The impact of what babies and young childrenexperience in their early years of life can last a lifetime.This early period is a time of wonderful opportunitythat reflects the simultaneous competence andvulnerability of very young children. Caring for youngchildren, and getting the caring right, is both aresponsibility and an opportunity. Good caring canpositively lay the foundations for development andlearning that will ultimately impact upon individual lives,families, communities and society as a whole.

Care extends beyond the physical environment to alsoinclude social, emotional and psychological care. Bothresearch into the neurobiology of brain developmentand research into attachment relationships show thatwarm, sensitive, consistent, responsive and nurturingrelationships provide the best possible foundation fordevelopment and learning.

Attachment

‘Attachment’ is the term used for the types ofrelationships described above between babies orchildren and their significant carers.

Attachment is “an emotional bond between twopeople, in which there is an expectation of care andprotection” (Rolfe, 2004:6). Secure attachmentsnurture the development of emotional security andresilience and promote the child’s feelings of self-worth and competence.

The emotional security built through secureattachment relationships allows the child to positivelyexplore their environment, so these relationships arealso a foundation for cognitive and social development.

Attachment relationships are not limited to the bondbetween a child and a parent, but can relate to allsignificant carer relationships in the child’s life.

Most children form a network of attachmentrelationships with family and other carers. What isimportant is that there is at least one sensitive,

CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 20095 CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 20096

4. Clean and disinfect surfaces and toys regularly.

5. Ventilate facility by opening windows or doors orby using a ventilation system that periodicallyexchanges the air inside the facility.

6. Keep children well nourished and hydrated.

7. Make sure that children are not crowded together,especially during naps on floor mats, beds or cots.

Exclusion period

There is no need to exclude a child with a commoncold from childcare, unless the child is unwell.Excluding children with mild respiratory infections,including colds, is generally not recommended as longas the child can participate comfortably and does notrequire a level of care that would jeopardise the healthand safety of other children. Keeping children fromchildcare has little benefit since viruses are likely to bespread even before symptoms have appeared.

Managing the child with a common cold

There is no specific treatment for colds, but rest, extradrinks and comforting are important. Decongestantsand other cold remedies are widely promoted for therelief of symptoms of colds and flu, however, there is

little evidence that these help. In fact, evidence showsthat they may be harmful and cause unpleasant sideeffects such as irritability, confusion and sleepiness.Oral decongestants are not recommended for childrenunder the age of two years. Cough medicines are noteffective in reducing the frequency, intensity orduration of coughs. Like fever, the cough is there for areason – it serves a useful function by clearing mucusfrom the child’s airways and preventing secondaryinfection.

When to contact parents:

The following are more serious symptoms and parentswill need to be contacted and informed, and medicaladvice is recommended, if the child:

• has difficulty breathing

• refuses to drink fluids

• vomits

• is coughing uncontrollably

• complains of headaches, earache or has adischarging ear

• needs to be comforted constantly – has no interestin play

• has a fever (temperature of 38.5˚C or higher)

• is pale and sleepy.

Watch for new or more severe symptoms. Theymay indicate other more serious infections.

FDCQA: 4.3QIAS: 6.3, 6.6

Childcareand Children’s Health

VOL 12 NO 2 JUNE 2009

A national program developed by the Centre for Community Child Health at the Royal Children’s Hospital inMelbourne with support from Johnson & Johnson. This publication promotes current expert advice on childhealth and wellbeing and current policies and practices for those who work with young children and theirfamilies.

AN INITIATIVE OF SUPPORTED BYTHE AUSTRALIAN GOVERNMENT

DEPARTMENT OF FAMILIES, HOUSING,COMMUNITY SERVICES AND

INDIGENOUS AFFAIRS

SUPPORTED BY THENATIONAL CHILDCARE

ACCREDITATION COUNCILSUPPORTED BY AN

EDUCATIONAL GRANT FROM

National Editorial PanelMs Tonia Godhard AMMs Marie Lewis

EditorDr Estelle Irving

Production EditorMs Penny Miller

Contact DetailsTel: (03) 9345 7085Fax: (03) 9345 5900Email: penny.miller@mcri.edu.au

Websites:www.ecconnections.com.auwww.rch.org.au/ccchwww.raisingchildren.net.au

Promoting Secure Attachment Relationships

The common cold is caused by viruses that infectthe nose, throat and sinuses. Most colds seem tooccur during the winter season. To keep warmand dry means that we tend to stay indoors andexperience closer contact with other people.There are limited opportunities for outdooractivities and children and staff can become tiredas the winter progresses. This increases thechances of spreading the cold virus from personto person and in the case of childcare from childto child, child to carer or carer to carer.

Although some parents are convinced that thecommon cold results from exposure to coldweather or from getting chilled or overheated,there is no evidence to support this belief. Stressand tiredness, as well as illnesses that affect thenasal passages and weaken the immune system,increase the chances of developing colds.

Common cold infections are widespread and veryfew people escape infection. Most individualssuffer multiple colds each year and they are themost common infectious illness, especially foryoung children. Children can catch colds fromsiblings, parents, other family members, playmatesor carers. Due to the close contact involved,children with older siblings and those who attendchildcare have more colds. Young children mayhave 8-10 colds each year, with the highestnumber usually being during the first two years inchildcare, kindergarten or school. Once a child isexposed to a cold virus, the child developsimmunity to that virus. By the time children startschool, children who attended childcare may havefewer colds than other children.

Cold symptoms

Symptoms may include:

• a runny or stuffed up nose

• sneezing or coughing

• a mild sore throat

• little or no fever (38.5˚C or less)

• nasal discharge is usually clear to start with,and then within a day can becomes thicker,yellow and sometimes green.

Incubation period

The time from being infected to showingsymptoms (incubation period) is about 1-3 days.

Infectious period

2-4 days after the cold infection; this may bebefore the symptoms are present.

How are colds spread?

Cold viruses are found in the nose and throat.Children touch their noses, eyes and mouthsoften, put things in their mouths, and touch eachother often during play, so cold germs spreadeasily. There is also a lot of contact betweenparents or carers and children: holding hands,picking up, feeding and changing nappies.

• Children with colds get viruses on their handswhen they touch their runny noses or mouthsor when they cough or sneeze. When theytouch other children, they pass on the viruses.

• Cold viruses can live on objects for severalhours and can be picked up on the hands ofchildren who touch the same object asinfected children. These children then getinfected when they touch their eyes, nose ormouth.

• Carers can get viruses on their hands andspread them between children by touch.

• Some cold viruses may be spread through theair when a child with a cold coughs orsneezes. Droplets from the cough or sneezemay reach another child’s nose or mouth.

Controlling the spread of infection in thechildcare environment

1. Ensure all carers maintain good hand washingtechniques (and keep updated).

2. Encourage older children to cover their mouthand nose with a tissue when they sneeze orcough and immediately throw the tissue awayinto a closed bin. Assist younger children withnose wiping. Wash their hands with soap andwater, and dry thoroughly.

3. Carers and parents may choose to use anantiseptic hand rub if water is unavailable.

Childcare and the Common Cold

A full list of references and the Parent Fact Sheet(available in different community languages) can bedownloaded from the Early Childhood Connectionswebsite: www.econnections.com.au

“Being sensitive means being ‘tuned in’ to the child’sfeelings, and able to read their cues.”

“Being responsive means being psychologicallyavailable [i.e. not preoccupied or distracted byone’s own personal needs and/or other issues],and able to respond to children’s cues appropriately.Responsiveness and sensitivity are inter-related...”(Rolfe, 2004:223)

CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 20092 CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 2009 3 CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 2009 4

responsive and consistently available person whoprovides the sort of nurturing care and protectionrelationship that a child needs to develop a secureattachment. This is especially important in infancywhen development and learning is rapid.

Having a carer (or carers) who knows the baby andcan read and respond to their cues is especiallyimportant. Learning to ‘read’ the cues and signals ofindividual babies takes time and it requires on-goingobservation, based on listening, watching andreflecting. The need for attachment relationships thatare warm, responsive and consistent is universal, butthere will be cultural and family differences in just howthis care is given. For example, in some cultures,babies are carried most of the time, and some familiesare more physically demonstrative than others.Therefore, carers need to understand the culturalcontext of these attachment behaviours, so developingpartnerships with families and sharing informationabout the child is critical.

Each baby and child will bring their individualexperiences of attachment relationships to the caresetting. Understanding their attachment history is animportant factor in the carer’s ability to provide carethat is responsive to a child’s individual needs. Carersalso need to understand both this history and the

context of current and ongoing attachmentrelationships within the baby or child’s life. Reading thebaby’s cues and adapting care to respond to theirindividual needs is necessary. Although secureattachments are built through warm, responsive, andconsistent care, just how this is delivered will varyfrom one child to another; each attachmentrelationship is unique, just as each child is a uniqueindividual. Babies and young children will all havepreferences for how they are comforted, soothed,etc., and so again, ongoing communication withfamilies is important.

Attachments are not necessarily secure and somechildren will come to the care setting with experiencesthat have led to insecure or otherwise disrupted andproblematic attachments. Since all babies and youngchildren need secure attachment relationships, carerscan play a special role in the lives of those who maynot experience these relationships in other parts oftheir early lives.

Early attachment relationships provide the model forattachments throughout later life, so these earlyexperiences are of lasting importance in our personalrelationships and our own capacity to parent.Attachment histories also apply to carers. We all bringour own experiences of attachment relationships tothe settings in which we care for babies and youngchildren. Reflecting on these experiences andunderstanding both the importance of secureattachments and how they are developed will enhancea carer’s capacity to form and sustain theseattachments with the children in the care setting.

Secure attachments developed in the care setting are aprotective factor for babies and children who areat-risk in the context of their family situation or othersettings.

Implications

As well as strongly emphasising the importance ofinteractions that are warm, consistent and responsive,what is now understood about the importance ofsecure attachment has policy implications in all caresettings. These relate specifically to the ratio betweencarer and baby/child, staff rostering or changes ofcarers, and transitions from home to care or withincare settings.

Carers need to consider the following questions:

• Is there a respectful partnership between carer/sand families?

• Is there a carer/s who the child knows they canreliably go to when they need support?

• What happens when this carer is absent in a centreor within a Family Day Care scheme?

• Are the ratios between carer and baby/child lowenough to facilitate the type of individualised,sensitive and responsive care from which secureattachments grow?

• Do staff rosters support, disrupt or prevent thepromotion of secure attachments?

• Is there sufficient continuity of care for secureattachments to develop? How does thecentre/scheme minimise carer turnover?

To address the challenges these questions pose, carersmight like to:

• consider longer term planning and budgeting todecrease the ratio between carer and baby/childover a period of time

• make information available to families about thebenefits of better ratios for their child's well-being.

Family Day Care providers face particular challenges inproviding continuity of care when they are sick or onleave. Sharing resources (e.g. regular relievers) andstrategies between Family Day Care providers mayhelp provide solutions to these problems.

An understanding of the importance of secureattachment also has implications for practice issues.Transitions between carers and settings are particularlyimportant and they require special considerations andplanning. A question to consider is: Are orientationprocesses and transitions planned to allow sufficienttime for the child to build trust in the new carer/sbefore separation from their primary carer?

Separation from the parent (or other primary carer)and the baby or young child is a time of potentialstress, so drop-off and collection times also requirethoughtful care. Some questions to consider include:

• Am I available to welcome or farewell families atdrop-off and collection times?

• How do I talk to the baby/child and invite themin?

• How do I acknowledge to the baby/child that Iunderstand this may be stressful for them?

• How do I look for and respond to thebaby’s/child’s cues on a day-by-day basis?

• If I am feeling stressed or fragile, how do I managethese emotions, particularly at drop-off andcollection times, and how might this affect thebabies/children who are in my care?

Underpinning these considerations is the need forcarers to have the time and resources to be able toobserve and respond appropriately to the attachmentneeds of each child in their care. These are importantand challenging factors for carers, management andfamilies to discuss together.

Carers are also models for parents and have animportant role in promoting and modelling the type ofpositive interactions that are so important to thewell-being of children.

Since everything carers do provides a model for thechildren in care and their families, it might be useful toexplicitly consider:

• How do I respond to babies – especially whentaking babies into care at the start of each day?

• How do I respectfully communicate withbabies/young children?

• How do I adapt responses to the individual cuesfrom babies/young children?

• How do I respond to distress or other strongemotions in babies/young children?

• How do I involve families in planning for theirchild’s care?

References

Harrison, Linda (2003) Attachment

www.raisingchildren.net.au/articles/attachment

Rolfe, Sharne (2004) Rethinking Attachment for EarlyChildhood Practice

FDCQA: 1.1, 3.1QIAS: 1.1, 1.2, 1.3, 1.4, 1.5

Sustained, supportive relationships that developtrust and security through responding to individualneeds and preferences are central to the careprovided at the Lady Huntingfield Children’sCentre in North Melbourne.

In the orientation and settling-in stages for babiesand young children attending the Centre, parentsprovide much more than health and familyinformation; they are also asked about how theywant their baby or child to be cared for. Carersinvite parents to tell them about their child’sindividual care needs, patterns and preferences.What are their special toys? How are they used tobeing settled to sleep? How are they comforted?Are there special or familiar words that they wouldlike to have used?

This is only the starting point for the Centre’ssensitive and responsive care – care thatcharacterises attachment relationships. Secureattachment develops further as carers observe andrespond to the baby’s cues and communicationsabout their individual needs and wants. Babies andchildren learn that their carers can be relied uponto provide care and protection that is appropriateand predictable.

Secure attachments provide the safe base fromwhich babies and children explore and constructthe environment of the Centre. Two of theCentre’s three rooms are multi-age, each with 15children and three carers, and an age range fromthree months to four years. Much thought andplanning has gone into the physical environmentand in many ways the Centre resembles a home.Decorations reflect the family backgrounds of thechildren. Soft couches allow children to snuggle upto their carers and both the inside rooms and theoutdoors are divided into friendly, smaller spaces.

Carers follow the lead and interests of thechildren, and move with them as they play andexplore. In this environment, the carers are carefulnot to overwhelm the children with too many

choices. The effect is subtle and the atmosphere iscalm, purposeful and nurturing.

This flexibility and responsiveness is shown inother ways too. Meal and sleep times are notrigidly prescribed and fit instead with the children’sindividual needs. Small groups of children ofvarying ages can eat together at a small table in theCentre’s kitchen or they can eat in larger groups ata more regular time, if that suits.

Carers at the Centre take time to developrelationships with parents that support parenting,and carers are role models for secure attachmentsin the way they interact with and respond to thebabies and children.

The Centre’s manger, Maree Rabach, is alsoaware that many parents may have little or noexperience with babies or young children untilthey have their own. Consequently, parents mayhave little knowledge or understanding of theemotional needs of children. Advice and support isprovided in the context of on-going relationships inwhich the parent chooses which carer they arecomfortable with.

Continuity of care, both in the curriculum and inthe relationships formed between carers andchildren, is key to secure attachment. Every threeweeks, all carers at the Centre, whether they holdformal qualifications or not, are involved in aplanning day to keep everyone ‘in the loop’ andensure consistency of care. Without carefulplanning, this arrangement could potentially bedisruptive to the attachment relationships betweencarers and babies or children, however the Centrecounters this by using regular relievers. Therelievers also regularly work in the Centre whenthe permanent carers are absent, so they knowand are known by the children and their families.

Promoting Secure Attachment Relationships:Case Study

It is in the context of attachment relationships thateach child individually develops a working model ofhow the world around them works – is the worldfriendly and ordered, or hostile and unpredictable?Are people reliable and supportive or, alternatively,are they erratic and antagonistic? Attachmentrelationships also tell the baby and young childabout how they are valued by others. Are myneeds responded to appropriately?If emotional support is needed, is this provided?Does someone understand and respond to mycommunications? Am I greeted with pleasure andjoy? The answers to these questions tell the babyand young child how much they are valued andthey are the material the baby uses to develop theirown sense of self-worth. Overall, they answer aquestion that is fundamental to the development ofa child: am I loved and lovable?

CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 20092 CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 2009 3 CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 2009 4

responsive and consistently available person whoprovides the sort of nurturing care and protectionrelationship that a child needs to develop a secureattachment. This is especially important in infancywhen development and learning is rapid.

Having a carer (or carers) who knows the baby andcan read and respond to their cues is especiallyimportant. Learning to ‘read’ the cues and signals ofindividual babies takes time and it requires on-goingobservation, based on listening, watching andreflecting. The need for attachment relationships thatare warm, responsive and consistent is universal, butthere will be cultural and family differences in just howthis care is given. For example, in some cultures,babies are carried most of the time, and some familiesare more physically demonstrative than others.Therefore, carers need to understand the culturalcontext of these attachment behaviours, so developingpartnerships with families and sharing informationabout the child is critical.

Each baby and child will bring their individualexperiences of attachment relationships to the caresetting. Understanding their attachment history is animportant factor in the carer’s ability to provide carethat is responsive to a child’s individual needs. Carersalso need to understand both this history and the

context of current and ongoing attachmentrelationships within the baby or child’s life. Reading thebaby’s cues and adapting care to respond to theirindividual needs is necessary. Although secureattachments are built through warm, responsive, andconsistent care, just how this is delivered will varyfrom one child to another; each attachmentrelationship is unique, just as each child is a uniqueindividual. Babies and young children will all havepreferences for how they are comforted, soothed,etc., and so again, ongoing communication withfamilies is important.

Attachments are not necessarily secure and somechildren will come to the care setting with experiencesthat have led to insecure or otherwise disrupted andproblematic attachments. Since all babies and youngchildren need secure attachment relationships, carerscan play a special role in the lives of those who maynot experience these relationships in other parts oftheir early lives.

Early attachment relationships provide the model forattachments throughout later life, so these earlyexperiences are of lasting importance in our personalrelationships and our own capacity to parent.Attachment histories also apply to carers. We all bringour own experiences of attachment relationships tothe settings in which we care for babies and youngchildren. Reflecting on these experiences andunderstanding both the importance of secureattachments and how they are developed will enhancea carer’s capacity to form and sustain theseattachments with the children in the care setting.

Secure attachments developed in the care setting are aprotective factor for babies and children who areat-risk in the context of their family situation or othersettings.

Implications

As well as strongly emphasising the importance ofinteractions that are warm, consistent and responsive,what is now understood about the importance ofsecure attachment has policy implications in all caresettings. These relate specifically to the ratio betweencarer and baby/child, staff rostering or changes ofcarers, and transitions from home to care or withincare settings.

Carers need to consider the following questions:

• Is there a respectful partnership between carer/sand families?

• Is there a carer/s who the child knows they canreliably go to when they need support?

• What happens when this carer is absent in a centreor within a Family Day Care scheme?

• Are the ratios between carer and baby/child lowenough to facilitate the type of individualised,sensitive and responsive care from which secureattachments grow?

• Do staff rosters support, disrupt or prevent thepromotion of secure attachments?

• Is there sufficient continuity of care for secureattachments to develop? How does thecentre/scheme minimise carer turnover?

To address the challenges these questions pose, carersmight like to:

• consider longer term planning and budgeting todecrease the ratio between carer and baby/childover a period of time

• make information available to families about thebenefits of better ratios for their child's well-being.

Family Day Care providers face particular challenges inproviding continuity of care when they are sick or onleave. Sharing resources (e.g. regular relievers) andstrategies between Family Day Care providers mayhelp provide solutions to these problems.

An understanding of the importance of secureattachment also has implications for practice issues.Transitions between carers and settings are particularlyimportant and they require special considerations andplanning. A question to consider is: Are orientationprocesses and transitions planned to allow sufficienttime for the child to build trust in the new carer/sbefore separation from their primary carer?

Separation from the parent (or other primary carer)and the baby or young child is a time of potentialstress, so drop-off and collection times also requirethoughtful care. Some questions to consider include:

• Am I available to welcome or farewell families atdrop-off and collection times?

• How do I talk to the baby/child and invite themin?

• How do I acknowledge to the baby/child that Iunderstand this may be stressful for them?

• How do I look for and respond to thebaby’s/child’s cues on a day-by-day basis?

• If I am feeling stressed or fragile, how do I managethese emotions, particularly at drop-off andcollection times, and how might this affect thebabies/children who are in my care?

Underpinning these considerations is the need forcarers to have the time and resources to be able toobserve and respond appropriately to the attachmentneeds of each child in their care. These are importantand challenging factors for carers, management andfamilies to discuss together.

Carers are also models for parents and have animportant role in promoting and modelling the type ofpositive interactions that are so important to thewell-being of children.

Since everything carers do provides a model for thechildren in care and their families, it might be useful toexplicitly consider:

• How do I respond to babies – especially whentaking babies into care at the start of each day?

• How do I respectfully communicate withbabies/young children?

• How do I adapt responses to the individual cuesfrom babies/young children?

• How do I respond to distress or other strongemotions in babies/young children?

• How do I involve families in planning for theirchild’s care?

References

Harrison, Linda (2003) Attachment

www.raisingchildren.net.au/articles/attachment

Rolfe, Sharne (2004) Rethinking Attachment for EarlyChildhood Practice

FDCQA: 1.1, 3.1QIAS: 1.1, 1.2, 1.3, 1.4, 1.5

Sustained, supportive relationships that developtrust and security through responding to individualneeds and preferences are central to the careprovided at the Lady Huntingfield Children’sCentre in North Melbourne.

In the orientation and settling-in stages for babiesand young children attending the Centre, parentsprovide much more than health and familyinformation; they are also asked about how theywant their baby or child to be cared for. Carersinvite parents to tell them about their child’sindividual care needs, patterns and preferences.What are their special toys? How are they used tobeing settled to sleep? How are they comforted?Are there special or familiar words that they wouldlike to have used?

This is only the starting point for the Centre’ssensitive and responsive care – care thatcharacterises attachment relationships. Secureattachment develops further as carers observe andrespond to the baby’s cues and communicationsabout their individual needs and wants. Babies andchildren learn that their carers can be relied uponto provide care and protection that is appropriateand predictable.

Secure attachments provide the safe base fromwhich babies and children explore and constructthe environment of the Centre. Two of theCentre’s three rooms are multi-age, each with 15children and three carers, and an age range fromthree months to four years. Much thought andplanning has gone into the physical environmentand in many ways the Centre resembles a home.Decorations reflect the family backgrounds of thechildren. Soft couches allow children to snuggle upto their carers and both the inside rooms and theoutdoors are divided into friendly, smaller spaces.

Carers follow the lead and interests of thechildren, and move with them as they play andexplore. In this environment, the carers are carefulnot to overwhelm the children with too many

choices. The effect is subtle and the atmosphere iscalm, purposeful and nurturing.

This flexibility and responsiveness is shown inother ways too. Meal and sleep times are notrigidly prescribed and fit instead with the children’sindividual needs. Small groups of children ofvarying ages can eat together at a small table in theCentre’s kitchen or they can eat in larger groups ata more regular time, if that suits.

Carers at the Centre take time to developrelationships with parents that support parenting,and carers are role models for secure attachmentsin the way they interact with and respond to thebabies and children.

The Centre’s manger, Maree Rabach, is alsoaware that many parents may have little or noexperience with babies or young children untilthey have their own. Consequently, parents mayhave little knowledge or understanding of theemotional needs of children. Advice and support isprovided in the context of on-going relationships inwhich the parent chooses which carer they arecomfortable with.

Continuity of care, both in the curriculum and inthe relationships formed between carers andchildren, is key to secure attachment. Every threeweeks, all carers at the Centre, whether they holdformal qualifications or not, are involved in aplanning day to keep everyone ‘in the loop’ andensure consistency of care. Without carefulplanning, this arrangement could potentially bedisruptive to the attachment relationships betweencarers and babies or children, however the Centrecounters this by using regular relievers. Therelievers also regularly work in the Centre whenthe permanent carers are absent, so they knowand are known by the children and their families.

Promoting Secure Attachment Relationships:Case Study

It is in the context of attachment relationships thateach child individually develops a working model ofhow the world around them works – is the worldfriendly and ordered, or hostile and unpredictable?Are people reliable and supportive or, alternatively,are they erratic and antagonistic? Attachmentrelationships also tell the baby and young childabout how they are valued by others. Are myneeds responded to appropriately?If emotional support is needed, is this provided?Does someone understand and respond to mycommunications? Am I greeted with pleasure andjoy? The answers to these questions tell the babyand young child how much they are valued andthey are the material the baby uses to develop theirown sense of self-worth. Overall, they answer aquestion that is fundamental to the development ofa child: am I loved and lovable?

CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 20092 CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 2009 3 CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 2009 4

responsive and consistently available person whoprovides the sort of nurturing care and protectionrelationship that a child needs to develop a secureattachment. This is especially important in infancywhen development and learning is rapid.

Having a carer (or carers) who knows the baby andcan read and respond to their cues is especiallyimportant. Learning to ‘read’ the cues and signals ofindividual babies takes time and it requires on-goingobservation, based on listening, watching andreflecting. The need for attachment relationships thatare warm, responsive and consistent is universal, butthere will be cultural and family differences in just howthis care is given. For example, in some cultures,babies are carried most of the time, and some familiesare more physically demonstrative than others.Therefore, carers need to understand the culturalcontext of these attachment behaviours, so developingpartnerships with families and sharing informationabout the child is critical.

Each baby and child will bring their individualexperiences of attachment relationships to the caresetting. Understanding their attachment history is animportant factor in the carer’s ability to provide carethat is responsive to a child’s individual needs. Carersalso need to understand both this history and the

context of current and ongoing attachmentrelationships within the baby or child’s life. Reading thebaby’s cues and adapting care to respond to theirindividual needs is necessary. Although secureattachments are built through warm, responsive, andconsistent care, just how this is delivered will varyfrom one child to another; each attachmentrelationship is unique, just as each child is a uniqueindividual. Babies and young children will all havepreferences for how they are comforted, soothed,etc., and so again, ongoing communication withfamilies is important.

Attachments are not necessarily secure and somechildren will come to the care setting with experiencesthat have led to insecure or otherwise disrupted andproblematic attachments. Since all babies and youngchildren need secure attachment relationships, carerscan play a special role in the lives of those who maynot experience these relationships in other parts oftheir early lives.

Early attachment relationships provide the model forattachments throughout later life, so these earlyexperiences are of lasting importance in our personalrelationships and our own capacity to parent.Attachment histories also apply to carers. We all bringour own experiences of attachment relationships tothe settings in which we care for babies and youngchildren. Reflecting on these experiences andunderstanding both the importance of secureattachments and how they are developed will enhancea carer’s capacity to form and sustain theseattachments with the children in the care setting.

Secure attachments developed in the care setting are aprotective factor for babies and children who areat-risk in the context of their family situation or othersettings.

Implications

As well as strongly emphasising the importance ofinteractions that are warm, consistent and responsive,what is now understood about the importance ofsecure attachment has policy implications in all caresettings. These relate specifically to the ratio betweencarer and baby/child, staff rostering or changes ofcarers, and transitions from home to care or withincare settings.

Carers need to consider the following questions:

• Is there a respectful partnership between carer/sand families?

• Is there a carer/s who the child knows they canreliably go to when they need support?

• What happens when this carer is absent in a centreor within a Family Day Care scheme?

• Are the ratios between carer and baby/child lowenough to facilitate the type of individualised,sensitive and responsive care from which secureattachments grow?

• Do staff rosters support, disrupt or prevent thepromotion of secure attachments?

• Is there sufficient continuity of care for secureattachments to develop? How does thecentre/scheme minimise carer turnover?

To address the challenges these questions pose, carersmight like to:

• consider longer term planning and budgeting todecrease the ratio between carer and baby/childover a period of time

• make information available to families about thebenefits of better ratios for their child's well-being.

Family Day Care providers face particular challenges inproviding continuity of care when they are sick or onleave. Sharing resources (e.g. regular relievers) andstrategies between Family Day Care providers mayhelp provide solutions to these problems.

An understanding of the importance of secureattachment also has implications for practice issues.Transitions between carers and settings are particularlyimportant and they require special considerations andplanning. A question to consider is: Are orientationprocesses and transitions planned to allow sufficienttime for the child to build trust in the new carer/sbefore separation from their primary carer?

Separation from the parent (or other primary carer)and the baby or young child is a time of potentialstress, so drop-off and collection times also requirethoughtful care. Some questions to consider include:

• Am I available to welcome or farewell families atdrop-off and collection times?

• How do I talk to the baby/child and invite themin?

• How do I acknowledge to the baby/child that Iunderstand this may be stressful for them?

• How do I look for and respond to thebaby’s/child’s cues on a day-by-day basis?

• If I am feeling stressed or fragile, how do I managethese emotions, particularly at drop-off andcollection times, and how might this affect thebabies/children who are in my care?

Underpinning these considerations is the need forcarers to have the time and resources to be able toobserve and respond appropriately to the attachmentneeds of each child in their care. These are importantand challenging factors for carers, management andfamilies to discuss together.

Carers are also models for parents and have animportant role in promoting and modelling the type ofpositive interactions that are so important to thewell-being of children.

Since everything carers do provides a model for thechildren in care and their families, it might be useful toexplicitly consider:

• How do I respond to babies – especially whentaking babies into care at the start of each day?

• How do I respectfully communicate withbabies/young children?

• How do I adapt responses to the individual cuesfrom babies/young children?

• How do I respond to distress or other strongemotions in babies/young children?

• How do I involve families in planning for theirchild’s care?

References

Harrison, Linda (2003) Attachment

www.raisingchildren.net.au/articles/attachment

Rolfe, Sharne (2004) Rethinking Attachment for EarlyChildhood Practice

FDCQA: 1.1, 3.1QIAS: 1.1, 1.2, 1.3, 1.4, 1.5

Sustained, supportive relationships that developtrust and security through responding to individualneeds and preferences are central to the careprovided at the Lady Huntingfield Children’sCentre in North Melbourne.

In the orientation and settling-in stages for babiesand young children attending the Centre, parentsprovide much more than health and familyinformation; they are also asked about how theywant their baby or child to be cared for. Carersinvite parents to tell them about their child’sindividual care needs, patterns and preferences.What are their special toys? How are they used tobeing settled to sleep? How are they comforted?Are there special or familiar words that they wouldlike to have used?

This is only the starting point for the Centre’ssensitive and responsive care – care thatcharacterises attachment relationships. Secureattachment develops further as carers observe andrespond to the baby’s cues and communicationsabout their individual needs and wants. Babies andchildren learn that their carers can be relied uponto provide care and protection that is appropriateand predictable.

Secure attachments provide the safe base fromwhich babies and children explore and constructthe environment of the Centre. Two of theCentre’s three rooms are multi-age, each with 15children and three carers, and an age range fromthree months to four years. Much thought andplanning has gone into the physical environmentand in many ways the Centre resembles a home.Decorations reflect the family backgrounds of thechildren. Soft couches allow children to snuggle upto their carers and both the inside rooms and theoutdoors are divided into friendly, smaller spaces.

Carers follow the lead and interests of thechildren, and move with them as they play andexplore. In this environment, the carers are carefulnot to overwhelm the children with too many

choices. The effect is subtle and the atmosphere iscalm, purposeful and nurturing.

This flexibility and responsiveness is shown inother ways too. Meal and sleep times are notrigidly prescribed and fit instead with the children’sindividual needs. Small groups of children ofvarying ages can eat together at a small table in theCentre’s kitchen or they can eat in larger groups ata more regular time, if that suits.

Carers at the Centre take time to developrelationships with parents that support parenting,and carers are role models for secure attachmentsin the way they interact with and respond to thebabies and children.

The Centre’s manger, Maree Rabach, is alsoaware that many parents may have little or noexperience with babies or young children untilthey have their own. Consequently, parents mayhave little knowledge or understanding of theemotional needs of children. Advice and support isprovided in the context of on-going relationships inwhich the parent chooses which carer they arecomfortable with.

Continuity of care, both in the curriculum and inthe relationships formed between carers andchildren, is key to secure attachment. Every threeweeks, all carers at the Centre, whether they holdformal qualifications or not, are involved in aplanning day to keep everyone ‘in the loop’ andensure consistency of care. Without carefulplanning, this arrangement could potentially bedisruptive to the attachment relationships betweencarers and babies or children, however the Centrecounters this by using regular relievers. Therelievers also regularly work in the Centre whenthe permanent carers are absent, so they knowand are known by the children and their families.

Promoting Secure Attachment Relationships:Case Study

It is in the context of attachment relationships thateach child individually develops a working model ofhow the world around them works – is the worldfriendly and ordered, or hostile and unpredictable?Are people reliable and supportive or, alternatively,are they erratic and antagonistic? Attachmentrelationships also tell the baby and young childabout how they are valued by others. Are myneeds responded to appropriately?If emotional support is needed, is this provided?Does someone understand and respond to mycommunications? Am I greeted with pleasure andjoy? The answers to these questions tell the babyand young child how much they are valued andthey are the material the baby uses to develop theirown sense of self-worth. Overall, they answer aquestion that is fundamental to the development ofa child: am I loved and lovable?

The impact of what babies and young childrenexperience in their early years of life can last a lifetime.This early period is a time of wonderful opportunitythat reflects the simultaneous competence andvulnerability of very young children. Caring for youngchildren, and getting the caring right, is both aresponsibility and an opportunity. Good caring canpositively lay the foundations for development andlearning that will ultimately impact upon individual lives,families, communities and society as a whole.

Care extends beyond the physical environment to alsoinclude social, emotional and psychological care. Bothresearch into the neurobiology of brain developmentand research into attachment relationships show thatwarm, sensitive, consistent, responsive and nurturingrelationships provide the best possible foundation fordevelopment and learning.

Attachment

‘Attachment’ is the term used for the types ofrelationships described above between babies orchildren and their significant carers.

Attachment is “an emotional bond between twopeople, in which there is an expectation of care andprotection” (Rolfe, 2004:6). Secure attachmentsnurture the development of emotional security andresilience and promote the child’s feelings of self-worth and competence.

The emotional security built through secureattachment relationships allows the child to positivelyexplore their environment, so these relationships arealso a foundation for cognitive and social development.

Attachment relationships are not limited to the bondbetween a child and a parent, but can relate to allsignificant carer relationships in the child’s life.

Most children form a network of attachmentrelationships with family and other carers. What isimportant is that there is at least one sensitive,

CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 20095 CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 20096

4. Clean and disinfect surfaces and toys regularly.

5. Ventilate facility by opening windows or doors orby using a ventilation system that periodicallyexchanges the air inside the facility.

6. Keep children well nourished and hydrated.

7. Make sure that children are not crowded together,especially during naps on floor mats, beds or cots.

Exclusion period

There is no need to exclude a child with a commoncold from childcare, unless the child is unwell.Excluding children with mild respiratory infections,including colds, is generally not recommended as longas the child can participate comfortably and does notrequire a level of care that would jeopardise the healthand safety of other children. Keeping children fromchildcare has little benefit since viruses are likely to bespread even before symptoms have appeared.

Managing the child with a common cold

There is no specific treatment for colds, but rest, extradrinks and comforting are important. Decongestantsand other cold remedies are widely promoted for therelief of symptoms of colds and flu, however, there is

little evidence that these help. In fact, evidence showsthat they may be harmful and cause unpleasant sideeffects such as irritability, confusion and sleepiness.Oral decongestants are not recommended for childrenunder the age of two years. Cough medicines are noteffective in reducing the frequency, intensity orduration of coughs. Like fever, the cough is there for areason – it serves a useful function by clearing mucusfrom the child’s airways and preventing secondaryinfection.

When to contact parents:

The following are more serious symptoms and parentswill need to be contacted and informed, and medicaladvice is recommended, if the child:

• has difficulty breathing

• refuses to drink fluids

• vomits

• is coughing uncontrollably

• complains of headaches, earache or has adischarging ear

• needs to be comforted constantly – has no interestin play

• has a fever (temperature of 38.5˚C or higher)

• is pale and sleepy.

Watch for new or more severe symptoms. Theymay indicate other more serious infections.

FDCQA: 4.3QIAS: 6.3, 6.6

Childcareand Children’s Health

VOL 12 NO 2 JUNE 2009

A national program developed by the Centre for Community Child Health at the Royal Children’s Hospital inMelbourne with support from Johnson & Johnson. This publication promotes current expert advice on childhealth and wellbeing and current policies and practices for those who work with young children and theirfamilies.

AN INITIATIVE OF SUPPORTED BYTHE AUSTRALIAN GOVERNMENT

DEPARTMENT OF FAMILIES, HOUSING,COMMUNITY SERVICES AND

INDIGENOUS AFFAIRS

SUPPORTED BY THENATIONAL CHILDCARE

ACCREDITATION COUNCILSUPPORTED BY AN

EDUCATIONAL GRANT FROM

National Editorial PanelMs Tonia Godhard AMMs Marie Lewis

EditorDr Estelle Irving

Production EditorMs Penny Miller

Contact DetailsTel: (03) 9345 7085Fax: (03) 9345 5900Email: penny.miller@mcri.edu.au

Websites:www.ecconnections.com.auwww.rch.org.au/ccchwww.raisingchildren.net.au

Promoting Secure Attachment Relationships

The common cold is caused by viruses that infectthe nose, throat and sinuses. Most colds seem tooccur during the winter season. To keep warmand dry means that we tend to stay indoors andexperience closer contact with other people.There are limited opportunities for outdooractivities and children and staff can become tiredas the winter progresses. This increases thechances of spreading the cold virus from personto person and in the case of childcare from childto child, child to carer or carer to carer.

Although some parents are convinced that thecommon cold results from exposure to coldweather or from getting chilled or overheated,there is no evidence to support this belief. Stressand tiredness, as well as illnesses that affect thenasal passages and weaken the immune system,increase the chances of developing colds.

Common cold infections are widespread and veryfew people escape infection. Most individualssuffer multiple colds each year and they are themost common infectious illness, especially foryoung children. Children can catch colds fromsiblings, parents, other family members, playmatesor carers. Due to the close contact involved,children with older siblings and those who attendchildcare have more colds. Young children mayhave 8-10 colds each year, with the highestnumber usually being during the first two years inchildcare, kindergarten or school. Once a child isexposed to a cold virus, the child developsimmunity to that virus. By the time children startschool, children who attended childcare may havefewer colds than other children.

Cold symptoms

Symptoms may include:

• a runny or stuffed up nose

• sneezing or coughing

• a mild sore throat

• little or no fever (38.5˚C or less)

• nasal discharge is usually clear to start with,and then within a day can becomes thicker,yellow and sometimes green.

Incubation period

The time from being infected to showingsymptoms (incubation period) is about 1-3 days.

Infectious period

2-4 days after the cold infection; this may bebefore the symptoms are present.

How are colds spread?

Cold viruses are found in the nose and throat.Children touch their noses, eyes and mouthsoften, put things in their mouths, and touch eachother often during play, so cold germs spreadeasily. There is also a lot of contact betweenparents or carers and children: holding hands,picking up, feeding and changing nappies.

• Children with colds get viruses on their handswhen they touch their runny noses or mouthsor when they cough or sneeze. When theytouch other children, they pass on the viruses.

• Cold viruses can live on objects for severalhours and can be picked up on the hands ofchildren who touch the same object asinfected children. These children then getinfected when they touch their eyes, nose ormouth.

• Carers can get viruses on their hands andspread them between children by touch.

• Some cold viruses may be spread through theair when a child with a cold coughs orsneezes. Droplets from the cough or sneezemay reach another child’s nose or mouth.

Controlling the spread of infection in thechildcare environment

1. Ensure all carers maintain good hand washingtechniques (and keep updated).

2. Encourage older children to cover their mouthand nose with a tissue when they sneeze orcough and immediately throw the tissue awayinto a closed bin. Assist younger children withnose wiping. Wash their hands with soap andwater, and dry thoroughly.

3. Carers and parents may choose to use anantiseptic hand rub if water is unavailable.

Childcare and the Common Cold

A full list of references and the Parent Fact Sheet(available in different community languages) can bedownloaded from the Early Childhood Connectionswebsite: www.econnections.com.au

“Being sensitive means being ‘tuned in’ to the child’sfeelings, and able to read their cues.”

“Being responsive means being psychologicallyavailable [i.e. not preoccupied or distracted byone’s own personal needs and/or other issues],and able to respond to children’s cues appropriately.Responsiveness and sensitivity are inter-related...”(Rolfe, 2004:223)

The impact of what babies and young childrenexperience in their early years of life can last a lifetime.This early period is a time of wonderful opportunitythat reflects the simultaneous competence andvulnerability of very young children. Caring for youngchildren, and getting the caring right, is both aresponsibility and an opportunity. Good caring canpositively lay the foundations for development andlearning that will ultimately impact upon individual lives,families, communities and society as a whole.

Care extends beyond the physical environment to alsoinclude social, emotional and psychological care. Bothresearch into the neurobiology of brain developmentand research into attachment relationships show thatwarm, sensitive, consistent, responsive and nurturingrelationships provide the best possible foundation fordevelopment and learning.

Attachment

‘Attachment’ is the term used for the types ofrelationships described above between babies orchildren and their significant carers.

Attachment is “an emotional bond between twopeople, in which there is an expectation of care andprotection” (Rolfe, 2004:6). Secure attachmentsnurture the development of emotional security andresilience and promote the child’s feelings of self-worth and competence.

The emotional security built through secureattachment relationships allows the child to positivelyexplore their environment, so these relationships arealso a foundation for cognitive and social development.

Attachment relationships are not limited to the bondbetween a child and a parent, but can relate to allsignificant carer relationships in the child’s life.

Most children form a network of attachmentrelationships with family and other carers. What isimportant is that there is at least one sensitive,

CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 20095 CHILDCARE AND CHILDREN’S HEALTH VOL. 12 NO. 2 JUNE 20096

4. Clean and disinfect surfaces and toys regularly.

5. Ventilate facility by opening windows or doors orby using a ventilation system that periodicallyexchanges the air inside the facility.

6. Keep children well nourished and hydrated.

7. Make sure that children are not crowded together,especially during naps on floor mats, beds or cots.

Exclusion period

There is no need to exclude a child with a commoncold from childcare, unless the child is unwell.Excluding children with mild respiratory infections,including colds, is generally not recommended as longas the child can participate comfortably and does notrequire a level of care that would jeopardise the healthand safety of other children. Keeping children fromchildcare has little benefit since viruses are likely to bespread even before symptoms have appeared.

Managing the child with a common cold

There is no specific treatment for colds, but rest, extradrinks and comforting are important. Decongestantsand other cold remedies are widely promoted for therelief of symptoms of colds and flu, however, there is

little evidence that these help. In fact, evidence showsthat they may be harmful and cause unpleasant sideeffects such as irritability, confusion and sleepiness.Oral decongestants are not recommended for childrenunder the age of two years. Cough medicines are noteffective in reducing the frequency, intensity orduration of coughs. Like fever, the cough is there for areason – it serves a useful function by clearing mucusfrom the child’s airways and preventing secondaryinfection.

When to contact parents:

The following are more serious symptoms and parentswill need to be contacted and informed, and medicaladvice is recommended, if the child:

• has difficulty breathing

• refuses to drink fluids

• vomits

• is coughing uncontrollably

• complains of headaches, earache or has adischarging ear

• needs to be comforted constantly – has no interestin play

• has a fever (temperature of 38.5˚C or higher)

• is pale and sleepy.

Watch for new or more severe symptoms. Theymay indicate other more serious infections.

FDCQA: 4.3QIAS: 6.3, 6.6

Childcareand Children’s Health

VOL 12 NO 2 JUNE 2009

A national program developed by the Centre for Community Child Health at the Royal Children’s Hospital inMelbourne with support from Johnson & Johnson. This publication promotes current expert advice on childhealth and wellbeing and current policies and practices for those who work with young children and theirfamilies.

AN INITIATIVE OF SUPPORTED BYTHE AUSTRALIAN GOVERNMENT

DEPARTMENT OF FAMILIES, HOUSING,COMMUNITY SERVICES AND

INDIGENOUS AFFAIRS

SUPPORTED BY THENATIONAL CHILDCARE

ACCREDITATION COUNCILSUPPORTED BY AN

EDUCATIONAL GRANT FROM

National Editorial PanelMs Tonia Godhard AMMs Marie Lewis

EditorDr Estelle Irving

Production EditorMs Penny Miller

Contact DetailsTel: (03) 9345 7085Fax: (03) 9345 5900Email: penny.miller@mcri.edu.au

Websites:www.ecconnections.com.auwww.rch.org.au/ccchwww.raisingchildren.net.au

Promoting Secure Attachment Relationships

The common cold is caused by viruses that infectthe nose, throat and sinuses. Most colds seem tooccur during the winter season. To keep warmand dry means that we tend to stay indoors andexperience closer contact with other people.There are limited opportunities for outdooractivities and children and staff can become tiredas the winter progresses. This increases thechances of spreading the cold virus from personto person and in the case of childcare from childto child, child to carer or carer to carer.

Although some parents are convinced that thecommon cold results from exposure to coldweather or from getting chilled or overheated,there is no evidence to support this belief. Stressand tiredness, as well as illnesses that affect thenasal passages and weaken the immune system,increase the chances of developing colds.

Common cold infections are widespread and veryfew people escape infection. Most individualssuffer multiple colds each year and they are themost common infectious illness, especially foryoung children. Children can catch colds fromsiblings, parents, other family members, playmatesor carers. Due to the close contact involved,children with older siblings and those who attendchildcare have more colds. Young children mayhave 8-10 colds each year, with the highestnumber usually being during the first two years inchildcare, kindergarten or school. Once a child isexposed to a cold virus, the child developsimmunity to that virus. By the time children startschool, children who attended childcare may havefewer colds than other children.

Cold symptoms

Symptoms may include:

• a runny or stuffed up nose

• sneezing or coughing

• a mild sore throat

• little or no fever (38.5˚C or less)

• nasal discharge is usually clear to start with,and then within a day can becomes thicker,yellow and sometimes green.

Incubation period

The time from being infected to showingsymptoms (incubation period) is about 1-3 days.

Infectious period

2-4 days after the cold infection; this may bebefore the symptoms are present.

How are colds spread?

Cold viruses are found in the nose and throat.Children touch their noses, eyes and mouthsoften, put things in their mouths, and touch eachother often during play, so cold germs spreadeasily. There is also a lot of contact betweenparents or carers and children: holding hands,picking up, feeding and changing nappies.

• Children with colds get viruses on their handswhen they touch their runny noses or mouthsor when they cough or sneeze. When theytouch other children, they pass on the viruses.

• Cold viruses can live on objects for severalhours and can be picked up on the hands ofchildren who touch the same object asinfected children. These children then getinfected when they touch their eyes, nose ormouth.

• Carers can get viruses on their hands andspread them between children by touch.

• Some cold viruses may be spread through theair when a child with a cold coughs orsneezes. Droplets from the cough or sneezemay reach another child’s nose or mouth.

Controlling the spread of infection in thechildcare environment

1. Ensure all carers maintain good hand washingtechniques (and keep updated).

2. Encourage older children to cover their mouthand nose with a tissue when they sneeze orcough and immediately throw the tissue awayinto a closed bin. Assist younger children withnose wiping. Wash their hands with soap andwater, and dry thoroughly.

3. Carers and parents may choose to use anantiseptic hand rub if water is unavailable.

Childcare and the Common Cold

A full list of references and the Parent Fact Sheet(available in different community languages) can bedownloaded from the Early Childhood Connectionswebsite: www.econnections.com.au

“Being sensitive means being ‘tuned in’ to the child’sfeelings, and able to read their cues.”

“Being responsive means being psychologicallyavailable [i.e. not preoccupied or distracted byone’s own personal needs and/or other issues],and able to respond to children’s cues appropriately.Responsiveness and sensitivity are inter-related...”(Rolfe, 2004:223)