Choosing Child Care

Topic Overview

What is child care?

Child care is short-term care by someone other than a parent. There are two basic types of child care: individual and group.

  • Individual providers care for only your child or children. Examples include a family member or friend, nanny, au pair, or babysitter.
  • Group providers care for your child and other people’s children. Your child may attend a small or large home day care, a child care cooperative, or a child care center such as a preschool or Montessori school.

Finding good child care can seem overwhelming and a bit scary. It is an important decision. But if you take your time and do some research, you can find a place where your child can play, learn, and be well taken care of.

How can you find good child care?

When choosing child care, consider your child's safety, how much you can afford to pay, and your daily routine. Finding high-quality care that fits your child's needs takes time and research.

When choosing child care, make sure that it is:

  • Safe. Check that it is licensed with your state and county (also called registration or certification). But licensing guidelines vary by state. So make sure that all care providers know how to handle emergencies and are trained in first aid and CPR. Also, ask for references. Get the names of people and agencies you can talk to about the care center’s safety record.
  • Right for your child's age, skill level, and natural outlook. Ask what ages of children go to the care center. Think about whether your child would do best at home, in a family home setting, or in a group center. For example, a child who makes friends easily may do well in a group center. A shy child may do better in a small, home-based center.
  • Right for your family’s values. Ask what kind of learning programs the center has. Think about whether these fit with your family’s beliefs and values.
  • Well staffed. Make sure there are enough staff members to care for the number of children at the center. Ask if caregivers are able to give each child one-on-one attention as needed. Check that the main caregivers and program directors are trained in child development and have a college degree or are otherwise highly experienced. Also, find out how long staff members have worked there. It can be upsetting for a child if the staff changes often.
  • Caring. Watch how the staff works with the children and if they are kind and caring with them.
  • Affordable. In the United States you can deduct part of child care costs from your state and federal income taxes. Your employer also may offer benefits or help with child care, or you may qualify for a reduced rate at some child care centers.
  • Reliable and consistent. You'll want to know that your provider will be available when needed. Have written agreements outlining specific hours, holidays, and other breaks.
  • Convenient. Think about the location of the care center, whether traffic will slow you down, and whether the hours work well with your schedule.

What if your child has special needs?

Federal and state laws allow equal access to public education and other services such as speech and physical therapy for children with disabilities or certain conditions that require special care. Find out which laws apply to your child and how to get available services. See the Community Services or Government listings section in your local telephone book for the local mental health office or state department of education.

How can you help your child get the right start?

Children need time to adjust to child care. It is common for a child to cling or cry when a parent leaves. But you can take steps to help your child do well in child care:

  • Prepare yourself and your child. It may help if you both get used to spending time apart. Hire a babysitter or ask a friend or relative to help watch your child for short periods, and gradually make them longer.
  • Tell your child what will happen. If your child is an older toddler or a preschooler, talk about meeting new friends and doing new things. Remind your child that you will come back to pick him or her up.
  • Work into the new routine slowly. You may keep the first visit short and stay with your child. Stay away a little longer each day. Follow your child's lead. He or she may be more ready to join the group than you thought.
  • Spend extra time saying good-bye for the first few days. Some children will be ready and eager for the new routine. An extra minute or two to get your child involved in a new project or with a group of children may be all that is needed.
  • Let your child bring something from home, if the center allows it. Having a special blanket or toy can be a comfort.

If you spend time with your child and are calm and loving, he or she will be more likely to adjust to and enjoy child care.

Frequently Asked Questions

Learning about child care:

Things to consider:

Keeping your child healthy and stimulated:

Ongoing concerns:

Child Care Options

Individual child care

  • Babysitters and mother's helpers. Babysitters provide informal, periodic, in-home care for your child, such as when you need to run errands or have planned an evening out. They are usually paid hourly and maintain general household order, but they are not expected to do housekeeping chores. A mother's helper is similar to a babysitter but is someone who watches your child while you are home.
  • Relative or family friend. When you have a relative or family friend care for your child, the formality of the arrangement is up to you. Some parents need help on occasion or on a part-time basis. Others have a regular and detailed arrangement that may or may not include payments.
  • Nanny. Usually a nanny cares for one or more children of a single family. Nannies usually have at least a high school education, and many have college degrees in childhood education or have completed a special training program. They have regular hours, usually between 40 and 60 hours a week in the family's home. Nannies often are responsible for taking children to different activities, such as sports practice, dance lessons, or visits to the library. Duties usually include chores directly related to the child, such as preparing meals, washing dishes, and doing laundry. Some nannies agree to do additional light household duties. A nanny is considered an employee. A formal contract usually is required, which includes:
    • A detailed schedule, including days off.
    • Pay rate. As an employer, you are obligated to pay the nanny a reasonable salary and comply with all rules and regulations of the federal, state, and local governments. These usually include withholding taxes; paying Social Security, workers compensation, and overtime; and complying with other provisions. Check with the United States Department of Labor (1-866-4-USA-DOL, or 1-866-487-2365) for details about these responsibilities.
    • Whether benefits are included, such as health or dental insurance.
    • Special requests of either party.
  • Au pair. Au pairs are child care providers from a foreign country. They speak English and typically live with a family for around 12 months. Au pairs usually are young adults (18 to 26 years of age) and often have completed a college degree or are pursuing further education. Families usually are matched with an au pair through an agency. Agencies differ in their amount of involvement. At minimum, most agencies review an au pair's background and medical records, including proof of immunizations. Agency policies usually provide for problems that may develop, such as homesickness or finding a replacement. A family hosting an au pair is expected to:
    • Include the au pair in family events and weekend trips.
    • Provide the au pair with a private room, meals, use of a car, and a monthly stipend. Au pairs usually have an international driver's license.
    • Give the au pair regularly scheduled time off. Some agencies specify that an au pair may not work more than 45 hours each week.
    • Pay for up to 6 credit hours of class each year at a local college or university.

Group child care

  • Child care cooperative. Child care cooperatives or babysitting cooperatives are set up and run by parents, usually for occasional child care. But some cooperatives provide regular child care for their members. Parents usually take turns watching each other's children instead of paying money for child care. This often works well for parents who have a flexible schedule, work part-time, or work at home. Most child care cooperatives have a director and a secretary to manage the operation. They are responsible for carrying out the governing policies made by the members.
  • Family child care. Family child care may offer more flexibility than larger group care centers, but quality varies among providers. All family child care operations should be registered or licensed in the state, even if it is not legally required. (Some states exempt family child care operations from licensing requirements.) Licensing requirements usually do not allow more than 12 children to be cared for in a family home, including those who live with the caregiver. Family child care also may be nationally accredited by the National Association for Family Child Care (NAFCC). Although the U.S. Department of Health and Human Services has recommendations for safe child-to-teacher ratios and group size, each state creates its own regulations.
  • Child care center. Centers that provide care for groups of children vary in size, setting, emphasis of educational programs, and types of activities offered. Get a list of child care centers in your region from your state licensing bureau. Each state sets its own licensing standards. Some are lax and others are very strict. Child care centers are sometimes called nursery schools, preschools, Head Start, Montessori schools, or day care centers. Some of these facilities have additional accreditation through national agencies that meet higher standards for child care than required by the state. Some child care organizations offer specialized education programs and activities, such as music and art classes. Each child care center has written policies about fees (including late fees, if charged), hours of operation, days when the center may be closed (such as holidays and staff education days), and guidelines for the care of sick children.

Other programs

Other types of child care are geared toward families that need to fill in gaps between school hours and parent work schedules. This may include programs that offer special activities during school breaks. This type of child care may include:

Selecting a Provider

Narrowing your search

When you start looking for child care, narrow down your selection by considering practical issues as well as your child's needs.

  • Do you need part-time or full-time child care?
  • What days of the week do you need child care? Are the days always the same, or do they change?
  • During what hours do you need child care (include your travel time if appropriate)?
  • What are you willing to spend each month for child care? Keep in mind that well-paid caregivers are less likely to quit.
  • What is your child's age? What behavior is expected of children that are your child's age? What are some ways you can involve a school-age child in deciding about the best type of care?
  • How would you describe your child's personality? Does he or she have any special interests? Do you think your child will do best in a small or large group of children?
  • Does your child have any lifelong conditions (such as diabetes) or special needs?

Selecting an individual care provider

If you are looking for an in-home child care provider, have a clear idea about what type of person you are looking for. It may be helpful to do the following:

  • Write down the qualities you want in a caregiver, such as educational background and experience.
  • Look for hidden costs.
  • If you are considering having a relative or family friend watch your child, think about how the arrangement could affect your relationship.

There are two basic ways to locate an individual child care provider:

  • Advertise. Talk with your neighbors and friends about the kind of person you are looking for. Post an advertisement in places where people in your community look for jobs or services, such as newspapers, local colleges, churches, or community bulletin boards. Make it clear what you need: number of days each week, provider to live with you (or not), any requirements or special needs, and how to contact you.
  • Use an agency. Some organizations will help you find appropriate individual child care. Many nannies and most au pairs are hired with agency help.

Screening potential providers is essential. Use a telephone interview for the initial screening, and explain your needs in detail. Then ask questions such as:

  • Do you have any questions about our needs?
  • What kinds of related experience do you have? Be specific. For example, if you prefer vegetarian meals, ask, "How would you rate your cooking abilities?" and "Have you ever cooked vegetarian meals?"
  • What concerns or questions do you have for me?
  • Who are three people I can call for references?

When you have narrowed down your selection, conduct a personal interview with each of your top choices. Allow enough time for the applicant to answer and ask questions and to be introduced to your child.

Be sure to check the references of your top choices. Ask each reference how long he or she has known the provider, specifics of the provider's duties, and why the employment ended. Find out about the relationship between the child and caregiver. Also include questions that will help give you a sense of the person's fit with your family. Ask the reference what else you should know about the provider.

Selecting a group child care provider

When you are choosing an out-of-home child care provider, research the options available in your community. Begin by asking friends and family and using your local library, newspaper, and telephone book. You also may want to contact referral organizations. For example, Child Care Aware is a national organization that has a Web site and hotline to help you find a good facility in your area. See the Other Places to Get Help section of this topic for more information.

Use a telephone interview and printed information to help you screen providers. Ask about or consider the following:

  • Basic facts, such as the location, price, and hours of operation, and whether there is a waiting list.
  • Age ranges of children. Also ask about the child-to-teacher ratio and the total group size.
  • Types of activities and educational programs offered.

Set up an appointment with the director of each facility or home setting that meets your initial screening. Plan time enough to take a tour and talk about their service guidelines, such as when payment is expected and scheduled closures. Make sure you are shown the entire facility or home. Evaluate its general cleanliness, condition, and safety. Notice whether the children appear happy and playful, and how they are treated by the care providers.

A child's environment should be safe, healthy, and clean. Make sure staff are knowledgeable about preventing safety hazards and responding to emergencies. There should be:

High-quality staff and programs are also important. All caregivers should have training in childhood development and be responsive to children. Programs should be small and well-designed for growth in all areas of development. All child care operations should at minimum be licensed. Ideally, an organization will have acquired special accreditation.

  • Child care providers of high quality will have a solid educational background, which includes training in childhood development, and will have acquired years of experience working with children. Group care programs should have low teacher turnover. Caregivers should be warm and responsive to children.
  • Safe staff-child ratio will vary by age group. Higher-quality centers have low child-to-staff ratios and small total group size. Children are generally grouped by age: infants (birth to 12 months), toddlers (13 to 35 months), preschoolers (36 to 59 months), and school-aged (5 to 12 years of age).
  • Educational programs and activities should offer variety and appropriate indoor and outdoor activities to match the varying ages and developmental levels of the children.
  • Licensing should be a consideration. Although any program you consider should be licensed by your state, in itself licensing doesn't mean the care given is of high quality. Each state has different child care licensing requirements and enforcement procedures.
  • Accreditation is additional insurance that a child care facility is of high quality. Look for those programs that have or are in the process of obtaining accreditation by the National Association for the Education of Young Children (NAEYC) and the National Association for Family Child Care (NAFCC).1

Selecting a babysitter or mother's helper

Choose a babysitter or mother's helper by asking friends and other caregivers you trust. You may also want to ask for recommendations from a local organization, such as the YMCA.

Find out whether the babysitter or mother's helper you are considering is experienced with children. Schedule a meeting with the caregiver and your child and watch how they interact. Some caregivers may not have confidence. This does not mean they will not ever be able to watch your child. But it may mean that you will need to have a few babysitting dates while you are present before leaving them on their own.

Classes help babysitters prepare for the responsibilities of watching your child. They can also provide valuable skills in case of an emergency, such as first aid and cardiopulmonary resuscitation (CPR) training. Classes often are available through local agencies, churches, hospitals, or schools.

Follow-up after making a selection

If your provider does not require a written contract, prepare one yourself. Include the hours of care, payments, and other details that are important to you. Keep a copy with your records.

Whether you choose an individual care provider or a group care setting, make sure you communicate and have an understanding with your care provider about expected behavior, discipline methods, and appropriate activities.

Visit the facility or caregiver's home and get involved in any special activities. Watch the interaction between caregivers and children. Make sure you feel comfortable with your decision.

Helping your child get started

At the start of a new child care routine, it is normal for a child to show some signs of anxiety, such as clinging or crying when you leave. Depending on your child's needs, consider trying to ease the transition:

  • Prepare yourself and your child. If you are enrolling your child in care for the first time, it may be helpful for you both to get used to spending time apart. Hire a babysitter or ask a friend or relative to help watch your child for short periods and gradually extend them. Some parents may find having a mother's helper for a few weeks before going back to work can help reduce some of the stress related to leaving their child.
  • Explain to your child what will happen. An older toddler or preschool-age child may understand at least some of what you tell him or her about the new situation. Talk about playing with new friends and the kinds of activities he or she will do, and reassure him or her that it is a safe place. Remind your child that you will come back to pick him or her up.
  • Introduce the new routine gradually. You may keep the first visit short and stay with your child, adding time slowly. Over the course of a few days, you and your child may feel more comfortable when you leave. But follow your child's lead. He or she may be more ready to join the group than you thought. Try to focus on dealing separately with any of your own anxiety that you may feel about leaving your child.
  • Spend extra time saying good-bye for the first few days. Some children will be ready and eager for the new routine. A simple extra minute or two to get your child involved in a new project or with a group of children may be all that is needed.
  • Allow your child to take something from home (such as a family picture or small toy), if allowed at the facility.

Make sure your child is immunized. Illnesses and disease can spread easily among a group of children. Keep your child's immunizations up to date and give a copy of the record(What is a PDF document?) to your child care provider. For more information on childhood immunizations, see the topic Immunizations.


If at any time you suspect your child may not be safe, immediately remove him or her from the situation. Notify the proper authorities if you suspect abuse.

When to Call a Doctor

Talk with your doctor about whether your child needs evaluation or treatment when:

  • Exposed to someone with a serious contagious illness, such as meningitis.
  • A chronic health condition, such as allergies, develops.
  • An injury is treated with first aid, but you are not sure it is enough.
  • Behavior problems develop that you or your child care provider is not able to effectively manage.

What to Think About

Paying for high-quality child care

Budgeting for child care takes work. Plan ahead and think about your future child care expenses as far in advance as possible. Keep in mind that it may take time to process applications or there may be a waiting list, especially if you are trying to qualify for financial assistance.

Child care referral agencies or other experts (such as some state or federal government agencies) can help you research your options for child care financial assistance. Some of the general options usually available are:2

  • State child care subsidies. Guidelines vary by state, but generally low-income families who are working or in school may be eligible for assistance.
  • Local programs. United Way, local government, community groups, or faith-based organizations are all potential sources of financial help.
  • Employer/college support. Some employers and colleges offer child care scholarships, child care discounts, or reduced rates at on-site facilities.
  • Child care program assistance. Some group child care providers offer scholarships, discounts, or pricing according to your income.
  • Pre-kindergarten (Pre-K) programs. Many school districts now offer free or low-cost educational programs for 3- and 4-year-olds.
  • Head Start and Early Start programs. Federal and state-funded programs are available that offer part-time or full-time free child care and other services for families who meet federal poverty guidelines.
  • Tax credits. You may be allowed state and federal tax credits for child care expenses. Specific programs and amounts depend on your household earnings, family size, and other factors.
  • Dependent Care Assistance Programs. This is a program offered by employers that allows you to have up to $5,000 a year taken out of your paycheck tax-free. The money is put in a special account for you to be reimbursed for child care expenses as they are billed.

Also, it may help to think creatively about affording child care and thinking about your options. Brainstorm ideas about ways you might be able to reduce the number of hours of child care you need or about ways to pay for it, such as:

  • Sharing a nanny with a neighbor or a friend.
  • Pursuing a flexible schedule at work that allows you to juggle child care and spend less. For example, you may ask if you can work 4 days a week for 10 hours and have an extra day off.
  • Child care cooperatives. If you need only part-time child care, you may be able to work some hours caring for other children at the same time as you care for your own.

Changing or ending child care

Child care changes are inevitable and require careful planning. As children grow, their needs change. Also, personal preferences, a move, or other life events may require a different arrangement. Allow time for both you and your child to adjust by talking about it ahead of time. You may want to plan something special for your child's last day at the child care center, such as bringing treats and taking pictures.

Evaluate and plan for how you will accommodate a new routine, such as different hours of care. Talk with your child about what to expect. Stress the positive parts of the change, but acknowledge the challenges. Devise strategies about how to overcome some of the expected difficulties.

Effects of child care

Many parents worry that the relationship with their child will suffer for having another caregiver. Current research on the mother-child relationship shows that its quality is mainly determined by family characteristics such as the mother's interaction with the child, her educational background, and family income level.3

Another common concern of parents is whether children will develop and learn to their potential in a child care setting. Research shows that the quality of the parent's (in this study, the mother's) relationship with the child best supports a child's mental and behavioral growth.3 The more sensitive, responsive, attentive, and mind stimulating the mother is, the better the child will do in child care.

Help prevent illness

Your child is more likely to become ill when he or she is frequently with other children. One recent study shows that children in child care with more than 6 other children and who are between 3 and 4½ years of age have more episodes of upper respiratory infections (such as a cold) than those in nonparental care with fewer children or who are cared for at home.4 The spread of many contagious diseases can be reduced by practicing healthy hygiene habits regardless of what type of child care arrangement you have. Hand sanitizers (such as Purell) can work as well as or better than soap and water.

Establish a backup plan

Plan what you will do if your regular provider cannot keep your child or if your child is sick. Children with mild upper respiratory illnesses such as minor colds usually can attend child care. (Usually, mild upper respiratory illnesses are transmitted before symptoms developed.) Keep your child at home if he or she has a condition that prevents attending child care, such as a fever or a rash.

Know your responsibilities

If you use an individual care provider for your family on a regular basis, you may be obligated to comply with employer rules and regulations of the federal, state, and local governments. Call the United States Department of Labor (1-866-4-USA-DOL [1-866-487-2365]) for information about your responsibilities.

Other Places To Get Help


Administration for Children and Families (U.S. Department of Health and Human Services)
370 L'Enfant Promenade SW
Washington, DC  20447
Web Address:

This government agency has information on parenting and childcare, including adoption and foster care. ACF addresses issues of child abuse and neglect, child support, and children with special needs. The Web site also has information on building healthy marriages to provide a strong and stable environment for raising children.

Child Care Aware
3101 Wilson Boulevard
Suite 350
Arlington, VA  22201
Phone: 1-800-424-2246
Fax: (703) 341-4101
TDD: 1-866-278-9428 toll-free
Web Address:

This nonprofit organization helps parents locate quality child care and child care resources in their community by increasing the visibility of local child care resource and referral agencies nationwide.

International Nanny Association
3801 Kirby Drive
Suite 540
Houston, TX  77098
Phone: 1-888-878-1477
(713) 526-2670
Fax: (713) 526-2667
Web Address:

The International Nanny Association (INA) is a nonprofit organization for nannies and those who teach, place, employ, and support professional in-home child care providers. The INA Web site lists nanny training and employment programs and has information on salaries and other aspects of nanny care.

National Association for Family Child Care (NAFCC)
5202 Pinemont Drive
Salt Lake City, UT  84123
Phone: 1-800-359-3817
(801) 269-9338
Fax: (801) 268-9507
Web Address:

This organization accredits family child care programs and provides resource materials. The NAFCC also organizes conferences for people with family child care programs.

National Network for Child Care
Web Address:

The National Network for Child Care (NNCC) offers newsletters, an e-mail group, and regional support and assistance for issues about family child care, center-based child care, and school-age child care. The Web site has many publications and resources about child care issues.

National Resource Center for Health and Safety in Child Care and Early Education
P.O. Box 6511
Aurora, CO  80045
Phone: 1-800-598-KIDS (1-800-598-5437)
Fax: (303) 724-0960
Web Address:

This Web site has detailed information about child care licensing requirements in the United States. Each state's requirements are listed. There is also information about cleanliness, emotional health, healthy habits, illnesses, special needs, and safety.



  1. Alkon AD (2003). Nonparental child care section of Psychosocial issues. In CD Rudolph et al., eds., Rudolph's Pediatrics, 21st ed., pp. 512–515. New York: McGraw-Hill.
  2. Child Care Aware (2003). Five steps to healthy child care budgeting. Finding Help Paying for Child Care. Available online:
  3. National Institute of Child Health and Human Development (2002). The NICHD Study of Early Child Care. Available online:
  4. National Institute of Child Health and Human Development (NICHD), Early Child Care Research Network (2003). Child care and common communicable illnesses in children aged 37 to 54 months. Archives of Pediatrics and Adolescent Medicine, 157: 196–200.

Other Works Consulted

  • Dworkin PH (2003). Families matter—even for kids in child care. Journal of Developmental and Behavioral Pediatrics, 24(1): 58–62.
  • National Association of Child Care Resource and Referral Agencies (2006). Why Care About Child Care? Available online:
  • Phillips D, Adams G (2001). Child care and our youngest children. Caring for Infants and Toddlers, 11(1): 35–51. Also available online:
  • Sosinsky LS, Gilliam WS (2007). Child care. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., pp. 81–86. Philadelphia: Saunders Elsevier.


Author Debby Golonka, MPH
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Michael J. Sexton, MD - Pediatrics
Last Updated September 26, 2008

Last Updated: September 26, 2008

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