Finding Appropriate Day-Care By Timothy J. Patrick-Miller, M.D and Mark B. Levin, M.D. The Pediatric Group, P.A., Princeton

This is the thirtythird article in a series written for Princeton Online. Click here for an archive of other articles.

Finding an appropriate child care setting is a challenge for even the most diligent parents. Many of us work outside the home and must find care for our child(ren) while we are away. We want something that will offer our child a safe, loving environment. Once we have found a setting with which we are comfortable, we always worry about the consequences of our choice when our child falls ill.

Your first step is to select a setting that meets your needs. As child care is a substitute for parental presence, the ideal situation is a one-on-one person in your home:

This is usually the most expensive option and the hardest to find. It also raises issues of trustworthiness, not only with respect to your belongings, but also regarding the care giver being alone with your child without other adults nearby to watch, supervise or help. We have all read about parents installing video cameras in their home in an effort to check on the potentially misguided child care employee. Fortunately, the need for this is rare. Like hiring someone for any other position, you must approach this with a job description (will the person change diapers, be sympathetic and loving when your child needs a hug, keep up your routine so the baby does not have to make a big adjustment). Interview the prospective job candidates regarding their experience and skills, check out references and be sure you have thoroughly explored how to handle emergencies (Does the person drive? Do you have an extra car seat for the baby? Does the child care person know infant CPR?).

It makes sense to maximize your chances of finding the right person by starting with reliable sources. Referrals from friends are fine, if they are willing to share their information. If you are close to a hospital or nursing school, nurses who are trained in pediatrics are a good bet. They know CPR, drive and are responsible people who are often looking for extra sources of income after their shift work. Graduate student, especially if they have their own young child, may be another valuable resource. Once you have decided on someone, have them come to your home before you start work to be with your baby under your watchful eye. This way you can be sure that your child adjusts comfortably to the new caretaker and you are happy with the care taker.

The ultimate one-on-one is the live-in care taker. A nanny typically will cook and do housework, as well as child care. It is important to clarify what you expect regarding the balance between these responsibilities. Too many chores will take away from a quality interaction between your child and the caretaker. A certified nanny hired from a licensed reputable agency is a better bet than one without these references. An au pair, typically a foreign older teen or young adult who comes to the United States to earn some money and travel, is not as good a choice. Au pairs are usually not trained in child care and are unfamiliar with emergency procedures. They may decide to leave after a short time and may not be very sympathetic to your child. There are always exceptions, but most of the complaints we hear in this setting involve au pair employees.

The most available and least expensive option (although by no means cheap) is a day care center:

Here, six or more children are supervised by multiple child care workers. Find a place that has been licensed by your state. That way you can be sure that the facility complies with safety, staff qualification requirements, worker-to-child ratios, cleanliness and health standards and program activities. If you can find a place conveniently located near your home or work, or at least on the way between the two locations, you will be happier. As with an in-home care taker, you should observe the facility in action before placing you child in it (look for care taker interaction with the children, as well as at available opportunities for learning and creative expression), obtain and check out references, inquire about food, transportation, emergency procedures and sick child protocols (will they take an ill child or do you have to leave or miss work to tend to your child during an illness? will they administer medication?), drop off and pick-up times, vacation schedule and fees.

The main disadvantage to a multiple child care setting is spread of respiratory and gastrointestinal infections. Viral illnesses, and the consequent secondary infections (ear infections, for example) are more common in day care. If your child is prone to ear infections, you would be well advised to choose a setting with fewer rather than more children. On the other hand, recent research suggests that early viral infections may protect against later development of asthma. Regardless of the setting you choose, insist on good handwashing, as this is the primary way to prevent spread of germs.

An intermediate solution, both in terms of cost and availability, is family day care:

The criteria you should use for this situation are the same as for the two listed above. Many states will also license this situation. If you can find a licensed caretaker, it is to your child's advantage to use that person for the same reasons listed above.

Whatever setting you choose, be sure you clarify that children should never be left unattended. You should start your search early, as many centers have long waiting lists. In New Jersey, you can obtain a list of all licensed canters from the Bureau of Licensing in the Division of Youth and Family Services (DYFS). You may also be able to find information from the yellow pages in the telephone book (check under the headings "Schools" and "Day Nurseries and Child Care"), classified ads in the newspaper and at libraries, extension services, places of worship and community groups.

If you are often away from your phone at work, you may wish to carry a beeper in case day care personnel wish to reach you.

Parents who place their child in day care often worry about the child's emotional development.

Because there are so many families with parents who work outside the home, extensive research has been done to assess the effect on the children. Emotional difficulties are not found with increased frequency in these children, unless a parent is having emotional difficulties. If parents are satisfied with their reasons for wishing to work, the child is likely to show no adverse effects. Children in day care, however, do tend to be more self-confident and independent. Although these qualities may make parenting more difficult in the early years, they are beneficial to the child in the long run. Research also makes it apparent that the quality of the time parents spend with their child that is more important than the quantity of time. Even parents who are in the home with their child often spend up to 95% of their time on non child-related activities (chores , etc.). Available time can be increased by strategies such as pre-preparing meals, parents taking turns with housework, or hiring someone else to do some of the chores.

Questions about breast feeding an infant upon return to work, your child's emotional interests and whether your criteria regarding day care selection are sound are best discussed with your pediatrician because the circumstances vary greatly from family to family. Although child care selection is a difficult choice, with careful assessment and consideration of the above, you can maximize the chances that you and your child will be happy.

Resources:

Choosing a Child Care Center, published by the New Jersey Department of Health and Human Services, Division of Youth and Family Services, One S. Montgomery Street, CN 717, Trenton, NJ 08625; tel: 609-292-1018

Division on Women,, NJ Department of Community Affairs, 379 W. State Street, CN 800, Trenton, NJ 08625; tel:609-292-8840

State Child Care Advisory Council, One S. Montgomery Street, CN 717, Trenton, NJ 08625; tel: 609-292-0406

Dr. Mark B. Levin 

Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.

Dr. Timothy Patrick-Miller Dr. Patrick-Miller has been a member of the staff at The Pediatric Group since 1985. Dr. Patrick-Miller has served on several Departmental and hospital committees. He has published original work while at The Pediatric Group. He and his wife enjoy travel. He also likes hiking, biking, gardening and reading.

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