When parents tour daycare settings, they often notice the physical environment: the toys available, the artwork on the walls, the garden space, the soft play areas. These things matter, but research on what actually predicts child outcomes in early years settings points to something harder to see in a tour: the quality of the conversations and interactions between carers and children.
Healthbooq helps families understand what to look for in early years settings.
The Evidence Base
The most rigorous evidence on what makes early years settings effective comes from two large longitudinal studies: the NICHD Study of Early Child Care in the United States and the EPPE (Effective Pre-school and Primary Education) study in the UK.
The EPPE study followed over 3,000 children from age 3 through secondary school, examining what features of preschool settings predicted the strongest outcomes in cognitive development, language, literacy, numeracy, and social-emotional development. The study found that the single most important quality indicator was something the researchers called sustained shared thinking.
What Sustained Shared Thinking Is
Sustained shared thinking is defined in the EPPE research as an episode where two or more individuals — typically an adult and a child — work together in an intellectual way to solve a problem, clarify a concept, evaluate activities, or extend a narrative. Both participants contribute to the thinking and extend understanding.
In practice, sustained shared thinking looks like:
- A child is building with blocks, and a caregiver sits beside them, asks "What are you making?", listens to the answer, says "Oh, and what goes on top?", and genuinely engages with the child's explanation for several exchanges
- A child is looking at a picture in a book and the caregiver asks an open question, waits for the child's answer, adds to it, and the conversation extends over several turns
- A child is doing a puzzle and a caregiver doesn't direct or solve but asks questions that prompt the child's own thinking ("I wonder if it would fit the other way around?")
What is not sustained shared thinking:
- A caregiver asking a closed question ("What colour is that?"), getting the answer, and moving on
- A caregiver narrating what the child is doing without genuine back-and-forth
- Adult-directed activity where the child follows instructions
Why the Activity Itself Matters Less
The EPPE findings challenged the assumption that what settings do (the specific curriculum, themed activities, structured learning sessions) is the primary driver of outcomes. The same activity — reading a book, building with blocks, playing in the sand — produces very different developmental outcomes depending on how the adult interacts during it.
This has practical implications. A setting that has children doing a daily craft activity, where adults supervise and redirect but do not engage in extended conversation, will produce less cognitive benefit from that activity than a setting where children choose their own activity and adults engage with them genuinely about what they are doing.
What Good Practice Looks Like in a Setting Visit
When visiting a daycare setting, observing the quality of interaction rather than the activity schedule gives a more reliable picture of quality:
- Are there genuine back-and-forth conversations between adults and individual children?
- Do adults follow children's interest rather than constantly redirecting?
- When a child says something, does the adult respond in a way that extends the child's thinking or invites more?
- Do adults get down to children's physical level and give them their full attention during these interactions?
- Are there spaces in the day where children choose freely and adults are available to engage rather than managing transitions?
A setting that ticks curriculum boxes but lacks this kind of interaction quality will be less effective developmentally than one where caregivers naturally engage this way.
Ratio and Interaction Quality
Staff-to-child ratios matter because they affect the possibility of quality interaction. When one adult is responsible for many children, the practical time available for individual, extended conversations is limited. Current UK regulations specify a minimum ratio of 1:3 for children under 2, 1:4 for 2-year-olds, and 1:8 for 3–5 year olds. Settings that maintain ratios above the minimum — more adults per child — generally produce better interaction quality, though ratio alone does not guarantee it.
Key Takeaways
Research on early years quality consistently finds that the quality of adult-child interaction is a stronger predictor of child outcomes than the curriculum, the activities on offer, the physical environment, or the resources available. A setting with simple resources and highly responsive, intellectually engaged caregivers produces better outcomes than a well-resourced setting with poor interaction quality.
