecurity: associations with at-risk infant and toddler development.
        Pediatrics. 2008; 121: 65-72
        • Gundersen C
        • Ziliak JP.
        Food insecurity and health outcomes.
        Health Aff. 2015; 34: 1830-1839
      13. Minnesota Department of Health. Am I eligible for WIC? WIC income guidelines. Accessed November 2, 2021.

        • Roll S
        • East J.
        Financially vulnerable families and the child care cliff effect.
        J Poverty. 2014; 18: 169-187
      14. Cohn D and Passel JS. Pew Research Center. A record 64 million Americans live in multigenerational households. Published April 5, 2018. Accessed June 22, 2020.

        • Karoly LA
        • Gonzalez GC.
        Early care and education for children in immigrant families.
        Futur Child. 2011; 21: 71-101
        • Barofsky J
        • Vargas A
        • Rodriguez D
        • et al.
        Spreading fear: The announcement of the public charge rule reduced enrollment in child safety-net programs.
        Health Aff. 2020; 39: 1752-1761
        • Chilton M
        • Black MM
        • Berkowitz C
        • et al.
        Food insecurity and risk of poor health among US-born children of immigrants.
        Am J Public Health. 2009; 99: 556-562
      15. U.S. Chamber of Commerce Foundation. Childcare: an essential industry for economic recovery. Published September 2020. Accessed April 1, 2021.

      16. Malik R, Hamm K, Lee WF, et al. The coronavirus will make child care deserts worse and exacerbate inequality. Published June 22, 2020. Accessed April 1, 2021.

      17. Rockeman O and Pickert R. Child-care workers are quitting the industry for good in the U.S. Published April 27, 2022. Accessed June 22, 2022.

        • AAP Council on Community Pediatrics
        Poverty and child health in the United States.
        Pediatrics. 2016; 137 (e20160339-e20160339)
        • Hartline-Grafton H
        • Hassink SG.
        Food insecurity and health: practices and policies to address food inseurity among children.
        Acad Pediatr. 2021; 21: 205-210
      18. Hatfield BE, Hoke K. Family, friend, and neighbor care: status of states’ support for FFN care. Published August 18, 2016. Accessed February 4, 2019.

      19. Chun R, Punelli D. Minnesota family assistance - a guide to public programs providing assistance to Minnesota families. Published January 2004. Accessed October 21, 2021.

      20. Minnesota Department of Human Services. The Children's Health Insurance Program in Minnesota. Updated December 1, 2017. Accessed September 29, 2019.