Avoiding Day Care Nightmares

From the WebMD Archives

Feb. 7, 2001 -- OK, you have a child -- and you have a job. You don't, however, have a friend or relative who can take care of the little angel, and hiring a nanny or governess is not in the stars. The next step, then, is to find a suitable day care center or babysitter in a private home. But where do you start looking?

First, you should know that no national standards exist for licensing or monitoring facilities that look after children. States generally handle that, and most of them require licenses for centers that take in more than 12 children. They also require background checks for the caregivers -- not only in day care centers, but also for people caring for three or more children in their homes.

"In a licensed setting someone visits, inspects, and writes a report on the center," says Sherry Workman, executive director of The National Association of Child Care Professionals. The state keeps these annual inspection reports on file, and parents can ask for a copy.

A good standard to go by in choosing a day care facility, Workman tells WebMD, is whether or not it is accredited by a professional organization such as hers. Other accrediting agencies are the National Association for the Education of Young Children (NAEYC) and the National Child Care Association. All these groups require centers to meet certain criteria and evaluate them regularly to make sure they do. Ask your day care center director if the facility is accredited.

No matter whether the care takes place in a home, a church, or a commercial center, Workman says, parents should ask for references and details of the caregivers' training and the director's credentials. In Texas, for instance, caregivers are required to have 20 hours of education per year and to know CPR and first aid.

Workman and other experts say it's not enough for someone to be with your child; the caregiver needs to offer the children activities and toys that are age-appropriate.

"You should look at the play area. If the children are 2 or 3 years old and there are a lot of toys around that can easily be swallowed, this is probably not the place for you," says Kirk Davis, MD, a pediatrician in Fort Worth, Texas.

It's also important for children to be challenged and stimulated mentally. This is especially true for infants and toddlers, because they are developing rapidly physically, mentally, and psychologically.

A measure of how well a child care facility handles this is whether youngsters are allowed to pursue activities they enjoy. Workman calls this "child-centered care" rather than teacher-centered. In other words, the children shouldn't all be forced to do the same activity at the same time for the convenience of the teacher.

These activities are an important way your child will learn socialization skills -- that is, how to get along with other kids, says Kim Cavender, MSE, a child life specialist at Children's Medical Center of Dallas.

"A lot of times, people don't think about what experience the child will have, just that someone is there to watch them," Cavender says. "They assume that if someone is there, and it's safe and affordable, that's enough."

But it's not that easy. Parents need to visit the center several times, at different times of the day, to see how the staff interacts with the children, experts recommend. Once your child begins attending the facility, you should still expect unrestricted -- and unannounced -- visits.

"Find out if you can come in unexpectedly. If you can't, this is a big red flag," Cavender says. You should be allowed in all parts of the center, including the bathrooms, kitchen, nursery, and outside play area. In these areas, you should check for cleanliness, appropriateness of toys and playground equipment, and condition of playthings.

In addition, learn how many workers are available for each child. The American Academy of Pediatrics (AAP) recommends one staff member for every three kids up to 2 years old, and says a group of about six is ideal. These recommended numbers increase as the children age; at age 6, for instance, the AAP suggests a staff/child ratio of 10 to 1 in a group of 20.

But no matter what the ratio, Workman says it's best if a child has one staff member who is the primary caregiver.

"We want them to grow a bond," Workman says.

Davis says that it's important to find out if the center requires all children to have up-to-date immunizations. Most states require this, so be prepared to present a copy of your child's immunization records.

In addition, he says, find out what the center's policy is on sick children. The medical recommendations are that it's safe for a child to return to day care 24 hours after a fever is broken. And they need to stay home when they have diarrhea.

The cost of child care varies greatly depending on the region of the country, the services provided, whether the facility is accredited, and the age of your child. The NAEYC estimates that costs range from $4,000 to $10,000 a year; some top-of-the-shelf programs can be more expensive than a private college. The average: $286 a month, according to the 1997 National Survey of Families from the Department of Health and Human Services.

WebMD's sources say you also should check the following when choosing a day care facility:

  • Is the diaper-changing area separate from the play and kitchen areas?
  • Are hand-washing facilities available for the children and the staff in diaper areas, kitchens, and bathrooms?
  • What are the hours of operation?
  • Has the place ever been involved in a Child Protective Services investigation?
  • How long has each staff member worked there?
  • How long has the primary caregiver for your child worked with that age group?
  • How often is cleaning done?
  • Are electrical outlets covered and/or grounded to prevent electrocution if a child tries to stick something in them?
  • Are they all trained in CPR and first aid?
  • Is the outdoor play area fenced?
  • What is served for meals and snacks? Be sure to explain any specific dietary requests to the caregiver.
  • Find out whether they have options for part-time care, such as two days a week rather than five.

Most of all, Workman says, "I encourage people to pay attention to your gut feeling. How do you feel there? How are you treated? How do you think your child will fit in?" If you don't feel comfortable, she says, chances are your child won't either.