The Toothpaste Theory of Child Development

iStock_000001577492XSmall-283x424Have you ever studied the label on a tube of toothpaste? A good number of years ago, out of sheer boredom, I picked up the tube while supervising my daughters as they brushed their teeth for the proverbial and interminable “two minutes.”

The label reads: “Active ingredient: sodium fluoride.” Its function: cavity prevention. And just below that was a list of “inactive ingredients” with functions unlisted. Suddenly it hit me: the million-dollar question (actually, more like billion-dollar) about child development:

What is the active ingredient that promotes children’s positive development?

I was stumped. I had encountered many answers in the course of my work as a researcher—and none rises to the status of being the single “active ingredient.” There are research- or technology-based answers: computer-based intelligent tutoring systems, online and cyber education, or robotics curriculum as the fourth “R.” There are system-building answers: academic content standards, professional standards, and standards for evaluating entire classrooms, centers, and schools. There are also blunt “carrot and stick” answers: accountability systems that penalize or incentivize schools, centers, or teachers depending on their “performance.” Few of these ingredients worked consistently and effectively on a large scale in the real, time-pressed, and messy world.

There is a better answer, and it was right in front of my eyes. At the time, I had been part of a team to evaluate quality of care in orphanages—hardly anyone’s ideal child development setting. Around the world, the chronic understaffing, overcrowding, and rigid routines in institutions like orphanages often resulted in a style of mechanical, impersonal, and assembly line–like care. Yet, even with such constraints, a handful of conscientious caregivers can spark wonders in the most mundane daily rituals like diaper change (a one-minute video segment captures just that in a Chinese orphanage).

What catches the eye here is not the institutional efficiency, but the richness of human interactions that can be squeezed into such a tiny fraction of time. One cannot help but notice the smiles, the conversations, and—most remarkably—the twirling fingers that encouraged tiny infants (often with physical and developmental disabilities) to want to lift their small bodies and reach for the adults’ beckoning hands.

What I had missed until then, despite having a doctorate in psychology (maybe because of the degree), was something that was apparent to most people who have spent time working with children day in and day out. It was something that Fred Rogers emphasized in nearly all of his public speeches or interviews:

Human relationships are primary in all of living. When the gusty winds blow and shake our lives, if we know that people care about us, we may bend with the wind, but we won’t break.

Other ingredients, like computers, although helpful, “don’t begin to compare in significance to the relationship between the teacher (or parent) to the child that is human and mutual.” The scientific evidence behind this is now stronger, clearer, and supported by a larger consensus.

Yet, how we measure quality of early development settings has not yet evolved to keep pace with science or the knowledge of practitioners. For example, the Quality Rating and Improvement System (QRIS) for early childhood care throughout the United States still uses an elaborate set of indicators to measure every aspect of a facility, from furnishing, to curricula, bathrooms, and staff credentials. Although the quality of human connection is included in these measures, they are not accorded the essential role of being the “active ingredient.” To give equal weight in quality scoring to both quality of human interaction and features of a physical facility is like equating the concentration of sodium fluoride with the packaging or flavor design of a toothpaste tube. Curricula, computers, toys, or facilities do not by themselves help children grow. These resources are useful only when they enrich and empower the growth of human interactions between children and adults.

This unnecessary complexity of our current quality rating systems undermines their effectiveness in measuring and improving actual quality. For the last 10 years, large-scale studies of early childhood rating systems have consistently found the quality metrics behind the QRIS are not predictive of children’s subsequent development. Rather, the only predictive measure is quality of human interactions, the single active ingredient, between staff and children.

In the same way that a diaper change routine can provide a glimpse of the quality of human interaction, each of us, whether parents or practitioners, trainers or researchers, can see and notice all the other small, simple, and everyday moments in every place that nurture children’s development. I want to share one of my favorite moments in visiting child care centers (with a 7-minute video): It started when a young child, who was spending her very first week in child care, grew tearfully anxious as naptime approached.

There are so many things to see and talk about in that small moment. I particularly loved when Ms. Devore handed little Taj those two little strips of paper to hold. I thought it was a beautiful illustration of what Fred Rogers said in his final public speech: “Every one of us longs to know that there’s something about us that’s worth giving.” Even a teary child can find safety and trust in doing something helpful, and it takes a wise and gracious adult to ask for and receive that help.

Although a tube of toothpaste helped me ask the right question, my real teachers are the caregivers and teachers, like those in the orphanages or Ms. Devore, who embodied the real significance of human relationships for children—day and night. It is up to each of us in the early learning profession, whether we are providers, trainers, content developers, researchers, or policymakers, to capture and broadcast what this good is all about and allow that to inform everything we produce—from standards to quality measures, professional development, and professional compensation.

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  • Junlei Li / 25 November 2015 9:29

    Thank you for your comment on the “toothpaste” article. I am glad that it connected with you. I am overseas at the moment, and yesterday I worked with a group of early educators in an international school and they are from all over the world. We worked on the “toothpaste” type of community learning at the end of the school day, and a French teacher sent a message afterwards that at the end of a long day, the last thing she had wanted was to be in any kind of a “session”, but once she was in it, she felt like she “got a mama’s hug” to be reminded how much of a difference teachers make in the small, ordinary things in life.

    You probably already see this. But I thought you might also be interested in our latest blog entry “Simple Interactions: The Flu Shot Theory of Change” – which extends beyond the toothpaste metaphor and talks about our work with child-serving professionals to capture and learn from these interactions.

  • Marjery / 26 January 2017 8:28

    I like the way the teacher help and comfort the little girl and made her feel safe

  • Tara Villanueva / 25 September 2017 1:35

    What a wonderful provider. This is the type of care and understanding we should all strive to provide to our children. She clearly knows that you get out what you put in. The way a child learns to self-soothe (as well as trust) is to be provided soothing by an adult, not by being left on their own to “learn” how to cope. Yes, it’s time consuming but as shown in the video, it’s temporary until the child becomes comfortable with her surroundings.

  • heather / 7 May 2018 11:46

    I believe the key is love. Let the babies know you love them and magic happens.

  • Child-Caregiver Relationship: Key Foundation for Children's Language Development - Military Families Learning Network / 17 July 2018 9:40

    […] stressed the importance of fostering relationships through play. Her illustration of the toothpaste theory was insightful when we consider all the things we debate as providers – What type of […]

  • Cassie / 19 October 2019 10:51

    I love this video because I know this family! I am currently a Pre-K counts teacher at the YWCA in Homewood and I had Taj’s little sister in my class last year. This method of helping Taj relax works with all my kids as well as her sister. I usually have the children look at books or do puzzles before naptime. And if one child is restless, i’ll choose their book to read. They enjoy it because they like to pick which books I read. I love that the teacher let Taj help her as well because it is just so satisfying for children.