Day care refers to the care provided for infants and toddlers, preschoolers, and school-aged children, either in their own homes, in the home of a relative or other caregiver, or in a center-based facility.
The last half of the twentieth century saw a dramatic rise in the numbers of women with young children who worked outside of the home. In 2000, 55 percent of mothers with infants were in the labor force. In 2001, 64 percent of mothers with children under the age of six, and 78 percent of mothers with children ages six to seventeen were in the labor force. These developments led to an increased demand for childcare providers by parents while they are at work.
In 2001, 61 percent of all children participated in some sort of nonparental care. As children grow older, the likelihood they will receive care from someone other than a parent increases.
Center-based care may also be labeled child or daycare centers, nursery schools, or preschools. These facilities care for children in groups. They may have different sponsors, including universities, schools, churches, social service agencies, independent owners or chains, and employers. Many parents choose center-based care because they believe the presence of multiple caregivers, larger groups of children, and state inspections make them both safer and more dependable. Some parents also consider these types of centers a better learning environment for their children.
The National Association for the Education of Young Children (NAEYC) issues recommendations relating to the organization and structure of daycare centers, particularly those that provide care for infants and toddlers. These recommendations are considered to be the minimum standards a daycare center should observe. Their recommendations concerning staff to child ratios are as follows:
- There should be no more than four infants per caregiver, and no more than eight infants per one group of children in center-based care.
- There should be no more than four young toddlers (12–24 months) per caregiver, with a maximum of 12 young toddlers and three caregivers per group. They recommend there be no more than six older toddlers (24–36 months) per caregiver, and a maximum of 12 older toddlers and two caregivers per group.
Some of the advantages of center-based care are:
- The staff are trained and supervised.
- There are more resources and equipment available.
- Care is still available when a staff member is absent.
- The centers are more likely to be licensed and subject to state regulation.
- Children in center-based care demonstrate slightly better cognitive development than those cared for in homes, possibly because they have more opportunities to interact with other children and are exposed to more learning materials.
Some of the disadvantages of center-based care are:
- The costs are higher than for other types of care.
- The background of staff can vary greatly, and there is often greater staff turnover.
- Larger groups of children may mean less individual attention for the child.
- There is a greater likelihood of exposure to communicable illnesses.
Family childcare providers
Family childcare providers offer care for children in the provider's home. Requirements differ from state to state. However, the majority of states require that providers be regulated if they are watching more than four children. Many states may have a voluntary regulation process in place for those providers caring for four or fewer children. Regulations usually require providers to meet minimum health, safety, and nutrition standards. In addition, they are usually required to have a criminal background check. Some states yearly inspect the homes of family childcare providers, and many require ongoing training. Parents often make this childcare choice because they prefer their children to stay in a more home-like environment. This arrangement may be less expensive and more flexible than center-based care. Parents may also believe that their children are better off in smaller groups with a single caregiver.
The American Academy of Pediatrics recommends that family childcare providers should have six children or fewer per one adult caregiver, including the caregiver's own children. The total number should be fewer if infants and toddlers are involved. No caregiver who works alone should be caring for more than two children younger than two years of age.
Some of the advantages of family child care are:
- There are usually fewer children than in center-based care.
- There may be children of different ages.
- The child gets to stay in a home-like environment.
Some of the disadvantages of family child care are:
- Many family childcare providers are not licensed or regulated.
- Resources and equipment may vary widely.
- Family childcare providers normally work alone, which may make it more difficult to judge their work.
In-home care occurs in the child's own home. This care includes both live-in and live-out nannies and baby-sitters. Most in-home caregivers are not state-regulated, though many nanny-placement agencies are subject to state regulation. If in-home caregivers receive childcare subsidy payments, they may be required by many states to have a criminal background check done, and a very few states have minimal health and safety training requirements.
The advantages of in-home caregivers are:
- Children receive one-on-one care.
- Children may be safer and feel more secure in their own home.
- Parents may feel they have more control over the type of care their children receive.
- There is the possibility of more flexible scheduling.
- Care will usually be available even if the child is ill.
There are also disadvantages to in-home care. These include:
- It is often the most expensive type of care.
- The parent may bear the burden of obtaining background checks and providing ongoing supervision.
Care provided by relatives, friends, and neighbors
This type of care is often referred to as kith and kin care and may take place either in the child's or the caregiver's home. Some of the advantages of this type of care are:
- Parents may believe their children are receiving more loving, affectionate care and that the child is more secure.
- A relative, friend, or neighbor may be more likely to share the parents' values.
- The child receives one-on-one care.
- There may be a great deal of flexibility in this option.
- Care may be low- or no-cost.
Some of the disadvantages of having friends and relatives caring for children include:
- There is minimal regulation required by most states (though some parents may view this as an advantage).
- There may be a lack of care if the friend or relative is sick or on vacation.
The type of care chosen is related to the child's age. Twenty-three percent of newborn to two-year-olds and 22 percent of three- to six-year-olds are cared for in a home by a relative. Eighteen percent and 14 percent of these same respective ages were cared for by a nonrelative in a home environment. Higher percentages of three- to six-year-olds (56%) participated in center-based programs while only 17 percent of newborn to two-year-olds did. Some children may participate in more than one type of arrangement.
Center care is more common for black and white children with working mothers (30% and 24%, respectively) than for Hispanic children (10%). However, relative care is more common for Hispanic children (39%) versus black and white children (27% for blacks; 25% for whites). Use of parent care does not differ depending on racial and ethnic background. Black children with working mothers are more likely to be in care full-time than are white and Hispanic children (58% for black children, 36% for white children, and 34% for Hispanic children).
Choosing and finding high-quality child care is important and may play a key role in a child's health and development. Parents need to consider a variety of factors when deciding who should care for their child. There are several positive factors parents should look for when evaluating child-care options. These include:
- There is adequate supervision and attention to each child. Parents can find out their state's specific daycare regulations by contact their state's department of health and human services.
- Caregivers are well-trained and professional.
- Close attention is paid to health and safety issues. There are proper hand-washing routines, and the facility (or home) is clean. Caregivers have training in first aid and cardiopulmonary resuscitation. Safety precautions and accident prevention measures are in place.
- Children are encouraged to explore and are exposed to games, songs, and conversation in order to foster language development.
- There is appropriate and sufficient equipment and play materials.
- Parents are welcomed to make unscheduled visits and are encouraged to voice concerns and suggestions.
- Stability of caregivers is recognized as an important component of quality care. There is a low rate of staff turnover.
The following signs may indicate that there are problems with the child care provider or facility:
- The caregiver or center staff do not answer questions or address parent concerns.
- There is no written copy of center day-care policies.
- There is a high turnover of staff.
- The child indicates he or she is not happy with the day-care experience.
- There are recurring unexplained accidents.
- Parents are discouraged from participating in activities or voicing opinions about policies or practices.
- Other parents report concerns or problems.
Parents who are deciding to place their children in some sort of day care should be aware that some problems may occur. A comprehensive study of early child care was started in 1991 by the National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health. More than 1,300 children were followed from birth to find out how the amount, type, and quality of day care they encounter affected their development. The study found that, at 15 months, child care neither promoted nor negatively affected infants' attachment to their mothers. However, a low-quality child-care environment combined with less sensitive mothering did leave infants less securely attached. The findings from this study also suggest that toddlers who spend long hours in day care display a slightly weaker bond with their mothers.
Child care can influence the behavior of the child, as well. More time spent in day care during the first two years led to more caregiver-reported behavioral problems at age two, although the effect was negated by age three. Higher quality care led to better child compliance and self-control, and children in larger groups (over three) appeared to be more cooperative than those in smaller groups. The biggest indicator of a child's behavior, however, was the family environment, particularly the sensitivity of mothering practices. This also carried over into the area of cognitive development, in which researchers found no benefit for children being raised exclusively by the mother. Those in high-quality care were at an advantage compared to those with exclusive maternal care, while low-quality child care presented a disadvantage. In general, fewer problem behaviors, higher cognitive performance, and better mother-child attachments were noted when children received higher quality care.
An additional concern for parents is that children who attend day care, especially in center-based environments, are more frequently exposed to communicable diseases and more frequently experience respiratory illnesses, ear infections, and diarrhea than children who are cared for primarily at home. The size of the group the child is in seems to play a role. Larger groups have higher incidences than smaller groups. In contrast, however, children who spend more time in day care miss fewer days of school than their peers who were cared for at home. Finally, parents need to consider who will care for their child if the child is ill, since most daycare providers will not accept ill children for fear of infecting other children.
Most parents are concerned about how their child will cope and adapt to being cared for by someone else. Parents can help their child adjust to a new childcare arrangement in several ways. They can arrange a visit to the center or home where they will receive care. Introducing them to the caregiver(s) may make the first days away from their parents easier. Some children like to bring a reminder of home with them when they attend day care. Parents may also choose one of the several books for children about day care and read it to their child.
Center-based care—Also called childcare centers or daycare centers, these facilities care for children in groups.
See also Attachment between infant and caregiver.
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Deanna M. Swartout-Corbeil, RN