Feature Archive

Choosing Child Care Service

Whether you are looking for a day care center or at-home care, choosing child care service requires doing your homework.

By Richard Trubo
WebMD Feature

Reviewed By Brunilda Nazario

Expectant parents should have more on their minds than shopping for playpens and stocking up on enough diapers to fill a three-car garage. They can't overlook one of the most important decisions they'll make for the well-being of their new baby - finding high-quality child care service.

For decades, two-career families have been the norm in many American households, requiring a search for someone to care for the children, either inside or outside the home. In the aftermath of the events of Sept. 11, 2001, there was actually a trend toward more families deciding that one parent or the other would reduce work commitments and become the primary caretaker. But now, the momentum appears to be shifting in the opposite direction again, leaving more parents competing for the available care out there.

"After 9/11, all of the child care centers I consult for reported a reduction in the number of children they care for," says Pam Schiller, PhD, a child development specialist and author of The Practical Guide to Quality Child Care and Start Smart: Building Brain Power in the Early Years. "But now the enrollments have picked up again."

Looking for Quality

Child care service isn't always what it should be. The majority of available care isn't high quality, cautions child psychiatrist Stanley Greenspan, MD, clinical professor of psychiatry and pediatrics at George Washington University School of Medicine and Health Sciences. So it makes sense to start the search for good care early and do your homework.

If you're going to need child care service in the first few weeks or months of your baby's life, begin looking before your newborn arrives. "Set aside time in the last trimester of your pregnancy to visit centers in your area," advises Sherry Workman, executive director of the National Association of Child Care Professionals. "Ask friends and neighbors for referrals. Keep in mind that in some areas of the country, there are waiting lists for infant care."

The No. 1 priority should be the well-being of your child, but the perfect fit might be available in a variety of venues: a formal child-care center, informal care of small groups of children in private homes (so-called "family child care"), or a babysitter or au pair who comes into your own home. A study at the University of Washington in 2002 found that the majority of child care service -- involving tens of millions of American children -- is provided by relatives, friends, and neighbors. Grandparents, for example, provide much of this care for young children.

The Optimal Caregiver

Many child development experts believe that in an ideal world, parents should be the primary caregivers, particularly in the early weeks and months of a child's life. "Parental care is particularly important for babies, who need to be properly nurtured and receive plenty of interaction with the caregiver," says Greenspan.

Greenspan says more parents should consider an approach that he describes in his book, The Four-Thirds Solution, in which parents arrange their work shifts and schedules to reduce or eliminate the need for outside child care service -- for example, each parent works two-thirds of a full-time week, and devotes the remaining time to their baby.

According to Schiller, the first six weeks of a baby's life are important times for one or both parents to assume the caretaking role. "The child is brand new to the world, and is just getting used to his or her environment at home," she says. "Also, anytime you put a child into group care, you run the risk of colds and other communicable illnesses, which you'd like to avoid in the earliest weeks of life."

The Search Goes On

If you're selecting a nanny or au pair to come into your home, make sure you check references carefully. Is this someone who has a proven record of responsibility and trustworthiness? Has she gotten high marks from other families she has worked for? How does she interact with your baby the first time or two that they meet?

When you're considering a child-care center or a family home that cares for children, talk to other parents who have sent their youngsters there and get a sense of whether they've been happy with the experience. No matter what venue you choose, however, many of the same selection criteria apply:

  • Visit the facility or home several times before making a decision.
  • Meet the director and caretakers, and visit the rooms or the nursery where your child will be spending time.
  • Look for warmth and responsiveness in caregivers.
  • Get a sense of whether caregivers talk and sing to babies, and have ongoing interactions with every child.
  • Are there plenty of play areas, and mobiles over each crib?
  • Is the environment rich with stimulation -- sounds and colors that increase a child's awareness of his or her world?
  • Is the facility clean? Does it have good sanitary procedures in the kitchen and diaper-changing areas?

Seek a staff-to-child ratio that allows each youngster to get plenty of attention. "In the case of infants, a ratio of two babies per caregiver is ideal," says Greenspan.

According to the American Academy of Pediatrics, child-care centers should provide no less than one adult caregiver per three infants less than 24 months old. For older children, acceptable ratios are:

  • One adult per four children 25 to 30 months old
  • One adult per five children 31 to 35 months old
  • One adult per seven children at age 3 years old
  • One adult per eight children 4 to 5 years old

In addition to numbers, ask about the turnover of staff and look for consistency in personnel. "The caretaker should be a permanent fixture," says Schiller. "You don't want a caretaker who keeps the job for two weeks and quits, and then someone else comes in and doesn't stay long either."

Talking Money, Talking Quality

Costs of child care service can vary widely by region. "You should seek the best care you can buy with your dollar," says Workman.

Using a nanny or au pair is an increasingly popular trend, even though it is generally more expensive to have someone come into the home to care for a child one-on-one. "If you can afford it, this can be a good choice for the first couple years of life," says Schiller. "Once the child is 3 and 4 years old, then social interaction becomes critical, and you want children to have the experiences that occur in groups."

Ask whether the center or private home is licensed or registered with the appropriate state or local government agencies, which means that the program is visited regularly for inspections, says Workman.

Keep in mind that no matter where your baby is cared for, this is a time of rapid development of her brain as well as her body. "It's important that children are read to, talked to, and sung to during the first year because so much of the wiring of the brain is taking place," says Schiller. "If children are in a child-care setting where no one ever speaks to them, then a very important window of opportunity is missed for that child's cognitive development."

Published April 21, 2003.