Choosing Child Care

Selecting a Provider

Narrowing your search

When you start looking for child care, narrow down your selection by considering practical issues as well as your child's needs.

• 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.
• What is your child's age? What behavior is expected of children that are your child's age? What are some ways you can involve a school-age child in deciding about the best type of care?
• 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?
• Does your child have any lifelong conditions (such as diabetes) or special needs?

Selecting an individual care provider

If you are looking for an in-home child care provider, have a clear idea about what type of person you are looking for. It may be helpful to do the following:

• Write down the qualities you want in a caregiver, such as educational background and experience.
• Look for hidden costs.
• If you are considering having a relative or family friend watch your child, think about how the arrangement could affect your relationship.

There are two basic ways to locate 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. Make it clear what you need: number of days each week, provider to live with you (or not), any requirements or special needs, and how to contact you.
• Use an agency. Some organizations will help you find appropriate individual child care. Many nannies and most au pairs are hired with agency help.

Screening potential providers is essential. Use a telephone interview for the initial screening, and explain your needs in detail. Then ask questions such as:

• Do you have any questions about our needs?
• What kinds of related experience do you have? Be specific. For example, if you prefer vegetarian meals, ask, "How would you rate your cooking abilities?" and "Have you ever cooked vegetarian meals?"
• What concerns or questions do you have for me?
• Who are three people I can call for references?

When you have narrowed down your selection, conduct a personal interview with each of your top choices. Allow enough time for the applicant to answer and ask questions and 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. Find out about the relationship between the child and caregiver. Also include questions that will help give you a sense of the person's fit with your family. Ask the reference what else you should know about the provider.

Selecting a group child care provider

When you are choosing an out-of-home child care provider, research the options available in your community. Begin by asking friends and family and using your local library, newspaper, and telephone book. You also may want to contact referral organizations. For example, Child Care Aware is a national organization that has a Web site and hotline to help you find a good facility in your area. See the Other Places to Get Help section of this topic for more information.

Use a telephone interview and printed information to help you screen providers. Ask about or consider the following:

• Basic facts, such as 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.

Set up an appointment with the director of each facility or home setting that meets your initial screening. Plan time enough 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. Evaluate its general cleanliness, condition, and safety. Notice whether the children appear happy and playful, and how they are treated by the care providers.

A child's environment should be safe, healthy, and clean. Make sure 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-related 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. All caregivers should have training in childhood development and be responsive to children. Programs should be small and well-designed for growth in all areas of development. All child care operations should at minimum be licensed. Ideally, an organization will have acquired special accreditation.

• Child care providers of high quality will 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 varying 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).¹

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.

Find out whether the babysitter or mother's helper you are considering is experienced with children. Schedule a meeting with the caregiver and your child and watch how they interact. Some caregivers may not have confidence. This does not 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 cardiopulmonary resuscitation (CPR) training. Classes often are available through local agencies, churches, hospitals, or schools.

Follow-up after making a selection

If your provider does not require a written 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.

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.

Helping your child get started

At the start of a new child care routine, it is normal for a child to show some signs of anxiety, such as clinging or crying when you leave. Depending on your child's needs, consider trying 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 them. Some parents may find having a mother's helper for a few weeks before going back to work can help reduce some of the stress related to leaving their child.
• 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, and reassure him or her that it is a safe place. Remind your child that you will come back to pick him or her up.
• Introduce 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. He or she may be more ready to join the group than you thought. 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 (What is a PDF document?) to your child care provider. For more information on childhood immunizations, see the topic Immunizations.

Note:

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.

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Author:	Debby Golonka, MPH	Last Updated: September 26, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Michael J. Sexton, MD - Pediatrics
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