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. The provider may be a family member or friend, a nanny, an au pair, or
    a 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

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.

When choosing child care, make sure that
it is:

  • Safe. Check that it is
    licensed with your state (also called registration or
    certification). 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
  • 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
  • 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. A good caregiver helps your child learn, interact, and solve problems while protecting him or her from making choices that could be harmful.
  • 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 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. Contact your local government’s mental health
office or your 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 the sessions
  • 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
  • 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
  • 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:

Keeping your child healthy and stimulated:

Ongoing concerns:

Beginning Your Search

Think about what you need

When you start looking for
child care, narrow down your choices by considering practical issues as well
as your child’s needs. Do you need an individual or group care provider? Or do you need an after-school program or camp to fill in gaps between school hours and
your work schedule? Here are some other questions to consider:

  • Do you need part-time or full-time child
  • 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.
  • 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?

Visit the care setting

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.

Individual Care Providers

Types of individual providers

  • Babysitters and mother’s helpers. Babysitters provide informal 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
  • 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 part-time. Others have a detailed arrangement that may or may not
    include payment.
  • Nanny. Usually a nanny
    cares for one or more children of a single family. Nannies usually have at
    least a high school education. Many have college degrees in childhood
    education or have completed a special training program. Nannies are considered employees. They may work part-time or full-time in the family’s home. For more information, contact the International Nanny Association at
  • Au pair. Au pairs are
    child care providers from a foreign country. They 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

Selecting an individual care provider

Have a clear idea about what type
of person you are looking for. It may be helpful to:

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

There are two basic ways to find 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.
  • Use an agency.
    Some organizations will help you find child care. Many
    nannies and most au pairs are hired with agency help.

It’s important to interview potential providers. Use a
phone interview for the initial screening. Ask questions about their work experience, their references, and whether they have questions for you.

When you have narrowed down your selection, conduct a
personal interview with each of your top choices.
Allow enough time for the applicant 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.

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.

Before you hire a teen to watch your child:

  • Ask the teen what other jobs he or she has had and what he or she was responsible for. Find out what activities he or she likes to do with children. Also ask how the teen would handle certain situations, such as a baby that cries for a long time or a toddler who is talking back.
  • Tell the teen your rules, including how much TV and computer time is okay and what type of TV programs are okay.

Schedule a meeting with the
caregiver and your child, and watch how they interact. Some caregivers may not
have confidence. This doesn’t 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
CPR (cardiopulmonary resuscitation) training. Classes often are
available through local agencies, churches, hospitals, or schools.

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.

Group Child Care Providers

Types of 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.
  • Child care in someone’s home. 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.) 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, programs, and types of
    activities. 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.

Selecting a group child care provider

Begin your search by asking friends and family and using your local
library and newspaper. You also may want to contact referral
organizations and your doctor. See
the Other Places to Get Help section of this topic for more information.

Choose a few providers you’d like to interview, and write down the questions you have. Do a first screening over the phone and take notes. Ask about or consider:

Set up a meeting with the director of each facility
or home setting that passes your first screening. Plan enough time 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. Notice whether the
children appear happy and playful, and notice how they are treated by the care

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

High-quality staff and programs
are also important:

  • 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
  • Educational programs and activities should offer
    variety and appropriate indoor and outdoor activities to match the 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
  • 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).

Helping Your Child Get Started

At the start of a
new child care routine, it’s common for a child to show some signs of anxiety,
such as clinging or crying when you leave. With your child’s needs in mind,
try 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 these sessions.
  • 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.
    Remind your child that you will come back to pick him or her
  • Start 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. Try to focus on dealing separately with any of your own anxiety
    that you may feel about leaving your child.
  • Spend extra time saying
    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
  • 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


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

Paying for 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 that 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 aid. Some general options may include:footnote 1

  • 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, and faith-based organizations are all potential
    sources of financial help.
  • Employer/university support. Some employers
    and universities 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 offer free or low-cost educational programs for 3- and
  • Head Start and Early Start programs. Federal and state-funded programs may offer part-time or full-time free child care and other services for families who meet federal income 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 some employers that allows you to have money taken out of your paycheck tax-free each year. The money is put in a special account for you to be reimbursed for child care expenses as they are billed.

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
  • 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
    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

Other Concerns

Helping care go smoothly

Ask providers if they require a written contract. If you pick a provider who doesn’t use a 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

Changing or ending child care

Child care changes will occur and will 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.

Talk with
your child about what to expect. Stress the positive parts of the change, but
acknowledge the challenges.

Worrying about the effects of child care

Some parents worry that the relationship with their
child will suffer for having another caregiver. Another common concern of parents is whether
children will develop and learn to their potential in a child care setting.

The quality of the child care, the type of care (for example, group or individual), and how much time a child spends in child care have an effect on a child’s development. But it is not as great as the effect that you have on your child.footnote 2 You have a big impact during the times that you are with your child. Spend quality time with your child whenever you can. For example, have meals together and do fun things that help your child learn and grow in healthy ways.

Preventing illness

Your child is more likely to become ill when he or she is frequently with
other children. The spread of many diseases can be
reduced by practicing healthy hygiene habits regardless of what type of child care arrangement you have.

Having 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 spread before symptoms develop.) Keep
your child at home if he or she has a condition that prevents attending child care, such as
a fever or a rash.

Some cities have child care centers just for sick children.

Other Places To Get Help

Organizations (U.S.)

National Association for Family Child Care (U.S.)



  1. Child Care Aware (2009). Finding Help Paying for Child Care. Available online:
  2. Sosinsky LS, Gilliam WS (2011). Child care: How pediatricians can support children and families. In RM Kleigman et al., eds., Nelson Textbook of Pediatrics, 19th ed., online chap. 15. Philadelphia: Saunders. Available online:

Other Works Consulted

  • American Academy of Pediatrics (2009). Early education and child care. In SP Shelov et al., eds., Caring For Your Baby and Young Child: Birth to Age 5, 5th ed., pp. 421-456. New York: Bantam.
  • American Academy of Pediatrics (2013). Finding a sitter. Available online:
  • Bauer NS (2011). Nonparental childcare. In CD Rudolph et al., eds., Rudolph’s Pediatrics, 22nd ed., pp. 364-366. New York: McGraw-Hill.
  • Committee on Early Childhood, Adoption, and Dependent Care, American Academy of Pediatrics (2005, reaffirmed 2009). Quality early education and child care from birth to kindergarten. Pediatrics, 115(1): 187-191.
  • Moran D (2009). Childcare. In WB Carey et al., eds., Developmental-Behavioral Pediatrics, 4th ed., pp. 159-163. Philadelphia: Saunders Elsevier.
  • National Institute of Child Health and Human Development (2006). The NICHD Study of Early Child Care and Youth Development. Available online:


ByHealthwise Staff
Primary Medical Reviewer John Pope, MD – Pediatrics

Current as ofMay 4, 2017

Current as of:
May 4, 2017