With more two income families than ever before- “Who should take care of the children?” -has become one of the most heart-wrenching and challenging decisions facing today’s families. From au pairs to preschool, daycares to neighbors- making decisions about child care can be overwhelming.

The majority of the women in the United States with children younger than 1 year are in the work force. Most infants begin “nonmaternal” care before 4 months of age and receive such care for an average of almost 30 hours/week. By the time an infant is 1 year old, more than a third of infants have been in 3 nonmaternal care arrangements.Parents want to make the most informed decision about if and when to return to work and the best type of care for their child. Parents want to know what the short and long term effects of day care are and also have questions about the quality of day care.

Town and Country Pediatrics’ providers just like other pediatric medical offices are in the position to help parents make informed decisions about child care. The following information is designed to help you as a parent make a choice on child care. It is important to consider though, that no decision has to be final- being open to making changes as they fit your lifestyle may be needed.

Evaluating your child care needs

First things first- Should I go back to work?
Sometimes, the decision to return to work is not under parental control. In the U.S., maternal leave is typically 6 weeks for a normal delivery and 8 weeks for a caesarean delivery. The Family Medical Leave Act passed by Congress in 1993 requires employers with more than 50 employees to grant unpaid leave with protected job security for as long as 12 weeks to care for a newborn or newly adopted child. There are no clear guidelines for child care however, and pediatric experts advise parents to make the best decision that fits with the family’s philosophy and needs in relation to income, career path and desire to be at home or work. The experience for both infant and parents will likely be beneficial, provided that the child care provided is stable and of good quality, the parents are content in their work and their decision about day care, and that the time that the child spends in day care is not excessive. Sometimes the decision is based on income- perhaps it will cost more for child care than the parent can earn at his/her place of work. However, it may be important for the parent to pursue his/her career goals, provide for the family, and still play the role of caregiver. If the decision is made to return to work or continue working there are many factors to consider- the most important of which is the following.

Your child(ren)’s needs
Do your children have any special needs, such as dietary requirements, wheelchair access, developmental or educational needs? Is your child exceptionally gifted, or have dyslexia or attention deficit-conditions that may necessitate an appropriate program to enhance their learning process. If you have more than one child, is it important that they attend the same program?

Your schedule
It is important to be realistic about your schedule. First choose the basic hours that you will need child care. Then consider the location of the facility-how close is it to your home? work? Does the facility have extended hours in case you and/or your partner get stuck at work? Is there a back up plan?

Your budget
There is more than a hourly or weekly fee involved with child care-You must factor in the gas, lunches, snacks for your children if they are not included in the fees. You may have to provide for your sitter’s food, gas, or public transportation if this benefit is negotiated. If you have an in home care provider- who will pay for taxes? Will you budget for income tax credits; charges if you pick up your children late, or nights, weekends; application fees; contracts? Will you pay for a background check? A less expensive program or provider may be cheaper for a reason- the quality may suffer. Are you willing to pay more for a better provider to child ratio, more flexible hours, a better location and a more intensive learning/resource program?

Types of Day Care

In home care
This category includes anyone watching children in your home- from grandparents to nannies to an au pair to a teenage neighbor. Unlike family or center care, in home providers do not need to be licensed through the state. The advantages – child can be cared for in his/her own environment, more individual attention, possibility of flexible scheduling, and possibility of care if the infant is ill. Also you may not need to worry about transportation if the caregiver is able to get to your home. The disadvantages-tends to be the most expensive if a sitter is hired to come to your home. There may be a burden of executing extensive background checks and references, to determine if the caregiver is responsible. Children may miss out on supervised play with other peers and more structured physical and academic programs provided by agencies and centers. If your caregiver is sick or on vacation- back up care is needed.

Family Day Care
This category typically includes an adult watching children in his/her own home. Family care providers must be licensed through the state and generally cannot accommodate more than 10-12 children by law. They must adhere to the standards upheld by Department of Child and Family Services (DCFS) – see section on Standards of Care. The advantages: your children may be more comfortable in a home setting even if it is not their own, they may be more flexible about drop-off and pick-up times and the cost may be considerably lower than in-home care. There may be opportunity for interaction with peers. There will probably be a smaller number of children than larger centers. The disadvantages: more chance of your child contracting communicable illnesses. This factor may lead to missed days of work as the day care will restrict access to a sick child. In addition, resources and equipment may vary depending on what is available at the home. It also may be necessary to determine if the center is in compliance with DCFS standards and has been licensed.

Child Care Center
This category includes non home state licensed facilities. Most centers provide structured academic programs dividing the children up into several peer groups for more age-specific care and activities. The advantages: training and supervision of staff, great resources and equipment, care is available if someone on staff is on vacation or ill, children will get lots of peer interaction. The centers have to be certified and licensed by DCFS. The disadvantages: Your children may get less individual attention from providers since there are more children to be supervised. Most centers have set hours, leaving you to work around their schedules, instead of the other way around. Your children are most at risk than any of the other categories of contracting communicable illnesses. This may lead to missed work again as the child may not be asked to return “until symptom free”. Some may even require a doctor’s note necessitating a trip to the pediatrician as well.

Testing out your child care choice- “a trial run”

Whichever choice for child care you make it is important to plan some time when both you and your child can do a “trial run” - visiting the facilities or observing interaction between the care providers and your child. It is normal for children to need time to adjust to new surroundings, providers and other kids. If the child does not adjust after the first few weeks, it may be necessary to revisit another option. The most important factor to consider is….follow your instincts. When you find the right provider, you’ll know it.

In home care
If your choice is an in home care provider- you will need to interview multiple candidates in order to decide on the best person. Will you need an agency, rely on word of mouth, or receive a referral through the newspaper or friend? It is wise to consider your criteria before the baby is born. A plan of action is important before you go in to the hospital to have your baby. Get out and go to places where children congregate- parks, playgrounds, etc. Spend some time observing how they interact with the children. It is probably a good guess that these people will want to strike up a conversation with you, if for no other reason than to ask how you are feeling or when you are due. This will give you an opportunity to ask them about their work, what they do why they became a nanny- tell them you are looking for a nanny- start your “nanny network”. “Go with your gut”-if you do not like anything about any interaction with a nanny- believe your instinct.

Sample Interview questions for your prospective nanny

1. Why do you wish to be a nanny?
   - look for an answer like –love children, realize it is a big commitment
2. What are your child care experiences?
   - past jobs
   - formal training/classes/degrees
   - Why did you leave previous job(s) as nanny?
   - obtain 3-4 references
   - Why do you wish to take care of children in a home as opposed to a day care center?
3. Have you ever handled a medical emergency with a child?
   - certification in CPR/First Aid
   - TB skin test (confirm exposure to TB)-may be performed at Town and Country
   - immunizations up to date- ever had chicken pox?
   - Walk me through the steps you would follow if my child fell down the steps or started choking?
4. What would you do if my child is sick? Will you still come to work?
5. What will you do if you are sick?
6. If you wish you could ask the nanny to indicate whether or not she has ever had any of these medical conditions/problems?
   - asthma -anorexia/bulimia -AIDS/HIV
   - cancer -diabetes -Epilepsy/seizures
   - fainting -heart disease -hepatitis
   - herpes -high blood pressure -sexually transmitted diseases
7. Are you currently taking any medication?
8. What are your child rearing philosophies?
9. How would you handle a temper tantrum in a store/playground? In our home?
   - firm yet gentle and nurturing
10. How do your punish/praise/comfort children?
11. What is your philosophy on discipline?
    - it is important that you share her/his same philosophy- if you are fairly laid back and casual or rigidly methodical it is important to find a sitter with a similar disposition
12. Supply her/him with job requirements?
    - sound like something you could handle?
    - discuss withholding of taxes
    - hours, responsibilities, days off, overtime, vacations, salary, benefits
    - benefits may include health insurance, car insurance, cell phone
    - in “x month/year” one of the children will be going to preschool/kindergarten and your responsibilities/hours may change
13. What are your hobbies/interests?
    - athletic or musical sitters may inspire the same in your child
    - explain the family’s hobbies/interests/philosophy/religious beliefs
14. What qualities are you looking for in a family? Employer?
15. Do you have any pet peeves about parents/children that you have worked with before?
16. What was your childhood/upbringing like?
    - what are your memories from childhood? How is your current relationship with your family?
17. Do you smoke? Drink?
18. Can you read?
19. Can you drive? Do you have a license? Auto insurance? Driving record?
    - extra child safety seats
    - mileage reimbursement policy
    - inspect the car if the nanny will be transporting the children in the car
    - if the car is supplied, discuss frequency, cost, and restrictions
20. Do you have any dietary/other restrictions? Allergies?
21. What is not so desirable about being a nanny?
    - What do you find to be the most challenging (or interesting) part of working with children?
22. What do you see as your primary responsibility for my child(ren) –considering their ages?
    - What types of indoor educational activities/outdoor play would you suggest?
    - How much television do you think a child this age should be allowed?
    - What television programs? No television for the sitter is this okay?
23. Are you willing to supervise play time with other children in our home and/or take our child to an activity?
24. What will you do with yourself while my child(ren) are sleeping?
    - personal phone calls, visits from significant others/other children
25. What are your favorite TV shows?
    - some parents ask this question and cross candidates off the list if they name a lot of daytime programs
26. Are you willing to do any light chores while baby is sleeping? Which ones?
    - Would you be comfortable cooking some of the children’s meals?
27. Will you ever be available to work evenings?weekends?
28. Will you be available to travel with family for weekends/vacations?
29. Have you ever had a disagreement with a parent about childrearing and how did you handle it?
    - what was your worst experience in childcare and how did you fix it?
30. Did your previous employer encourage you to sign a written contract? Would you be opposed to signing one with us? If we were to hire you, are you prepared to make at least a one-year commitment to staying with our family?
31. Are you willing to undergo a background check at our expense?

Explain to her that you want to hire her well before you go back to work.
A minimum is two weeks before (plan for this financially, now). During that time, while you’re still at home, observe her, as opposed to directing her. You want to see the kinds of judgments she’s going to make when you’re not at home. You want to know if she’s trustworthy and worth your time and money.

Some other factors to consider:

• If a candidate talks of salary or benefits upfront, they should not be considered for employment.
• If the children are present during the interview – is the sitter paying attention to them and attempting to interact with them appropriately?
• Explain to the prospective candidate that being a nanny entails the highest personal demands and involvement for all parties- in this respect it is very important that you feel comfortable “in the right family”.
• While you are at work- will you feel at ease knowing your child is at home with her?
• Go with your “gut”-follow your instinct.

Child care center
A site visit is wise before you have the baby, many agencies or centers have waiting lists necessitating money down before your baby is even born. Make an appointment for a 60-minute or longer visit at the day care you are considering. Spend 20 minutes walking around to check out the physical environment.

From the outside, check to see if the day care is situated in a safe environment and has designated areas and equipment for outdoor play. See if the classroom is clean, safe, orderly, organized into interest areas and oriented towards children’s activity based on developmental level.

• Does it have sanitary bathrooms and diaper changing areas?
• How do the toys look?
• Are they age appropriate, educational, and mentally challenging?

Observe classroom activities. Pay attention to the teachers, the children, their interaction, and the educational program.

• Do teachers devote enough attention to and engage in conversations with each individual child?
• Are the teachers interested, responsive, and playful?
• Do they practice creative play?
• Do they practice good hygiene?
• Do they possess previous experience or training in working with children?
• Are the room temperatures comfortable?
• Are there rounded table corners and other furniture safety features?
• Are healthy snacks or meals featured?
• Are cleaning materials kept safely out of reach?
• Is their license or registration certificate on file?
• Are the rules clearly explained?
• How is good behavior encouraged and not so good behavior handled?
• Do you see laughing, caring, sharing and generally happy children?

Child Care Safety Checklist

All day care centers should be in compliance with these safety regulations.

Cribs
Make sure cribs meet current national safety standards. Government manufacturing standards set in 1973 have greatly improved crib safety so most new cribs sold in the U.S are very safe. Despite this, cribs continue to be associated with the highest child injury rates of any nursery item. Approximately 50 infants each year are killed and another 9000 are injured in crib-related accidents in the U.S.

• The vertical bars or slats must be no further apart than two and three-eighth inches or 60 mm, to prevent infants from slipping through or becoming stuck between them. An infant's head is relatively larger than the rest of his body and could become stuck between bars that are too far apart if his body slips through. Any openings at the end walls of the crib, such as decorative cutouts, must not exceed 2 3/8 inches, because they might also allow an infant's body to slip through. If a vertical bar on a crib side is broken off, the gap between the remaining bars will likely be dangerous to an infant inside. Be sure the crib bars are sturdy and intact.
• Injury can also occur if an infant crawls or climbs over the side of a crib. Be sure the top of each crib side is not less than 9 inches at its lowest position and 26 inches when raised.

Soft Bedding
Be sure that no pillows, soft bedding or comforters are used when your baby is laid down to sleep. Babies should be put to sleep on their backs in a crib with a firm, flat mattress.

Playground Surfacing
Look for safe surfacing on outdoor playgrounds – at least 12 inches of wood, chips, mulch, sand or pea gravel or mats made of safety-tested rubber or rubber-like materials.

Safety Gates
Be sure that safety gates are used to keep children away from potentially dangerous areas especially stairs.

Window Blinds and Curtain Cords
Be sure miniblinds and Venetian blinds do not have looped cords. Check that vertical blinds, continuous looped blinds and drapery cords have tension or tie-down devices to hold the cords tight and inaccessible. Check that inner cord stops have been installed.

Clothing Drawstrings
Make sure that when your child is dressed for the day- there are no drawstrings around the hood and neck of children’s outerwear clothing. Other types of clothing fasteners like snaps, zippers or hook and loop fasteners (Velcro) should be used.

Recalled Products
Check the website www.cpsc.gov for recalled items that may be in use at the center.

Standards of Care

The Department of Children and Family Services (DCFS) is responsible for licensing day care centers. When a day care is licensed, it means that a DCFS licensing representative has inspected the center and the center was found to meet minimum licensing requirements. A license is valid for 3 years. The day care center’s license must be posted. The sign should indicate the maximum number of children that are permitted in the center. A toll free information line provides information to the public on the past history including violations of licensed day care homes, day care centers and group day care homes. This number is 1-877-746-0829. Some of the standards are listed here in printed form and a complete list is also accessible at http://www.state.il.us/dcfs/daycare.

• The day care center must have a qualified child care director on site at all times. The director must be at least 21 years old, have completed 2 years of college or have equivalent experience and credentials.
• Early childhood teachers must be at least 19 years old, have 2 years of college or have equivalent experience and credentials.
• School-age workers must be at least 19 years of age and at least 5 years older than the oldest child in their care. They must have completed 1 year of college or have the equivalent experience and credentials.
• Early childhood assistants and school-age assistants must have a high school diploma or the equivalent and must work under direct supervision of an early childhood teacher or school-age worker.
• The director and all child care staff must have 15 hours of in-service training annually.
• All staff must have current medical reports on file and are subject to background checks for any record of criminal conviction or child abuse and neglect.
• A person certified in first aid including CPR and the Heimlich maneuver must be present at all times.
• Parents must be allowed to visit the center without an appointment at any time during normal hours of operation.
• Children may not be left unattended at any time.
• A refrigerator and sink must be easily accessible.
• Toys and indoor equipment must be cleaned and disinfected daily.
• Either the day care center or the parent may provide food for infants not consuming table food. Feeding times and amounts consumed must be documented in writing.
• No food other than formula, milk, breast milk, or water may be placed in a bottle for infant feeding. Microwaves are not to be used for bottle warming.
• Play space must be fenced or otherwise enclosed or protected from traffic or other hazards.
• Protective surfaces must be provided under equipment from which a child may fall.
• During hours of operation and at all times that children are present there must be a means for parents of enrolled children to have direct telephone contact with a center staff person.
• Infants must sleep in safe, sturdy free standing cribs or portable cribs.
• Toddlers may use either stacking cots or full size cribs.
• Infants and toddlers must be housed and cared for at ground level unless special approval has been granted from DCFS.
• Toilets and lavatories must be readily accessible to the children.
• Exits must be unlocked and free of equipment and debris.
• Drills for fire and tornado must be conducted. A floor plan must be posted in every room indicating the areas providing the most safety in the case of a tornado and the primary and secondary routes in the case of fire.
• Smoking or the use of tobacco products in any form is prohibited in the presence of children.
• First aid kits must be maintained and readily available for use.
• Children who cannot turn over alone must be place on their sides or backs.
• The facility must have a clearly defined diaper changing area with the procedure for changing diapers clearly posted. A hand washing sink must be accessible for handwashing. Staff changing diapers must wash their hands and the child’s hands with soap and running water after diapering.
• Information about feeding, elimination and other important information should be provided to parents at the end of the day.
• Daily arrival and departure logs must be kept by the center.
• Parents must be given a copy of the guidance and discipline policy.
• The following are prohibited: Corporal punishment, threatened or actual withdrawal of food, rest or use of the bathroom, abusive or profane language, public or private humiliation, emotional abuse or isolating the child.
• “Time out” is to be limited to one minute per year of age. “Time out”may not be used for children less than 2 years of age.
• Age appropriate safety restraints must be used when transporting children in vehicles other than school buses.
• A medical report indicating that the child has been appropriately immunized must be on file for each child. A tuberculin skin test is to be included in the initial exam unless waived by a physician. The medical report is valid for 2 years for infants and preschool children.
• Children aged 1-6 years of age must have either a lead risk assessment or a lead screening.
• Water must be freely available to all children.
• Children’s hands must be washed with soap and water upon arrival at the center, before and after meals or using the toilet, after wiping or blowing their noses, after outdoor play, and after coming into contact with soiled objects.

Conclusion

High-quality child care will provide a healthful environment, educational opportunities, and a setting for favorable social and emotional growth for your child while you work. Make sure you're getting the best care possible for your child. Five steps to follow when choosing child care include:

1. Begin looking early. Finding the right care can take some time, so start your search early.
2. Make a phone call, either to the state of Illinois to check licensing 1-877-746-0829 or a background check.
3. Plan a visit and ask lots of questions! Or ask questions of babysitter candidates via comprehensive interviews.
4. Make a “best fit” choice – the choice should fit your family lifestyle and philosophy.
5. Continue to be involved – Have parent-caregiver meetings regularly, and ask questions. Offer to volunteer time at the center when needed, like participating in clean up days, fixing broken toys. Be there for your child’s party. Visit your child at child care and read a book aloud. Once the child care choice is made, it is a critically important experience in the life of a child.

Links

www.naeyc.org - National Association for the Education of Young Children
www.workingmother.com - Provides info for working parents on a variety of topics
www.parents.com
www.zerotothree.org
www.cpsc.gov
www.kidsindanger.org
www.state.il.us/dcfs/daycare - Website for DCFS
www.naccrra.org - National Association for Child Care Resource and Referral Agencies
www.business-at-home-network.com/daycare - Start your own daycare. Then you can stay home and earn a living at the same time!