Continuity of Care

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Article - Continuity of Care

Child care provider showing plant to children.Use this resource to help communicate the importance of continuity of care. It will help promote essential program practices to ensure quality in family child care and center-based programs that serve infants and toddlers.


High-quality relationship-based care is central to children’s early brain development, emotional regulation, and learning (Center on the Developing Child, 2012). The Program for Infant/Toddler Care recommends six essential program practices as a framework for relationship-based care, One of these practices is continuity of care—the practice in which primary caregivers and children stay together for as long as possible, preferably for the children’s first 3 years, creating opportunities for caregiver-child, caregiver-family, and child-child relationships to develop and deepen over time (Lally & Mangione, n.d.). Continuity of care practices support the development of secure attachments and strong positive relationships as well as a secure base for exploration and learning (Honig, 2002). Research shows that attachment security significantly contributes to children’s long-range social-emotional development and self-confidence (Sroufe et al., 2005).

Continuity of care can be provided in either same-age or mixed-age group care settings. In same-age settings, the most frequent strategies are (1) to keep a group of children in one environment and change it to fit the children’s needs as they grow or (2) to move the caregiver with the small primary group of children to rooms or spaces that are appropriate for their developing abilities (Lally et al., 2009). In mixed-age settings, the program needs to ensure that the environment meets the needs of each age group served.

Why Is Continuity of Care Important for Infants and Toddlers?

  • Continuity of care increases the amount of time caregivers and children spend together and therefore increases the opportunity for caregivers to develop more meaningful relationships with the children over time (Ruprecht et al., 2016).
  • When an infant has a chance to develop a relationship with a sensitive and responsive caregiver, the infant learns who to trust and who will meet his or her needs (Howes & Spieker, 2008).
  • The secure emotional base provided by healthy relationships gives infants and toddlers the safety they need to explore their world and gain experiences (Ahnert et al., 2006; Howes & Spieker, 2008).
  • Continuity of care increases opportunities for caregivers to learn about individual infants and toddlers as well as time to develop positive working partnerships with families (McMullen et al., 2016).
  • The presence of a consistent, nurturing caregiver not only enhances positive experiences but also buffers infants and toddlers from stressful life events (Raikes & Edwards, 2009; National Scientific Council on the Developing Child, 2014).

How Does Continuity of Care Promote Positive Child Outcomes?

  • Consistent and responsive caregiver interactions support infant and toddler learning and development in areas such as emotion regulation, attention, memory, planning actions, and self-control (Tarullo et al., 2009).
  • Sensitive and responsive caregivers increase the likelihood of infants showing higher levels of peer play and greater language development (National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, 2005).
  • Infants and toddlers who have experienced a consistent, secure, responsive relationship with a care provider are more effective in their peer relationships than their counterparts are (Raikes & Edwards, 2009).

Planning to Implement Continuity of Care in Diverse Child Care Settings

Goal: High-quality infant and toddler programs practice continuity of care for all infants and toddlers.

  • Develop a system of continuity of care so that children have the same primary caregiver for up to 3 years of age or during the length of enrollment.
  • Implement written guidance to support continuity of care throughout the program. This includes creating staff and family handbooks that share the importance of, as well as practices for, continuity of care.
  • Create job descriptions for infant and toddler caregivers to include expectations for continuity of care practices.
  • Attend, create, or advocate for professional development that addresses continuity of care. Support ongoing conversations with center-based or family child care administrators to sustain continuity of care.
  • Use an intentional review process to continually strengthen continuity of care across the center or family child care program.


Ahnert, L., Pinquart, M., & Lamb, M. E. (2006). Security of children’s relationships with nonparental care providers: A meta-analysis. Child Development, 77, 664–679.

Center on the Developing Child. (2012). Executive function: Skills for life and learning [InBrief summary].

Honig, A. (2002). Secure relationships: Nurturing infant/toddler attachment in early care settings. National Association for the Education of Young Children.

Howes, C., & Spieker, S. (2008). Attachment relationships in the context of multiple caregivers. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical application (2nd ed., pp. 317–332). Guilford Press.

Lally, J. R., & Mangione, P. L. (n.d.). About the Program for Infant/Toddler Care. WestEd; California Department of Education. Retrieved March 10, 2020, from

Lally, J. R., Stewart, J., & Greenwald, D. (Eds.). (2009). Infant/toddler caregiving: A guide to setting up environments (2nd ed.). California Department of Education.

McMullen, M. B., Yun, N., Mihai, A. & Kim, H. (2016). Experiences of parents and professionals in well-established continuity of care programs. Early Education & Development, 27, 190–220.

National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. (2005). Childcare and child development: Results from the NICHD study of early childcare and youth development. Guilford Press.

National Scientific Council on the Developing Child. (2014). Excessive stress disrupts the architecture of the developing brain: Working paper 3. content/uploads/2005/05/Stress_Disrupts_Architecture_Developing_Brain-1.pdf

Raikes, H., & Edwards, C. (2009). Extending the dance in infant and toddler caregiving. Paul H. Brookes Publishing Company, Inc.

Ruprecht, K., Elicker, J., & Choi, J. (2016). Continuity of care, caregiver-child interactions, toddler social competence and problem behaviors. Early Education and Development, 27, 221–239.

Sroufe, L. A., Egeland, B., Carlson, E., & Collins, W. A. (2005). The Development of the person: The Minnesota study of risk and adaptation from birth to adulthood. Guilford Publications.

Tarullo, A. R., Obradovic, J., & Gunnar, M. R. (2009). Self-control and the developing brain. Zero to Three, 29(3), 31–37.