These days, many families have two parents working outside the home. Before entering school, the majority of kids have had regular care from someone other than their parents. This care can be in child care centers, preschools, their own homes, relative’s homes, or family day care homes. The quality of care in these crucial early years varies, and parents need to make informed choices regarding child care.
The American Academy of Pediatrics policy statement on childcare states that quality care should have:
- Adult caregivers who have experience or training in child development
- A warm, nurturing, attentive, developmentally appropriate and intellectually stimulating home environment
- Small child to adult ratio, with consistent long-term adult caregivers
- Good parent/staff communication.
What are the different kinds of child care to consider?
Choosing the right type of care is a personal choice. When deciding, you will need to consider your hours, finances, values, need for flexibility versus routine, and most importantly, your child! In order to find care that fits your child, choose childcare that is in line with your child’s personality.
- Center-Based Daycare: Centers can vary widely, and you may need to make several visits before finding a center you are comfortable with. Centers should be licensed by the state. They can also apply for accreditation, which is optional. Accreditation by the National Association for the Education of Young Children (NAEYC) is an indicator of an excellent program. The criteria that must be met to earn accreditation are the kinds of things that research shows are important for quality care.
- Family Home Daycare: Home daycare must also be state licensed (but state requirements may be less stringent than for centers), and can earn accreditation through the National Association for Family Child Care (NAFCC). There will likely be a single care provider and a small group of children, which fosters good emotional development, and the feeling of a family environment. The quality of care can vary widely though, and the caregiver may have no background in child development.
- Nanny: A nanny is a caregiver employed by the family to provide in-home childcare, on either a live-in or live-out basis. Among nannies, there is a diversity of childcare experience, educational background, and willingness to do non-child related work. Some nannies may be accredited by a nanny school and have taken college level courses in child development. Deciding on the right person can be difficult and time-consuming. Here is what you need to know if you are considering a nanny.
- Au Pair: An au pair is a childcare provider, often a young person from outside the United States, who provides childcare for a family in return for room and board, exposure to family life and a new culture, and sometimes a small salary. The au pair is to be treated as a member of the family during the stay, which is often limited to one year.
- Relative or friend: Some parents feel that family members or friends are the best caregivers for their child. They are personally involved with the child, and are likely to be reliable and loving caregivers. They may also be more flexible when parents work odd hours. Costs may be lower, or there may be no cost. However, good communication with the family member or friend is key, and everyone involved must be clear about their expectations.
How do I decide between all the different types of care?
Here’s a chart to help you weigh some of the advantages and disadvantages:
| Type of care: | Pros: | Cons: |
| Center-based | Centers are licensed
Care is usually structured and predictable Staff will be stable in a well-run center Usually open year-round, but may close for holidays/school breaks |
May be less oriented to individual child if group is large
Usually expensive May have high staff turnover |
| Family day care | Usually reasonable in cost
Family day care is licensed Consistent caregiver and small groups allow close relationships to form |
Quality of care and skills of caregiver vary greatly
May have to find substitute care when caregiver is ill or on vacation |
| In-home (nanny or au pair) | Usually very flexible
Child may get more individual attention than in group care Usually caregiver will care for sick child, so parent does not have to miss work |
Usually most expensive type of care
Parents need to take on responsibilities of an employer, supervise daily activities, keep records, and pay taxes |
| Relative or friend | Usually most affordable
Often flexible hours |
May be conflicts over how to care for the child |
| School-aged care (at or near an elementary school site before and after school and during vacation time) | Provides safety, adult supervision, and peer companionship
Children supervised after school may be less at risk for social problems |
Cost is higher than leaving child alone, to care for self
Some older kids may not like being in an organized program |
Childcare for babies
If you are planning to work after your baby is born, you should shop around for childcare while you are pregnant. Choose several quality programs and get on their waiting lists, even if you have arranged for Grandma or a friend to care for the baby. Waits can be as long as a year and a half for daycare for babies!
Childcare for school-age kids (ages 6-12)
Consider after school activities, such as sports, or clubs. Your local rec and ed organization or YMCA may offer a variety of programs.
The Afterschool Alliance is dedicated to raising awareness of the importance of after-school programs and advocating for quality, affordable programs for all children.
Childcare for kids with special needs
Childcare options are similar to children without special needs, but depending on your child’s needs, a one-on-one or lower that typical caregiver to child ratio may be needed. Being upfront with your caregivers about your needs and expectations will make your search easier in the long run. Caring for a child that may need a breathing treatment requires a much different skill set and comfort level than a child that is in a wheelchair or on a ventilator.
What should I do to get my child ready to start in a new childcare setting?
You definitely need to begin to prepare your child before their first day. Make sure they have time to visit the center and play a little, so it's familiar. It can really help to read children's books about daycare together. Make sure your child gets to meet the new care provider before the first day.
When is my child old enough not to need care anymore?
There is no set age at which all kids are ready to stay home alone. You know your child best. Consider factors like:
- Can your child make good decisions?
- Do they know how to handle an emergency?
- Will they make good use of their time?
- How mature are they?
- Does your child know and follow house rules?
- Are they familiar with safety guidelines, such as what to do in case of fire?
- Are they comfortable using the phone and cell phone?
Moving your child to this level of independence is a process. If you think your child is ready, make sure they know all the important safety and house rules. Talk to your child about their feelings about being home alone. Start small, with short periods away, and gradually increase the time you are away if everyone is comfortable with it.
Children under age 7 should never be left alone. Kids ages 8-10 may be ready to be alone briefly, and ages 10-13 for longer periods, provided there is back-up supervision. Babysitters should be at least 12-13 years old, and can babysit for longer periods as they grow older. Again, this is a very individual decision, and these ages are only general guidelines. You need to decide if your child is mature enough.
What do I need to know about having an older sibling babysit for my younger kids?
If you plan to have your older child babysit for your younger children, it would be a good idea for them to take the American Red Cross babysitter class and become familiar with sitter safety information.
Additional resources:
- Tools to help in the search for quality care:
- Childcare Aware
- NAEYC
- Child Care Network
- Great Start to Quality
- Making Child Care Choices Count for your family (AAP)
- Choosing a child care center (AAP)
- When to keep a child home from daycare (AAP)
- How to Choose a Child Care Provider: 6 Tips from a Pediatrician (U-M Health Blog)
- COVID-19 Guidance for Operating Early Care and Education/Child Care Programs (CDC)
Reviewed by Andrea Buchi, MD
Updated by Sydney Ryckman, M.D. January 2022