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Choosing Child Care
What is child care?
Child care is short-term care by someone other than a parent. There are two basic types of child care: individual and group.
- Individual providers care for only your child or children. The provider may be a family member or friend, a nanny, an au pair, or a babysitter.
- Group providers care for your child and other people's children. Your child may attend a small or large home day care, a child care cooperative, or a child care center such as a preschool or Montessori school.
Finding good child care can seem overwhelming and a bit scary. It is an important decision. But if you take your time and do some research, you can find a place where your child can play, learn, and be well taken care of.
How can you find good child care?
When choosing child care, consider your child's safety, how much you can afford to pay, and your daily routine.
When choosing child care, make sure that it is:
- Safe. Check that it is licensed with your state (also called registration or certification). Licensing guidelines vary by state. So make sure that all care providers know how to handle emergencies and are trained in first aid and CPR. Also, ask for references. Get the names of people and agencies you can talk to about the care center's safety record.
- Right for your child's age, skill level, and natural outlook. Ask what ages of children go to the care center. Think about whether your child would do best at home, in a family home setting, or in a group center. For example, a child who makes friends easily may do well in a group center. A shy child may do better in a small, home-based center.
- Right for your family's values. Ask what kind of learning programs the center has. Think about whether these fit with your family's beliefs and values.
- Well staffed. Make sure there are enough staff members to care for the number of children at the center. Ask if caregivers are able to give each child one-on-one attention as needed. Check that the main caregivers and program directors are trained in child development and have a college degree or are otherwise highly experienced. Also, find out how long staff members have worked there. It can be upsetting for a child if the staff changes often.
- Caring. Watch how the staff works with the children and if they are kind and caring with them. A good caregiver helps your child learn, interact, and solve problems while protecting him or her from making choices that could be harmful.
- Affordable. In the United States you can deduct part of child care costs from your state and federal income taxes. Your employer also may offer benefits or help with child care. Or you may qualify for a reduced rate at some child care centers.
- Reliable and consistent. You'll want to know that your provider will be available when needed. Have written agreements outlining specific hours, holidays, and other breaks.
- Convenient. Think about the location of the care center and whether the hours work well with your schedule.
What if your child has special needs?
Federal and state laws allow equal access to public education and other services such as speech and physical therapy for children with disabilities or certain conditions that require special care. Find out which laws apply to your child and how to get available services. Contact your local government's mental health office or your state department of education.
How can you help your child get the right start?
Children need time to adjust to child care. It is common for a child to cling or cry when a parent leaves. But you can take steps to help your child do well in child care.
- Prepare yourself and your child. It may help if you both get used to spending time apart. Hire a babysitter or ask a friend or relative to help watch your child for short periods, and gradually make the sessions longer.
- Tell your child what will happen. If your child is an older toddler or a preschooler, talk about meeting new friends and doing new things. Remind your child that you will come back to pick him or her up.
- Work into the new routine slowly. You may keep the first visit short and stay with your child. Stay away a little longer each day. Follow your child's lead. He or she may be more ready to join the group than you thought.
- Spend extra time saying good-bye for the first few days. Some children will be ready and eager for the new routine. An extra minute or two to get your child involved in a new project or with a group of children may be all that is needed.
- Let your child bring something from home, if the center allows it. Having a special blanket or toy can be a comfort.
If you spend time with your child and are calm and loving, he or she will be more likely to adjust to and enjoy child care.
Beginning Your Search
Think about what you need
When you start looking for child care, narrow down your choices by considering practical issues as well as your child's needs. Do you need an individual or group care provider? Or do you need an after-school program or camp to fill in gaps between school hours and your work schedule? Here are some other questions to consider:
- Do you need part-time or full-time child care?
- What days of the week do you need child care? Are the days always the same, or do they change?
- During what hours do you need child care (include your travel time if appropriate)?
- What are you willing to spend each month for child care? Keep in mind that well-paid caregivers are less likely to quit.
- How would you describe your child's personality? Does he or she have any special interests? Do you think your child will do best in a small or large group of children?
Visit the care setting
Visit the facility or caregiver's home, and get involved in any special activities. Watch the interaction between caregivers and children. Make sure you feel comfortable with your decision.
Individual Care Providers
Types of individual providers
- Babysitters and mother's helpers. Babysitters provide informal in-home care for your child, such as when you need to run errands or have planned an evening out. They are usually paid hourly and maintain general household order. But they are not expected to do housekeeping chores. A mother's helper is similar to a babysitter but is someone who watches your child while you are home.
- Relative or family friend. When you have a relative or family friend care for your child, the formality of the arrangement is up to you. Some parents need help on occasion or part-time. Others have a detailed arrangement that may or may not include payment.
- Nanny. Usually a nanny cares for one or more children of a single family. Nannies usually have at least a high school education. Many have college degrees in childhood education or have completed a special training program. Nannies are considered employees. They may work part-time or full-time in the family's home. For more information, contact the International Nanny Association at www.nanny.org.
- Au pair. Au pairs are child care providers from a foreign country. They typically live with a family for around 12 months. Au pairs usually are young adults (18 to 26 years of age) and often have completed a college degree or are pursuing further education. Families usually are matched with an au pair through an agency.
Selecting an individual care provider
Have a clear idea about what type of person you are looking for. It may be helpful to:
- Write down the qualities you want in a caregiver, such as educational background and experience.
- Look for hidden costs.
- Consider how having a relative or family friend watch your child could affect your relationship.
There are two basic ways to find an individual child care provider:
- Advertise. Talk with your neighbors and friends about the kind of person you are looking for. Post an advertisement in places where people in your community look for jobs or services, such as newspapers, local colleges, churches, or community bulletin boards.
- Use an agency. Some organizations will help you find child care. Many nannies and most au pairs are hired with agency help.
It's important to interview potential providers. Use a phone interview for the initial screening. Ask questions about their work experience, their references, and whether they have questions for you.
When you have narrowed down your selection, conduct a personal interview with each of your top choices. Allow enough time for the applicant to be introduced to your child.
Be sure to check the references of your top choices. Ask each reference how long he or she has known the provider, specifics of the provider's duties, and why the employment ended.
Selecting a babysitter or mother's helper
Choose a babysitter or mother's helper by asking friends and other caregivers you trust. You may also want to ask for recommendations from a local organization, such as the YMCA.
Before you hire a teen to watch your child:
- Ask the teen what other jobs he or she has had and what he or she was responsible for. Find out what activities he or she likes to do with children. Also ask how the teen would handle certain situations, such as a baby that cries for a long time or a toddler who is talking back.
- Tell the teen your rules, including how much TV and computer time is okay and what type of TV programs are okay.
Schedule a meeting with the caregiver and your child, and watch how they interact. Some caregivers may not have confidence. This doesn't mean they will not ever be able to watch your child. But it may mean that you will need to have a few babysitting dates while you are present before leaving them on their own.
Classes help babysitters prepare for the responsibilities of watching your child. They can also provide valuable skills in case of an emergency, such as first aid and CPR (cardiopulmonary resuscitation) training. Classes often are available through local agencies, churches, hospitals, or schools.
Know your responsibilities
If you use an individual care provider for your family on a regular basis, you may be obligated to comply with employer rules and regulations of the federal, state, and local governments. Call the United States Department of Labor (1-866-4-USA-DOL [1-866-487-2365]) for information about your responsibilities.
Group Child Care Providers
Types of group child care
- Child care cooperative. Child care cooperatives or babysitting cooperatives are set up and run by parents, usually for occasional child care. But some cooperatives provide regular child care for their members. Parents usually take turns watching each other's children instead of paying money for child care. This often works well for parents who have a flexible schedule, work part-time, or work at home.
- Child care in someone's home. Family child care may offer more flexibility than larger group care centers, but quality varies among providers. All family child care operations should be registered or licensed in the state, even if it is not legally required. (Some states exempt family child care operations from licensing requirements.) Although the U.S. Department of Health and Human Services has recommendations for safe child-to-teacher ratios and group size, each state creates its own regulations.
- Child care center. Centers that provide care for groups of children vary in size, setting, programs, and types of activities. Get a list of child care centers in your region from your state licensing bureau. Each state sets its own licensing standards. Some are lax, and others are very strict. Child care centers are sometimes called nursery schools, preschools, Head Start, Montessori schools, or day care centers.
Selecting a group child care provider
Begin your search by asking friends and family and using your local library and newspaper. You also may want to contact referral organizations and your doctor. See the Other Places to Get Help section of this topic for more information.
Choose a few providers you'd like to interview, and write down the questions you have. Do a first screening over the phone and take notes. Ask about or consider:
- The location, price, and hours of operation, and whether there is a waiting list.
- Age ranges of children. Also ask about the child-to-teacher ratio and the total group size.
- Types of activities and educational programs offered.
- Whether there are extra costs for late pick-up, food, supplies, and other things.
Set up a meeting with the director of each facility or home setting that passes your first screening. Plan enough time to take a tour and talk about their service guidelines, such as when payment is expected and scheduled closures. Make sure you are shown the entire facility or home. Notice whether the children appear happy and playful, and notice how they are treated by the care providers.
A child's environment should be safe, healthy, and clean. Make sure that staff are knowledgeable about preventing safety hazards and responding to emergencies. There should be:
- Emergency procedures, which include regular drills and staff training in first aid and CPR.
- Health and safety policies, including the immunization of all children and staff as well as how outbreaks of contagious illness are handled.
- Conduct rules for children, to help maintain order and help children know what is expected of them.
- Cleanliness and hygiene standards, including the general appearance, layout, and sanitation of the facility.
- Food handling and preparation standards, including where and what types of foods are prepared.
- Playground safety guidelines, such as the type of equipment and basic rules that children are expected to follow.
High-quality staff and programs are also important:
- Child care providers of high qualitywill have a solid educational background, which includes training in childhood development, and will have acquired years of experience working with children. Group care programs should have low teacher turnover. Caregivers should be warm and responsive to children.
- Safe staff-child ratio will vary by age group. Higher-quality centers have low child-to-staff ratios and small total group size. Children are generally grouped by age: infants (birth to 12 months), toddlers (13 to 35 months), preschoolers (36 to 59 months), and school-aged (5 to 12 years of age).
- Educational programs and activities should offer variety and appropriate indoor and outdoor activities to match the ages and developmental levels of the children.
- Licensing should be a consideration. Although any program you consider should be licensed by your state, in itself licensing doesn't mean the care given is of high quality. Each state has different child care licensing requirements and enforcement procedures.
- Accreditation is additional insurance that a child care facility is of high quality. Look for those programs that have or are in the process of obtaining accreditation by the National Association for the Education of Young Children (NAEYC) and the National Association for Family Child Care (NAFCC).
Helping Your Child Get Started
At the start of a new child care routine, it's common for a child to show some signs of anxiety, such as clinging or crying when you leave. With your child's needs in mind, try to ease the transition.
- Prepare yourself and your child. If you are enrolling your child in care for the first time, it may be helpful for you both to get used to spending time apart. Hire a babysitter or ask a friend or relative to help watch your child for short periods, and gradually extend these sessions.
- Explain to your child what will happen. An older toddler or preschool-age child may understand at least some of what you tell him or her about the new situation. Talk about playing with new friends and the kinds of activities he or she will do. Remind your child that you will come back to pick him or her up.
- Start the new routine gradually. You may keep the first visit short and stay with your child, adding time slowly. Over the course of a few days, you and your child may feel more comfortable when you leave. But follow your child's lead. Try to focus on dealing separately with any of your own anxiety that you may feel about leaving your child.
- Spend extra time saying good-bye for the first few days. Some children will be ready and eager for the new routine. A simple extra minute or two to get your child involved in a new project or with a group of children may be all that is needed.
- Allow your child to take something from home (such as a family picture or small toy), if allowed at the facility.
Make sure your child is immunized. Illnesses and disease can spread easily among a group of children. Keep your child's immunizations up to date and give a copy of the record to your child care provider. For more information on childhood immunizations, see the topic Immunizations.
If at any time you suspect your child may not be safe, immediately remove him or her from the situation. Notify the proper authorities if you suspect abuse.
Paying for Child Care
Budgeting for child care takes work. Plan ahead and think about your future child care expenses as far in advance as possible. Keep in mind that it may take time to process applications or that there may be a waiting list, especially if you are trying to qualify for financial assistance.
Child care referral agencies or other experts (such as some state or federal government agencies) can help you research your options for child care financial aid. Some general options may include:footnote 1
- State child care subsidies. Guidelines vary by state, but generally low-income families who are working or in school may be eligible for assistance.
- Local programs. United Way, local government, community groups, and faith-based organizations are all potential sources of financial help.
- Employer/university support. Some employers and universities offer child care scholarships, child care discounts, or reduced rates at on-site facilities.
- Child care program assistance. Some group child care providers offer scholarships, discounts, or pricing according to your income.
- Pre-kindergarten (Pre-K) programs. Many school districts offer free or low-cost educational programs for 3- and 4-year-olds.
- Head Start and Early Start programs. Federal and state-funded programs may offer part-time or full-time free child care and other services for families who meet federal income guidelines.
- Tax credits. You may be allowed state and federal tax credits for child care expenses. Specific programs and amounts depend on your household earnings, family size, and other factors.
- Dependent Care Assistance Programs. This is a program offered by some employers that allows you to have money taken out of your paycheck tax-free each year. The money is put in a special account for you to be reimbursed for child care expenses as they are billed.
Brainstorm ideas about ways you might be able to reduce the number of hours of child care you need or about ways to pay for it, such as:
- Sharing a nanny with a neighbor or a friend.
- Pursuing a flexible schedule at work that allows you to juggle child care and spend less. For example, you may ask if you can work 4 days a week for 10 hours and have an extra day off.
- Child care cooperatives. If you need only part-time child care, you may be able to work some hours caring for other children at the same time as you care for your own.
Helping care go smoothly
Ask providers if they require a written contract. If you pick a provider who doesn't use a contract, prepare one yourself. Include the hours of care, payments, and other details that are important to you. Keep a copy with your records.
Whether you choose an individual care provider or a group care setting, make sure you communicate and have an understanding with your care provider about expected behavior, discipline methods, and appropriate activities.
Changing or ending child care
Child care changes will occur and will require careful planning. As children grow, their needs change. Also, personal preferences, a move, or other life events may require a different arrangement. Allow time for both you and your child to adjust by talking about it ahead of time. You may want to plan something special for your child's last day at the child care center, such as bringing treats and taking pictures.
Talk with your child about what to expect. Stress the positive parts of the change, but acknowledge the challenges.
Worrying about the effects of child care
Some parents worry that the relationship with their child will suffer for having another caregiver. Another common concern of parents is whether children will develop and learn to their potential in a child care setting.
The quality of the child care, the type of care (for example, group or individual), and how much time a child spends in child care have an effect on a child's development. But it is not as great as the effect that you have on your child.footnote 2 You have a big impact during the times that you are with your child. Spend quality time with your child whenever you can. For example, have meals together and do fun things that help your child learn and grow in healthy ways.
Your child is more likely to become ill when he or she is frequently with other children. The spread of many diseases can be reduced by practicing healthy hygiene habits regardless of what type of child care arrangement you have.
Having a backup plan
Plan what you will do if your regular provider cannot keep your child or if your child is sick. Children with mild upper respiratory illnesses such as minor colds usually can attend child care. (Usually, mild upper respiratory illnesses are spread before symptoms develop.) Keep your child at home if he or she has a condition that prevents attending child care, such as a fever or a rash.
Some cities have child care centers just for sick children.
- Child Care Aware (2009). Finding Help Paying for Child Care. Available online: http://ccapub.childcareaware.org/docs/pubs/110e.pdf.
- Sosinsky LS, Gilliam WS (2011). Child care: How pediatricians can support children and families. In RM Kleigman et al., eds., Nelson Textbook of Pediatrics, 19th ed., online chap. 15. Philadelphia: Saunders. Available online: http://www.expertconsult.com.
Other Works Consulted
- American Academy of Pediatrics (2009). Early education and child care. In SP Shelov et al., eds., Caring For Your Baby and Young Child: Birth to Age 5, 5th ed., pp. 421–456. New York: Bantam.
- American Academy of Pediatrics (2013). Finding a sitter. Available online: http://www.healthychildren.org/English/family-life/work-play/Pages/Finding-a-Sitter.aspx.
- Bauer NS (2011). Nonparental childcare. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 364–366. New York: McGraw-Hill.
- Committee on Early Childhood, Adoption, and Dependent Care, American Academy of Pediatrics (2005, reaffirmed 2009). Quality early education and child care from birth to kindergarten. Pediatrics, 115(1): 187–191.
- Moran D (2009). Childcare. In WB Carey et al., eds., Developmental-Behavioral Pediatrics, 4th ed., pp. 159–163. Philadelphia: Saunders Elsevier.
- National Institute of Child Health and Human Development (2006). The NICHD Study of Early Child Care and Youth Development. Available online: http://www.nichd.nih.gov/publications/pubs/upload/seccyd_06.pdf.
Current as of: February 10, 2021
Author: Healthwise Staff
John Pope MD - Pediatrics
Kathleen Romito MD - Family Medicine
Current as of: February 10, 2021
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