Non-parental childcare attendance prior to school entry and children’s internalising and externalising symptoms: an individual participant data meta-analysis of six child cohort studies (EU Child Cohort Network)
Authors: Barry Katharine M , Avraam Demetris , Cadman Tim , Elhakeem Ahmed , Marroun Hanan El , Jansen Pauline W. , Welten Marieke , Nybo-Andersen Anne-Marie , Strandberg-Larsen Katrine , Safont Llúcia González , Soler-Blasco Raquel , Barreto-Zarza Florencia , Julvez Jordi , Vrijheid Martine , Heude Barbara , Charles Marie-Aline , Gomajee Alexandre Ramchandar , Melchior Maria 
Published: February 2024

Purpose
To test associations between children’s attendance of non-parental childcare prior to school entry and internalising and externalising symptoms throughout childhood and young adolescence.
Methods
Data come from six parent-offspring prospective birth cohort studies across five European countries within the EU Child Cohort Network. A two-stage individual participant data meta-analysis was performed. Linear regression models where implemented to test associations between non-parental childcare attendance anytime between ages 0-4 years and children’s scores of internalising and externalising symptoms (measured in three age groups: 5-6 years, 7-9 years, 10-13 years), in each cohort separately, and then cohort-specific coefficients and standard errors were combined using random-effects meta-analysis to attain overall association estimates. To test possible subgroup effects, statistical analyses were stratified by family socioeconomic position (SEP) and child’s sex.
Results
Internalising symptoms were studied among 74 453 children and externalising symptoms among 74 446 children. Compared to children cared for by their parents, those who attended centre-based childcare had lower levels of internalising symptoms between 10-13 years [-1.06 (95%CI: -1.95, -0.17), p=0.02]; in younger age groups we observed similar results but the coefficients did not reach statistical significance. Children who attended non-institutionalised childcare appeared to have elevated levels of internalising symptoms between 7-9 years [0.91 (95%CI: 0.23, 1.58), p=0.009]. Attendance of non-institutionalised childcare was also associated with increased levels of children’s externalising symptoms between 5-6 years [2.45 (95%CI: 0.35, 4.55), p=0.02] and 7-9 years [2.78 (95%CI: 0.60, 4.95), p=0.01]. Stratifying on family SEP, we observed that children from more deprived families who attended centre-based childcare had lower internalising symptoms between 5 and 6 years. To the contrary, children growing up in intermediate/high SEP families attending centre-based childcare appeared to experience higher levels of externalising symptoms between 5 and 6 years . Stratifying on child’s sex, we observed that boys seemed to particularly benefit from centre-based childcare attendance in terms of internalising symptoms in all studied age groups, but displayed high levels of externalising symptoms if they attended centre-based childcare (between 5 and 6 years) or non-institutionalised childcare (all age groups studied).
Conclusions
Our study suggests that attendance of centre-based childcare is associated with lower levels of internalising symptoms among children after school entry, but non-institutionalised childcare shows opposite associations with internalising and externalising symptoms. The effect of childcare attendance may be moderated by family’s SEP and child’s sex. Overall, our results suggest that attendance of centre-based childcare may be associated with positive impacts on children’s emotional development and could contribute to reducing social inequalities in this area in childhood and young adolescents.