Child care is short-term care
by someone other than a parent. There are two basic types of child care:
individual and group.
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.
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
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.
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.
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.
Learning about child care:
Keeping your child healthy and stimulated:
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:
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.
Have a clear idea about what type
of person you are looking for. It may be helpful to:
There are two basic ways to find an individual child
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.
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
Before you hire a teen to watch your child:
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.
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.
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.
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:
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
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:
High-quality staff and programs
are also important:
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.
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(What is a PDF document?)
to your child care provider. For more information on childhood immunizations,
see the topic
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
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
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:1
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:
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
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.
your child about what to expect. Stress the positive parts of the change, but
acknowledge the challenges.
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.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.
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.
This American Academy of Pediatrics website offers tips about how to improve early education and health and safety of children in out-of-home child care.
This nonprofit organization helps parents locate quality
child care and child care resources in their community by increasing the
visibility of local child care resource and referral agencies
nationwide. The website has information about how to choose quality child care.
This organization accredits family child care programs
and provides resource materials. The NAFCC also organizes conferences for
people with family child care programs.
The National Network for Child Care (NNCC) offers
newsletters, an e-mail group, and regional support and assistance for issues
about family child care, center-based child care, and school-age child care.
The Web site has many publications and resources about child care
This website has detailed information about child care
licensing requirements in the United States. Each state's requirements are
listed. There is also information about cleanliness, emotional health, healthy
habits, illnesses, special needs, and safety.
CitationsChild 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 ConsultedAmerican 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 (2010). 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:
September 14, 2012
Susan C. Kim, MD - Pediatrics & John Pope, MD - Pediatrics
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