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I also was very impressed with Dr. Friedman's presentation this morning. I felt the depth of American scholarship. Research on raising a child and the mother's feelings on child rearing is very difficult since it is in a field related to art, not the area of science. Dr. Friedman's research design was well thought out and the reliable data was presented in a prospective manner. It was very convincing since it was based on evidence. I listened and learned some new things. I am a clinical pediatrician and am unable to provide you with such a scholarly presentation as that of Dr. Uchida. I would like to talk about practical things based on our data.

Figure 1 is the age in months of children who have joined a day care center. This data dates from 1993 and is a little old, but comes from the Department for Women of the Japan General Workers Union. The average age when children were put in a day care center is 12.4 months. This data is for children whose mothers are employed full-time. I would particularly like to point out that 36.3% were put in day care between the ages of one and five months old. The percentage gradually declines for children from the age of six to 11 months and older. It is noted below that 50% of the one to five month group (18% of the whole) were put in a day care center two months after they were born. We can see that this group of children who are placed in day care following the end of the mother's maternity leave is quite large.

Next, I would like you to look at the responses in Table 1 and Table 2 given by three caregivers actively working at day care centers that are regarded as giving very high quality care. These three were asked to, "please give us your thoughts on the state of today's child rearing" and "please write your thoughts, including those that are positive and those that are negative, on what caregivers feel about parents that put their children into day care center soon after birth." There are many negative responses about these mothers and their children.

Although the data in Figure 2 is little old, the number of caregiving facilities in the country, about 22,000 has not changed in the past several years. The number of infant care facilities, however, has gradually increased. I think everyone will agree that there is a societal necessity for infant child care for working mothers. I believe this data supports this reality.

Figure 3 is the original copy of the three-page single medical checkup sheet used in the "Fukuoka City Medical Association." The data I am presenting is based on this. This is an infant medical checkup for infants 1-month, 7-months and 12-months that is used to supplement public medical exams. It has been in place for 12 years. A unique feature of this medical examination system is that it includes such subjects as the mother's feelings on child rearing, the children's emotional health, problems with accidents, the mother's smoking, even though 12 years ago anxiety about child rearing and the emotional health of children were rare. All of this data has been accumulated in the computers of the Kyushu University Medical Information Department.

Thanks to the Fukuoka City Medical Association, we have 70,000 infant medical examination (routine health check) records and 40,000 toddler medical examination records, a total of over 110,000 medical examinations on-line (Table 3). There are fewer toddler examinations because the system was introduced at a later date. Since this data dates back 12 years, we can check it in a prospective manner. For example, 3,000 infants had both the one-month and the seven-month exam. 1,100 infants had the one-month, the seven-month and the 12-month exam. 2,000 children had the one-month and the toddler exam. We now have enough records for matching prospective research. The matching was done by date of birth, name and telephone number. Compared with the NICHD data, please understand that this data is a by-product of medical exams and not something that was originally created to examine the quality of child care (Table 4).

I will now speak on the results of a comparison by caregivers regarding daytime child-care at the seven-month stage in the 380 cases where we were able to match seven-month exam and 3-year-old exam records. In the seven-month medical exam, the majority of the caregivers were either the mother or a day care center. In cases where the child was in a day care center at seven-months, some might think there would be some sort of adverse effect on the child. Others might imagine that putting the child in a day care center would yield advantages socially and in the development of the child. We took a look at these two opinions using the data from the three-year check up.

Our findings showed that at the 3-year stage, there was almost no significant difference. For example, under the field of the child's behavior, we looked at a number of items such as, "is easily frightened or alarmed" and "is excessively violent"(Table 5). In all items, we found no significant difference between the "mother" and the "day care center" groups. We also checked items related to movement and intellectual development such as "can alternate leg movement and climb stairs" and "knows the colors red, blue, green and yellow" (Table 6). In all items there were no significant differences between the "mother" and "day care center" groups. That is to say no differences between the group placed in day care at seven months, and the group that was not. We also checked easily caught sicknesses, such as colds, wheezing and fever (Table 7). In all areas, we again could find no significant differences between the "mother" group and the "day care center" group. We did find only one area where there was one significant difference. This was in the area of burns (Table 8). There were a significantly larger number of burns in the "day care center" group compared to the "mother" group. However, we found that regarding behavioral or emotional issues or the tendency of the child to get sick easily, there was no significant difference in the results of the 3-year medical exam based on whether or not a child was put in day care at seven months.

Next I would like to introduce some data that is not prospective. It analyzes only the data of the 3-year check up by "main daytime caregiver." There is clearly a significant difference in easily caught sicknesses (Table 9). There is a higher instance of colds and wheezing at day care centers. The only area where we did not find a significant difference was with convulsive fits. In short, the data shows that three-year olds that are in day care get sick more easily than those that are looked after by the mother alone. I have another interesting fact for you on children's behavior (Table 10). There are significant differences in this area. We found that "violent behavior" and "unreasonableness" were more common in the "day care center" group. On the other hand, "picky eaters" were more common in the "mother" group. The behavior of areas in which we found no significant differences were, "restlessness," "lethargic movement" and "indifference to parent(s) and others around self."

Now I would like to change focus slightly. I would like to show you some data on mother's feelings about child rearing based on some 37,000 Fukuoka City Public Medical Exam 18-month check ups (Table 11). 12,025 mothers replied "yes" to the statement that child rearing was "very tiring." 25,000 people responded either "neutral" or "no." The "neutral" group was interpreted as meaning that it did not find child rearing tiring and was thus combined with the "no" group. Looking at the results by the primary daytime caregiver, there was a significant difference. Those mothers who put their children in day care were less likely to find child rearing tiring. Even though there are other statements like "child rearing is enjoyable," significant differences in data show that those mothers who put their children in day care have a better attitude toward child rearing than those who are full time homemakers. This is data collected from the public medical examinations.

How are we to interpret the variety of data I have presented to you? I would like to leave it to your discretion.

I myself am a caregiver of sick children. Every day I see mothers who bring their sick children to the nursery that is associated with the clinic and come to get them in the evening and they seem to be quite tired. I tell them, "you seem to be tired so when you go home, don't do housework. Just hug your child for 30 minutes or an hour. That is the most important thing. Be sure to do it for the future." Looking at what makes up child rearing, if it is the mother within the family setting, it may be lying down next to the sleeping child and singing lullabies, or perhaps it is bodily contact. For children under the age of one, the nurse checks on how 4 or 5 of the children sleeping together are doing. For the infant under one, in terms of basically acquiring the sense of trust and the formation of attachment, I myself believe that mothering care given by the mother makes the mother feel more comfortable and is better for the emotional health of the child.

Four years ago I gave a lecture at the Japanese Medical Association Infant Health Care Seminar. My thoughts are still the same. The family is the basis for raising emotionally healthy and happy children, and maternal attachment that is developed in infancy is particularly important. It follows that for parents to spend for enough time on child care at home and for them to be economically stable and to raise a stable, healthy child, they will need at the very least 6-months or even better, 12 months of maternity leave. We must tell the country and society that during this period it is necessary for parents to receive adequate maternity pay and to be assured of time off. I hope we can create a system that has special respect and appreciation for child-birth and child rearing. I would hope we can bring about a national movement to create consensus that even if a mother or a father is away from work for a little while to raise a child, it is for the future of the country. It is particularly important to have a relaxed approach toward enjoyable child rearing for the future development of infants. Our current situation is unacceptable. We previously heard this from everyone and it is my conclusion, we have a movement for a national consensus.


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