For working parents, child care is an essential link that helps them balance the responsibilities of jobs and family. But that doesn’t stop parents from worrying about their young children when they leave the children behind. Choosing a Caregiver The idea of leaving your child with someone else—who may be a stranger at first—seems to go against everything you feel about good parenting. But if you take time to choose the right place and the right person, the experience for both you and your child can be a very positive one.

Types of Child Care

There are many types of child care today, including family members who will babysit, child-care centers, corporate day care, family- or home-based day care, nannies and au pairs, and parenting co-ops. Some parents use a combination of several types; they may leave their child with Grandma a few days each week and in their company-sponsored day-care center the other days of the week.

In-Home Care

In-home care means a family member or a nanny or au pair will take care of your child at your home. Many parents prefer this arrangement. Your child will stay in a familiar, comfortable environment with his own toys, his own bed, and his own food. It also may give you greater flexibility; you can accept overtime or attend late meetings at work because your caregiver is at home until you arrive, usually working 40 to 60 hours a week. If your child is sick, he can stay in his own home and recuperate without disrupting your work schedule. (Sick children are generally not allowed at day-care facilities, so parents must stay home from work to care for them.) And your child may not be sick quite as often if he is not exposed to the germs of other children.

What’s the downside of in-home care? It’s usually the most expensive type of child care—unless you’re fortunate enough to have a family member who is willing to take on the job. In-home care is also a problem if your caregiver becomes ill and cannot take care of your child. Also, some toddlers and preschoolers enjoy the company of (and learn socialization skills from) other children, which they may not experience at home. Finally, if you opt for a live-in nanny or an au pair, you face two concerns you need to think about carefully: You and your family will lose some privacy when you bring someone into your home 24 hours a day. And you also must be able to trust this person not only with the valuables in your home but also with your child—there is no one supervising this person all day long (which is why the hidden camera industry has seen a recent boom).

Family- or Home-Based Child Care

Family- or home-based child care provides care for children in the caregiver’s home, often with one adult supervising several children. The benefits of this type of care include small group size and a homelike setting for kids. Often, too, family day care is less expensive than other options, and some parents find they can work out parenting co-ops, where parents each take responsibility for providing child care to a group of children on a rotating schedule. What are the cons? Family child care is not as strictly regulated as day-care centers are, and the laws on licensing are different from state to state. In many places, there is little or no oversight. Also, many of the caregivers are not trained, although often they have young children of their own. And, if the caregiver is ill, parents are left without backup arrangements for their children.

Day-Care Center

Day care in a center, preschool, nursery school, or your workplace offers certain advantages: It is probably run in accordance with state regulations that set minimum standards for staff-to-child ratios, group size, staff training, and building safety. Day-care centers usually take children from six-week-old infants to schoolage children. The caregivers usually have training in early childhood development, and a staff illness doesn’t affect access to reliable care for your child.

The disadvantages of day care include waiting lists because of a limited number of licensed centers, a more structured environment for your child because of the focus on regulations, frequent turnover of staff, and usually inflexible pickup and drop-off times.

Age Considerations

The setting that is best for your child often depends on his age. A priority for infants is to make sure they are held and nurtured and that all their needs are met. Finding a completely trustworthy caretaker is crucial because the child has no way of telling you if there is neglect or abusive behavior. For toddlers ages 12 months to three years, the key is to find a safe and supervised situation. Toddlers need to explore, but they must always be watched closely because they are so vulnerable to accidents and injuries. Having lots of toys for learning to share is important, as is a caregiver who will spend time talking with toddlers and helping them learn to talk.

Preschool children between ages three and five start making friends, so look for child care where there are other children their age. Also, there should be fun opportunities for preschoolers to learn about colors, shapes, and numbers, as well as time for reading stories.

Think Safety

With any type of child care, safety is a primary consideration. When you’re looking for care for your child, consider the answers to these questions:

• How does the caregiver supervise the children on the playground? How old is the equipment, and has it been inspected recently? Is there soft sand, wood chips, or rubber mats under the equipment?
• Are the children grouped by age? If not, younger children could be hurt by older youngsters.
• Is the facility childproofed?
• Do staff-to-child ratios meet or exceed the recommended levels?
• Are infants always fed in the upright position, with no bottles ever propped or placed in bed with the baby?
• Are babies always put to sleep on their backs?
• Is the day-care center or home licensed or registered with the local government? Ask to see current inspection documents. Also, is the center accredited by the National Association for the Education of Young Children or the National Child Care Association?
• Are staff members or your in-home caregiver trained in first aid and CPR, and do they know how to respond if your child is choking? Do they know and follow the basics of sanitation, including frequent hand washing and changing diapers with disposable gloves to prevent the spread of infections?
• Does the day-care center perform monthly evacuation and emergency drills? A child-care facility should be as safe as your home. If you feel there are dangers, including open stairways, doors that can slam, uncovered electrical outlets, or hot radiators, look for another facility. If all looks fine but you want additional peace of mind, call the local health department to make sure there aren’t any outstanding complaints about the center.

Conduct an Interview

While touring a day-care or home-based center, spend some time observing the children and the staff. You may want to ask the following questions:

• Do you have an open-door policy on visits from parents?
• What is the policy on caring for sick children?
• What is your discipline policy?
• What are the educational backgrounds of the teachers or caregivers? Do they have basic training and experience in early childhood development?
• Does the center conduct reference and background checks?
• If your child has special needs, is the center or home accessible and able to meet your child’s needs?

If you’ve opted to hire an in-home caregiver, such as a nanny, you should interview the applicants at least twice. Ask about their child-rearing philosophy, methods of discipline, and previous experience. Present specific situations and ask how they would handle the situations. If you are using a placement agency, ask if they have conducted a criminal background check. Also, ask for several references and check them all. If the caregiver will be driving your child, it’s important to check her driving record.Besides inquiring about training in early childhood development, you should also ask a potential nanny or au pair these questions:

• Why are you interested in working with young children?
• Why did you leave your last job? (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 to elicit responses to situations that could arise. For example, if a child 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 are the opportunities you can 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?

During the interview for an in-home caregiver, put all the details on the table. Outline the duties, expectations, hours, salary, and paid-vacation and sick-leave policies. Talk about your own obligations as well. If the caregiver will be living with you, discuss living arrangements; personal, off-duty time; visitors; and holiday arrangements.

Getting to Know the Caregiver

Once you have chosen a caregiver, ease your child into the day-care experience. Visit the chosen day-care center or home-based program before the day you will be leaving your child behind. Invite your new nanny or au pair over for lunch; let her work a few days while you are still at home. Make sure your child knows that you like and trust the caregiver. Once your child has begun child care, give him and the caregiver a little time to adjust to each other before you make any judgments. Some days, your child might say he doesn’t like his teacher or he doesn’t want to go to day care. If you are concerned about your child’s feelings, talk with the caregiver and plan to sit in on the child-care program to help you understand why your child is having difficulty.

If you find that there’s nothing wrong otherwise, it could be that your child is anxious about leaving you—sometimes called separation anxiety. For babies up to seven months, separation anxiety isn’t usually an issue. Older infants, however, may get upset when their parents leave them. Toddlers may cry or act angry, and preschoolers sometimes regress and take on behaviors of younger children when they see their parents leave. If your child is usually happy, these moments may be normal separation anxiety.

If, after several weeks, your child is still upset when you leave, it could indicate a more serious problem. Talk with your child, your child’s doctor, and the staff to get to the root of the problem.

Keeping Your Child Healthy in Child Care

It’s going to happen. Your child is going to get sick, and it’s more likely to happen if she is in a day-care center or home-based center. In these environments, she’ll be around more children, and that means more germs.

Common Illnesses in Child-Care Settings

Children in day care are more prone to ear infections. If your child shows symptoms such as ear pulling, fussiness, or fever, contact her doctor. Conjunctivitis, otherwise known as pinkeye, is an infection of the lining of the eye, and it spreads among young children easily because they are often touching each other and sharing toys. Again, call your child’s doctor if she develops eye redness or discharge. Rash-producing illnesses, usually caused by viruses such as chicken pox, spread easily in a child-care setting. Because increasing numbers of children now receive the vaccination for chicken pox, this disease is becoming less of a concern for children in child care and for their parents. But if your child has not been immunized and develops chicken pox, expect to keep your child home from day care for about 10 days, until the blisters are scabbed over. For more information on these and other common infections encountered by children in child care such as head lice, pinworms, scabies, and ringworm.

More Serious Concerns

Some diseases of greater concern can spread in a child-care environment, especially if strict health and sanitation rules are not followed. Hand washing is a must, and diapering and food preparation areas must be entirely separate from each other. Each should be cleaned immediately after each use. Proper handling of dirty diapers and human waste must be observed to help prevent the spread of infections such as hepatitis and the diarrhea-producing parasitic infection giardiasis. Caregivers should have a written policy on how they handle bloody noses, dirty diapers, and other situations where illnesses might spread. Hepatitis A, a viral infection, and many bacterial diseases can be spread through human feces. HIV can be spread through contaminated blood, although the virus is extremely rare among U.S. children. Hepatitis B can also spread through blood, but the vaccinations children now routinely get during their first year protect them from this disease.

Child abuse in day care is every parent’s nightmare. While reports of child abuse by nannies or day-care workers get a lot of attention, the U.S. Department of Health and Human Services found that 75 percent of child abuse is committed by parents, while another 10 percent is committed by other relatives. Less than 1 percent of child abusers are child-care providers.

Still, it’s important to keep a close eye on how your child is being cared for. Watch for bite marks, unusual bruises, cuts or burns, a high incidence of injuries or accidents, and injuries to the face. For more information about signs of abuse and what to do if you suspect abuse of your child.

If the caregiver and your child give inconsistent stories about how the injuries occurred or your child seems frightened of the caregiver, see your child’s doctor about the injuries. If you believe your child has been abused, remove her from the situation immediately. If your child tells you she was abused, make sure you tell her she did the right thing by informing you. Also, make sure you report suspected abuse to the police.