Choosing a child care provider

Nearly 7 in 10 parents use some form of child care to look after their son or daughter. Choosing someone to care for a child can leave many parents feeling anxious.

First, figure out the amount of hours needed to care for your child. Will you need someone to look after him a few hours a day, a couple of times a week, or full-time care for at least 35 to 40 hours a week? Next, review the different kinds of child care available. There are many options parents can choose from.

In-home care

The family hires either an au pair or a nanny to look after the child in their home.

Au pair
A young adult takes part in a foreign-exchange program to care for children. In return, he or she receives free housing and food and the opportunity to learn a new culture.

Advantages

  • Having someone in the home is convenient and flexible.
  • The au pair provides one-on-one attention to the child.
  • Agencies identify the best match and take on paperwork.
  • The child learns a new culture or language from the au pair.
  • The child remains in a family setting.

Disadvantages

  • Hosting an au pair can be expensive.
  • The au pair stays for a specified amount of time (1-2 years).
  • Experience and training in child care vary widely among au pairs.
  • The child misses out on socializing with other children.

Nanny
A nanny provides regular care for a child and can either live with the family or come to the home only when looking after him.

Advantages

  • Parents have greater control over their child's care.
  • Having someone available in the home is convenient and flexible.
  • Accredited nannies often consider themselves professionals and take the job seriously.
  • Some provide light housework (laundry, cleaning up, etc.).
  • The child remains in a familiar setting.

Disadvantages

  • A nanny is often the most expensive option.
  • There is no backup for child care if the nanny is sick or unavailable.
  • It’s hard to find highly qualified nannies.
  • Background checks are often limited to references from past employers.
  • Parents must meet federal and state wage and tax-reporting requirements.

Family child care

Informal care is provided in someone else's home. Often, the person also looks after several children in the home.

Advantages

  • The child can play and socialize with other children.
  • Family child care is usually the most affordable option.
  • The ratio of adults to children is often good.
  • Often the caregiver is flexible and will make special arrangements for the family's needs.

Disadvantages

  • Few providers are formally licensed. Regulations vary from state to state.
  • Many homes aren't regularly inspected.
  • It’s hard to monitor the quality of care the child receives.
  • There is often no substitute if the provider is sick.

Child care centers

A facility, often with many staff, provides out-of-home care for several groups of children.

Advantages

  • The state licenses these facilities.
  • Staff are trained and supervised.
  • There is more than one caregiver; someone is almost always available.
  • It’s fairly easy to obtain background information.
  • Centers have structured programs or curricula to help children learn and grow.

Disadvantages

  • Centers may not be able to meet family needs outside of normal business hours.
  • Larger groups of children mean less personalized attention.
  • Although centers are licensed, regulations vary, depending on whether they are publicly or privately funded, of if they are religion-based.
  • Good centers often have waiting lists.

Key questions to ask

Does the caregiver have formal training or education?
Prior experience in caring for children is essential. But formal education or training, such as a degree or certification in early childhood development, is a bonus. Find out what kind of training or educational background the provider has.

How many children does the provider care for?
While some children do well with less direct supervision, others, especially younger children, need a watchful eye. The table below, from the New York State Office of Children and Family Services, outlines what is most appropriate for your child's age.

Birth to 6 weeks: 3 children per adult
6 weeks to 18 months: 4 children per adult
18 months to 36 months: 5 children per adult
3 years: 7 children per adult
4 years: 8 children per adult
5 years: 9 children per adult

Does the caregiver have any health certification?
Ideally, the person watching your baby should be trained to be a first-responder in an emergency situation. Make sure the provider is trained in first aid and CPR (cardiopulmonary resuscitation).

How safe is the environment?
Safety comes first when caring for children. Be sure the location and all items in it (including toys, dishware, cots, etc.) are clean and in good repair. Ask the provider if there is a fire extinguisher, an emergency exit plan, and a handy contact list for emergency services.

What kind of activities, materials and equipment are provided to children to help them grow and learn?
The early years of a child's life are the most important for brain development. Regular activities that stimulate thinking and problem solving (such as reading or playing games) can prepare your child for school and a love of learning.

For more information

Read Choosing a Child Care Center from the American Academy of Pediatrics.

Last reviewed April 2008

Most common questions

How do vaccines work?

Tiny organisms (like viruses and bacteria) can attack your body and cause infections that make you sick. When you get an infection, your body makes special disease-fighting substances called antibodies to fight the organism. In many cases, once your body has made antibodies against an organism, you become immune to the infection it causes. Immune means you are protected against getting an infection. If you're immune to an infection, it means you can't get the infection.

Vaccines usually have a small amount or piece of the organism that causes an infection. The organisms used in vaccines are generally weakened or killed so they won’t make you sick. The vaccine causes your body to make antibodies against the organism. This allows you to become immune to an infection without getting sick first.

Some vaccines have a live but weakened organism. These are called live-virus vaccines. While live-virus vaccines are usually safe for most babies and adults, they’re not generally recommended for pregnant women.

See also: Vaccinations and pregnancy, Your baby’s vaccinations

When should I start brushing my baby’s teeth?

As soon as your baby's first tooth appears, start brushing with water. Later, when she is old enough to spit, introduce toothpaste. When you use toothpaste, make it a small (pea-sized) amount of a non-fluoride brand. Don't use a toothpaste with fluoride until your child is 2 years old, unless recommended by her dentist. Don't give her fluoride mouth rinses until she's 6. Start flossing as soon as two teeth start to touch each other.

So when should you actually take her to the dentist? The American Dental Association recommends that your baby get her first dental visit within 6 months of getting her first tooth and no later than her first birthday. The dentist checks the shape of your baby's mouth, teeth and gums and looks for signs of damage caused by thumb sucking. Maintaining dental health early can help protect your baby's teeth for a lifetime.

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