“…Children attending highquality ECE programs show improvements in physical and mental health and school readiness. However, children attending these programs also have higher rates of upper respiratory and ear infections and are at increased risk for gastrointestinal illness and injuries compared with children cared for at home (Alkon, To, Wolff, Mackie, & Bernzweig, 2008;Belsky et al, 2007;Bradley, 2003;Stein, 2007). As more children attend ECE programs, in an economy of limited public financing for them, concerns about the quality of care they provide is on the rise (Alkon, Bernzweig, To, Wolff, & Mackie, 2009;Alkon, To, Mackie, Wolff, & Bernzweig, 2010;Spooner & Classen, 2009).…”