Choosing Child Care

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Enlisting qualified, nurturing caregivers is one of the best things you can do for both yourself and your child. Here’s how to find someone you want to trust with your most prized possession. From Drs. Michael F. Roizen and Mehmet Oz, bestselling authors of YOU: Raising Your Child

We’ve all heard the expression “It takes a village.” Part of your job as a parent is to create that special community for your child. Your village will include you, a partner if you have one, as well as grandparents and other family members who will interact with your child regularly. It may also include a nanny, day care professionals, and an assortment of occasional babysitters or mother’s helpers. Enlisting qualified, nurturing caregivers is one of the best things you can do for both yourself and your child. For one thing, every parent needs a break now and again — either to revive the romance in your relationship that led you to become a parent in the first place, or simply to recharge your batteries so you can return to diaper duty relaxed and refreshed. For another, it’s vitally important for your child to interact with adults other than you in order to learn how to socialize and to separate, skills that she’ll need to successfully start school. Unfortunately, not all caregivers are created equal, and it’s important to choose carefully and to pay close attention to the signs your child gives you after spending time with each one to know whether or not this is someone you want to trust with your most prized possession.

Choosing a Nanny.
Many people hire a nanny either because they prefer the convenience and individual attention a nanny can provide or else because, with multiple children, it may end up being more economical than day care. The key thing to remember is that, whether the nanny lives in or out, or works part time or full time, she is someone you are inviting into your home and your family. It’s a very intimate relationship, but it must also remain professional.

The most important criterion for a nanny is that she share your ideas and values about child rearing. That is best determined not only in a personal interview but also while watching her interact with your child. Accordingly, we suggest hiring her for a trial day before you seal the deal. Of course, you’ll also check all references, and in conversations with her former employers listen for nuances carefully. What is her approach to discipline? Nutrition? Sleep? TV? Is she a homebody or does she like to spend time outdoors? Is she someone who will take the initiative to make playdates for your child, take her to the zoo, the park, or enrichment classes? How are her language skills? Is she comfortable reading to your child and playing number games? Does she talk or sing to her, or does she spend more time chatting with friends on her cell phone?

As wonderful as a nanny may be with your child, it’s also important that you find someone who meets your needs. If you work long hours, can she come early and leave late, or does she have family obligations of her own? How is her health? Is she energetic enough to care for a young child? Does she know CPR? If not, you should arrange for her to take a class. If you need her to travel, is she comfortable doing so? Will you require her to do additional household chores, such as shopping, cooking, cleaning, or laundry? Be up-front about your expectations, as well as about salary, vacation, and sick days. And don’t hesitate to run a background check, including of her driving record if she will be driving your child. Finally, when you do reach an agreement, include a trial period of a few weeks; it gives both of you the chance to opt out if it looks like the arrangement isn’t working.

By the way, surveillance cameras, or “nanny cams,” are legal in all fifty states, but in some states it is not legal to record voices, so check before you do. If your nanny finds out that she has been secretly recorded, it may damage the trust on which your relationship is based; a better alternative is to be up-front about your intention so she knows you’re just doing due diligence.

Choosing a Day Care Center.
Day care can be an excellent choice for many reasons: It can be more affordable than a nanny. It can be more reliable; you don’t have to find coverage when the nanny is out sick or on vacation. And it can be more socially enriching, even if it provides less one-on-one attention. Again, the most important thing is to find a day care center that reflects your philosophies and values in terms of the level of structure, the approach of the providers, and the policies on nutrition, sleep, discipline, and TV. While all day care facilities must be licensed (if it’s not, don’t even consider it), requirements vary from state to state. In addition, check to see if the facility you’re interested in has been accredited by the National Association for the Education of Young Children or the National Early Childhood Accreditation Program, or if it has won any local award or recognition. Other key elements to discuss on the telephone with the director and confirm upon visiting include:

  • Child-to-staff ratio: The American Academy of Pediatrics recommends the following: Age: Birth to 12 months
    Child-Staff Ratio:
    Maximum Group Size:

    Age: 13 to 30 months
    Child-Staff Ratio:
    Maximum Group Size:

    Age: 31 to 35 months
    Child-Staff Ratio:
    Maximum Group Size:

    Age: 3 years old
    Child-Staff Ratio:
    Maximum Group Size:

    Age: 4 to 5 years old
    Child-Staff Ratio:
    Maximum Group Size:

  • Staff qualifications: In addition to being cheerful and loving, the staff should have a minimum of two years of college, with training in early childhood education and knowledge of first aid, including CPR. Ask about ongoing faculty development opportunities as well as the average length of tenure or rate of staff turnover.
  • Safety and cleanliness: Is the facility light and airy? Are there safe indoor and outdoor play spaces? Are the walls, floors, kitchen area, and bathrooms clean? And while you’re looking, are there developmentally appropriate pictures on the walls, or is it all signs saying, “Don’t Do That,” or pictures with a big X on them? Do the decorations stimulate or stifle creativity? Are the toys clean and in good repair? Are there visible first aid kits, fire extinguishers, smoke detectors and carbon monoxide detectors? Is there a childproof storage area for cleaning materials? Does the staff wash its hands after changing diapers and before preparing meals? How often do the children wash hands?
  • Clear policies: The center should have clear policies on everything from drop-off and pick-up procedures to fees, health, and vaccination requirements. If your child is sick, can you be reimbursed for missed days? And when is it okay for her to return to day care? Most important, the center should have an open-door policy for you to drop in unannounced to check on your child. Some facilities even have cameras set up so you can watch your child from your computer.
  • Scheduled activities: The best day care facilities have scheduled times for indoor and outdoor play, snack, meals, and naps or rest. Ideally, preschool-age children should have two hours a day of active play, including two visits a day to an outdoor play space, weather permitting. TV and video watching should not be on the schedule. Rather, there should be plenty of opportunities for creative play, including arts and crafts, music, story time, as well as games involving letters and numbers.

As with any child care arrangement, check references — in this case, current and former parents. Also, in addition to visiting the day care center yourself, visit a second time with your child and gauge her reaction to the staff and environment.

Home-Based or Family Child Care.
Some people prefer family child care to day care because it is less formal, includes fewer children, allows for different-aged siblings to be cared for together, and is in a home environment with a single caregiver. It is also less expensive. Most states require regulation of providers who care for more than four children, including background checks; ongoing training in early childhood development; minimum health, safety, and nutrition standards; and regular or random inspections. Nonetheless, you still have to do your homework, which includes checking references, inspecting the home to make sure it is smoke free and at least as safe and clean as your own, and confirming that there are age-appropriate toys and books and that children are not parked in front of the TV. If there are pets in the home, make sure they are well trained and that your child does not have an allergic reaction. Confirm that the children are never allowed outdoors unsupervised, especially if there is a swimming pool or hot tub. (Watching from the kitchen window doesn’t count.) And don’t be afraid to drop in for a random spot check to make sure everything is as it should be. Home-based child care providers may be accredited by the National Association for Family Child Care.

Babysitters and Mother’s Helpers.
Chances are, even if you are a fulltime mom, you’ll want to go out to a movie or run an errand sometime in the next five years and will have to hire a babysitter. Or you may find you want someone else to watch Junior for a couple of hours while you clean out your closets in peace. In these cases, babysitters and mother’s helpers are ideal. They’re not expensive, they don’t require a big commitment, and they usually have tons of energy and think it’s really fun to take care of kids. Mother’s helpers are traditionally preteens who provide an extra pair of hands while you’re still in the house. Babysitters are slightly older and more experienced, either from having been mother’s helpers themselves, having babysat other children, or having cared for younger siblings.

While there are certification classes for babysitters, an enthusiastic, intelligent, responsible teen doesn’t require certification (unless you want her to know CPR). You may have to teach her how to warm a bottle or change a diaper the first time around. Depending on your comfort level, you can allow her to bathe or cook a simple meal for your child or, if she is old enough, to drive Junior to an activity.

And on a very serious note: While there are wonderful male baby sitters out there, we do not recommend them. With boys, there’s a 1 in 6 chance that they’ve been sexually abused as children. With girls, there’s a 1 in 4 chance. But here’s the difference: Boys who are abused tend to take it out on another victim, while girls tend to be depressed and take it out on themselves. We’re not saying that males cannot be good caregivers, but if you’re playing the odds with people you don’t know (and perhaps even people you do), the evidence simply shows that your child is safer with female sitters.

The most important thing is to always leave your sitter with your cell phone number, numbers for a couple of neighbors and relatives, and the numbers for your pediatrician and for Poison Control. By the way, if you’re at a movie, put your cell phone on vibrate and instruct the sitter to call only in an emergency.

Michael F. Roizen, M.D., is a four-time New York Times number one bestselling author, and is cofounder and originator of the very popular website. He is chief wellness officer and chair of the Wellness Institute of the Cleveland Clinic and chief medical consultant of The Doctor Oz Show. Mehmet Oz, M.D., is also a New York Times number one best-selling author and Emmy Award-winning host of The Dr. Oz Show. He is professor and vice chairman of surgery at New York Presbyterian Hospital/Columbia University Medical Center and the director of the Heart Institute. They are the authors of YOU: Raising Your Child (Copyright © 2010 by Michael F. Roizen, M.D., and Oz Works, LLC).




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