Why the interest in daycare at my child’s check up? Do those questions that my health care provider keeps asking about my actual or intended child care situation really have anything to do with my child’s health?

Over the past few decades, families have gradually begun to rely more and more on non-family members for child care as both parents enter the work force. Many infants and children that we see at clinic spend eight to ten hours a day during the work week being cared for by someone other than a parent.

In these cases, and sometimes even when the amount of time is significantly less, the child care situation often has a huge impact on the overall health and development of these children.

As health care providers, we recognize that parents want the very best care they can find for their children; whether it be for health care or daily child care. Finding affordable, high quality child care can be one of the biggest challenges a family faces. One way to make the process of looking for child care less stressful is to think about what type of child care situation will best meet the needs of you and your child.

There are basically three types of child care:

• In home care. A caregiver comes into your home. This type of care is generally more expensive than the others.

• Family child care. Your child goes to the caregiver’s home. The American Academy of Pediatrics (AAP) recommends that a child care home have no more than six children (including the caregiver’s own children) per adult caregiver. The total number of children should be fewer when infants and toddlers are included.

• Center-based care. You take your child to a place that is organized and staffed to take care of groups of children. Centers usually have different rooms for the various ages of children. Group size/ caregiver ratio should meet standards.

Start looking for child care at the earliest date possible. For example, look for care before the birth of a new baby instead of after. Ask friends, relatives and coworkers for suggestions. Often communities have free referral services.

Look for home daycares/centers that are licensed and accredited. To be licensed, a daycare only needs to meet minimal standards. Accreditation means that an outside observer has evaluated the daycare and has determined that criteria have been met for high quality child care.

High quality child care has certain common characteristics regardless of the type or setting of the care. It is helpful for parents to be aware of these as they begin searching for child care and also as they continually re-evaluate their current child care. Four characteristics common to high quality child care are:

Appropriate caregiver/child ratio and group size.

National standards have been set. State licensing regulations can be reviewed on the National Resource Center for Health and Safety in Child Care website at nrc.uchsc.edu. The national standard for infants is one caregiver per three infants from birth to twelve months.

The national standard of toddlers is one caregiver per four toddlers from 13 months to 24 months. The AAP recommends that no caregiver working alone should care for more than two children younger than two years old.

Appropriate caregiver/staff training. This should include:

• Child developmental stages/theory (the types of behavior and activities that are typical for a certain age group).

• Techniques for positive effective discipline. (No  corporal punishment should be allowed.)

• Illness recognition.

• Cleanliness and safety standards.

• First aid and response to emergencies (CPR and choking).

• Home and center evacuation in case of fire/emergencies.

Appropriate physical environment.

• Adequate space for the number of
children.

• Adequate diapering area—space and separate sinks for cleanliness.

• Proper furniture that meets safety standards. Separate cribs for naps.

• Outdoor play area. Daycares should have an outdoor play area that is well maintained with safe equipment.

• TV/video time should be strictly limited. The AAP recommends no television for children less than two years old and no more than one to two hours of non-violent TV for children older than two years.

• Meals. Is there adequate space? Are meals nutritious?

• A smoke-free environment.

Appropriate and clearly stated policies and goals.

• Curriculum should be appropriate for the developmental age of the children.

• Health records (immunization records, etc.) should be maintained.

• A medication policy for giving prescription medications as well as giving over-the-counter medications should be clearly stated.

• An illness policy should be in place in the event that a child or caregiver is ill.

• An open door policy for parents should be implemented that states parents will be welcome to drop in any time unannounced.

• Other miscellaneous policies may cover issues such as: who has access to your child outside of the actual caregivers, are there other people in the home or center who will come in contact with your child and what is the nature of that contact? For example, do older children or teenagers help with the care of the children?

• Communication. Any formal policies?