Analysis of the influence of the timing of enrollment in daycares on child development

This study aimed to analyze the relationship between the age of enrollment into early childhood education (ECE) programs and child development. This is a cross-sectional study using data from the Birth Cohort of the Western Region of São Paulo, Brazil, with a 36-month follow-up of children born at the University Hospital of the University of São Paulo from 2012 to 2014, and their caregivers who participated in the 36-month follow-up conducted from 2015 to 2017. Child development was measured by the Engle Scale of the Regional Project on Child Development Indicators (PRIDI). ECE programs were evaluated in relation to their quality. The social characteristics of the children and their caregivers, as well as the characteristics of the economic and family context, were used as exposure variables. Our sample consisted of 472 children and their parents/caregivers. The enrollment into daycare from 13 and 29 months was the most frequent. When considered alone, a higher age of enrollment was associated with higher development score [β = 0.21, 95%CI: 0.02; 0.40, p = 0.027]. After adjusting for confounding variables in the regression models, it was observed that being enrolled in a private institution, total time of breastfeeding, time spent by the main caregiver working outside home, and inhibitory control were determinants in explaining the infant development at 36 months in the sample. Older age of entry into ECE programs may have a positive effect on infant development at 36 months of age, but these findings must be carefully considered.本研究旨在分析儿童早期教育（Early Childhood Education, ECE）项目入学年龄与儿童发育之间的关联。本研究为横断面研究，采用巴西圣保罗西部出生队列数据，研究对象为2012至2014年在圣保罗大学附属医院出生的儿童，以及2015至2017年参与36个月随访的其照料者，随访周期为36个月。儿童发育水平采用儿童发育指标区域项目（Regional Project on Child Development Indicators, PRIDI）的恩格尔量表（Engle Scale）进行评估。本研究同时对儿童早期教育项目的质量进行了评价，并将儿童及其照料者的社会特征、经济与家庭环境特征作为暴露变量。本研究样本共纳入472名儿童及其父母/照料者。其中，13至29个月龄入托的儿童占比最高。单因素分析结果显示，更高的入学年龄与更高的发育评分呈显著正相关（β=0.21，95%CI：0.02；0.40，p=0.027）。在回归模型中校正混杂变量后发现，就读民办机构、母乳喂养总时长、主要照料者外出务工时长以及抑制控制能力，均为解释该样本中36月龄儿童发育水平的关键影响因素。儿童早期教育项目入学年龄偏大可能对36月龄儿童的发育产生积极影响，但该研究结论需谨慎解读。