Choosing appropriate child care for your infant or young child can seem as overwhelming as helping your teenager select a college or university. As a parent, it is your responsibility to ensure that your child is safe and happy in a child care environment that is fun, educational, and nurturing. Here are some tips for making such an important decision.

Your Child and Family

About 70% of parents place their young children in some type of daily care. Whether you choose in-home or center-based care, a preschool, or someone else's home for your child's daily care setting, you should follow some specific guidelines to ensure receiving quality, professional care.

Most important is to know your own child's temperament, likes and dislikes, health, interests, and behavior. For a baby under 1 year old, give careful attention to your child's need to be nurtured and held, any special health needs, and the type of person you want to care for your child during the first year of life. For an older child, developing play and learning styles, interaction with other kids, intellectual curiosity, and need for individualized attention should be considered.

The family's own values and emotional needs also come into play. Some parents are overly anxious about leaving their very young child with one person, while others prefer this individual care. But by age 3 or 4, it's good for kids to have at least some exposure to other kids and participate in a structured program like preschool or daycare.

Before choosing a care setting, you should be aware of the options available and consider cost, location, and reputation.

What to Look for

Make a list of qualities you're looking for in a caregiver or day care, such as experience, religious background, discipline beliefs, and flexibility. The International Nanny Association (INA) recommends that you interview any prospective hire at least twice and that you conduct a criminal background check, which is usually done by most placement agencies.

Besides inquiring about training in early childhood development, ask a potential nanny or au pair:

• Why are you interested in working with young children?
• Why did you leave your last job? (You should always check references; ask that family why the relationship ended and whether they would recommend that caregiver.)
• What is your discipline policy? (Offer "what if" scenarios. For example, if a child hits another child or throws a tantrum over a toy someone else is playing with, what should the consequences be?)
• How will you provide new experiences to enhance my child's mental and physical development? What opportunities can you offer to experience art, music, group and individual play, and indoor and outdoor play?
• How would you handle toilet teaching?
• How would you handle separation anxiety?

If you're considering a day care center or other group setting, spend some time observing the center and talking to parents with kids there. Ask these questions in addition to those above:

• Do you have an open-door policy on parent visits?
• What are alternative arrangements for care if the program closes? On what holidays is the center closed?
• What is your policy on caring for sick children?
• How do you monitor kids on the playground? How old is the equipment and has it recently been inspected?
• How are kids grouped? By age?
• Do you welcome children of varying ethnic, cultural, and religious backgrounds to the program? Do you include kids with special needs?
• What are the educational backgrounds of the teachers?

In evaluating the responses to your questions, carefully consider how the philosophy of child rearing, discipline, and nurturing meshes with your personal vision of how your child should be guided and cared for each day.

Finally, do you have a sense of trust in this person or program? Do you believe that your child will be happy and have the opportunity to learn and grow in this environment?

If none of the candidates meet your expectations, don't settle for best of the worst. Instead, review your job requirements, begin your search again, and consider asking neighborhood parents or coworkers for recommendations.

In-Home Care

Some parents prefer the one-on-one contact an in-home care provider can offer, especially for an infant. Parents or couples with full-time careers may find that their work schedules require them to hire an in-home care provider for their child. Trying to juggle overtime, business trips, and child care demands can be impossible without live-in help. If you do need to hire a nanny or au pair, seek the services of licensed agencies with experience.

A nanny is someone who works on a live-in or live-out basis performing child care and perhaps some minimal household duties related to child care. Usually unsupervised during the day, the nanny has a workweek that is typically 40 to 60 hours. Nannies hired through agencies usually have minimal training in caring for young children.

An au pair also provides in-home care and lives with the family and cares for the child under the direct supervision of the parents. He or she often seeks work far away from home, as a kind of cultural learning experience. Au pairs often assist with light housework and work about 40 to 60 hours per week. Au pairs, who usually are young, may or may not have any child care training or experience.

The Fine Print

Once you've hired a caregiver, draw up a specific contract outlining expected duties, hours, salary, paid vacation, and sick leave; include parental obligations as part of that contract. Establish a review date within a few months to discuss how the arrangement is working and to fine-tune the agreement. Observe the caregiver's interaction with your child routinely and unexpectedly.

Warning Signs

Here are signs to look for if you suspect that your child is being mistreated:

• The caregiver has lied to you or stolen from you.
• He or she does not answer questions about the daily routine.
• You come home to find your child unsupervised.
• The caregiver does not respond to your child.
• Your child becomes moody or withdrawn or has problems eating or sleeping.
• Your child suddenly becomes upset when left with the caregiver.
• You simply have a bad feeling about the caregiver.

Parents should be sure the nanny or au pair has the support needed to be a positive caregiver, including adequate time off and opportunities to meet other caregivers in the area. Parents should always be available by phone or pager to answer emergency calls. In other words, work together and form a partnership for your child's care.

Out-of-Home Care

Out-of-home care includes day care centers (usually affiliated with a public or private agency such as a religious organization, corporation, or community center); family day care programs held in the caregiver's home; part-time child care programs such as preschools or play groups; and publicly funded preschool programs such as Head Start. These programs usually care for kids from birth to age 5.

The American Academy of Pediatrics (AAP) recommends that one adult should have the primary responsibility for no more than one baby under 12 months of age in any care setting. Babies need positive, consistent caregivers who learn to recognize their unique cues for hunger, distress, and play. This kind of nurturing interaction contributes significantly to an infant's social and emotional growth.

For overall infant care, the AAP recommends a child to staff ratio of 3:1.

Homes and Centers

Day care homes offer child care in the caregiver's home, often with a single adult supervising the children. Center-based care includes day care centers and preschools employing several adults to care for larger groups of children.

In either case, both the AAP and the National Association for the Education of Young Children (NAEYC) recommend that the home or agency be licensed and regularly inspected. Caregivers should have basic training in CPR and early childhood development. There should also be clearly written policies on sick children and discipline. Voluntary accreditation with the NAEYC or the National Association for Family Child Care (NAFCC) usually indicates that the center is committed to providing quality care and must participate in ongoing child development programs.

Health, safety, and hygiene must be given priority in all settings. All kids and staff members should have current immunizations; staff should have clear criminal background checks. The facility must be childproofed and all staff members should wear disposable gloves when changing diapers. Toys should be disinfected regularly and frequent hand washing should be promoted among the staff and kids to minimize the spread of infection.

You should also expect that your child will be assigned to the same caregiver to promote a sense of security and consistency. Inquire about the rate of staff resignations; low staff turnover minimizes the need for young children to repeatedly adjust to new caregivers.

Preschools

Preschools, as the name indicates, provide an educational program for young children before starting kindergarten or elementary school. Many day care centers now also incorporate early childhood curricula into their programs. The NAEYC lists these 10 signs of a great preschool:

• Children spend most of their time playing and working with materials or with other kids.
• Kids have access to various activities throughout the day.
• Teachers work with individual kids, small groups, and the whole group at different times during the day.
• The classroom is decorated with children's original artwork and projects.
• Kids learn numbers and the alphabet in the context of their everyday experiences.
• Children work on projects and have long periods of time to play and explore.
• Worksheets are used rarely, if at all.
• Kids have an opportunity to play outside in a safe play area every day.
• Teachers read books to kids individually or in small groups.
• Curricula are adapted for those who are ahead as well as those who need additional help.
• Children and their parents look forward to school.

Children With Special Needs

Federal law guarantees special education and related services to kids with disabilities from birth through age 5. Special services such as speech and physical and occupational therapy can now be brought into day care centers or preschools so that children with special needs can be included in "regular" care settings.

Early intervention services can be coordinated through your local Office of Mental Health/Mental Retardation for kids up to age 3 and through your state's Department of Education for ages 3 to 5.

At the End of the Day

After all your research, interviewing, and observing, you may need to reassure yourself that leaving your child in the care of someone else is what works best for your family.

Make the most of your time with your child. When you get home at the end of the workday, keep your time free and easy. Give yourselves and your kids time to relax and cuddle. That can be a wonderful interactive time and it reduces stress for the whole family.

It is also recommended that guilt-ridden parents use positive self-statements, such as "I am still a good mom or dad" and "My child is having wonderful experiences." Recognize the advantages of quality child care — kids are developing relationships with other kids and learning give and take.

Daily reports about the child's day and frequent onsite visits can help you to track progress and reassure you that your child is being nurtured and having fun.

Just as you need to feel confident in the caregivers, kids need time to adjust. Young infants up to 7 months old generally adapt quickly to caring adults; older infants may suffer from "stranger anxiety" and need extra time and parental reassurance. Many toddlers and preschoolers go through adjustment periods involving tears, pouting, and tantrums as they settle in. Visits with you, favorite objects (a familiar blanket or teddy bear, for example) in the child's backpack, and the reassurance that you will return at the end of the day can help the adjustment.

However, if your child is not happy and flourishing in child care, reassess the program or individual caregiver. Realize that bad days may happen from time to time; one bad day does not equal a bad day care facility or caregiver. But if problems persist, look for another arrangement as soon as possible. This will help your child boost your child's mental, physical, and social development, trust in other adults, and sense of self-worth.

Reviewed by: Steven Dowshen, MD
Date reviewed: November 2010
Originally reviewed by: Jennifer Shroff Pendley, PhD