The Dreaded Child Care Decision!

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Dr. Corinne Masur

Now that more daycares and preschools are opening up again, parents are asking themselves, “What is the best child care arrangement for my child?  How long is OK for my child to be in child care each day? What should I look for in a childcare provider or daycare?” and so many other questions related to child care.

The best way to make an informed decision about this is to consider three basic questions:

  • What are our family’s needs for childcare right now given our work schedules?
  • What are our options for child care?
  • What is best for our child given their age? 

This is a hard thing to talk about.  Parents need to work.  Parents want to work.  Women AND men have a place in the working world that is important. But one enormous problem is the fact that in the U. S. and most of the Western world, we live in societies that still expect women to take care of the children most of the time. In the U.S., our society does not support women, or parents in general, by providing sufficiently long parental leave after the birth of infants to care for the baby in an optimal way AND it does not provide universal high quality childcare for babies and toddlers once their parents have to return to work.

So – we have to talk about this.  

This post will not be about what parents should or should not do.  I am just going to try to describe the various child care options and provide some developmental information to consider.

Child Care Options

  1. Home care: 

Home care is a wonderful option for the newborn to the two year old.  If one parent does not work, then that parent can do the child care full or part time if that works for them. Or parents can trade off depending on schedules and ability. If both parents work or if there is only one parent,  a relative, friend or sitter who can take care of your baby during your work hours is a possibility.  If this person is loving and experienced with babies, this is a great option. A nanny share is also a good possibility.  Can you get together with a friend or two and have a babysitter take care of your children together? This simulates a family situation if you have a loving, experienced person to share with a friend or two (who have values and needs similar to your own) this can be a great option – as long as you work out the terms of the nanny share in advance of beginning!

  1. Out of home care: 

Small neighborhood day cares are a nice option which some parents choose.  What should you look for?  When you visit make sure you see each child or infant receiving the individual attention they need.  Make sure there is always one or two adults consistently available for each baby or toddler and that the babies are not just cared for by whomever out of the four or five adults available at that moment.  Make sure that there are never more than three babies or children being cared for by one adult at a time.  Find out how the daycare handles illness amongst the babies (Are they allowed to attend when ill?  How are they cared for in a way that ensures that other babies will not become ill? What are the hygiene practices at the daycare?) Make sure the babies get outside at least once a day in a stroller.  And make sure there is both a soothing environment available for nap time and a stimulating area available for play time.

Larger daycares can also be a good option for working parents – with a few things to keep in mind. First, the daycare needs to be clean and well organized. Second, good hygiene practices around illness and contagion should be in place.  Workers should wash hands each time they feed or diaper a baby or toddler. Third, look at the staff to child ratio. Fourth ask about what the actual practice at the daycare is in terms of who goes to your baby when your baby needs feeding, diapering, comfort, or play time.  What would be optimal is a day care whose practice it is to assign one or at most two workers to your baby so that your baby consistently interacts with the same person and learns that person’s rhythms and reactions in order to form a relationship with them.  Also, ask the daycare what their staff turnover rate is.  You want a day care which treats its staff well and where staff stay for years at a time so that your baby or toddler can be assured of seeing the same caregiver day after day so that they can establish a stable, consistent and loving relationship with the same one or two people there. It helps your baby feel comfortable, safe and secure to see the same face every time. 

Developmental Considerations

What option you choose can partly be guided by the age of your baby or toddler:

0 -1

The baby from birth to around one year of age is learning how to regulate their body and their feelings.  At birth, as every new parent knows, babies are not on a schedule.  They do not eat or sleep or poop at any specific time.  The caregiver’s job in this first phase of life is to provide prompt attention to the infant’s need for food, a clean diaper and soothing when they cry or fuss or feel uncomfortable. It is important that the caregiver also provides plenty of face to face time so that the baby can see their moods and feelings mirrored in the face of the caregiver as well as becoming accustomed to the rhythms and routines of that caregiver. This kind of attention to the baby’s bodily cues and emotions helps the baby begin to regulate.  From birth onward through the first year, what the baby really needs is one or two or three central caretakers – mother, father, grandmother, grandfather, aunt, friend, babysitter or childcare worker (who is assigned to your baby). In other words, the baby needs a consistent caregiver who is responsive to their own particular and unique moods, feelings and bids for engagement.  

Also, babies under one year of age do not NEED socialization with other babies, no matter what anyone tells you.  They need responsive love and care from one or two or three main adults (and a few other people from time to time when available). And they need time for play and stimulation from these caretaker(s) which might include activities like playing with toys on a blanket, music time, book time, and outdoor time in the stroller.

1 – 2

Later in development, as the infant becomes a toddler, the parent or caregiver is the bedrock from which the toddler begins to move into other relationships.  At this age babies are gaining mobility and interest in the world.  They love to see other babies and older kids.  They love to imitate them and to try to do what they are doing. At this age they still need their one or two or three consistent caretakers but they can also begin to spend time with other children, doing motor activities like running and climbing and chasing, and listening activities like short story or song times. 

2 – 3

At two and a half to three years of age, most children can begin to tolerate a full day of preschool or daycare – but if you can keep it to around six hours per day, that is best. More than that is a very long day for a young child. Longer days of ten and twelve hours can be taxing on an infant or toddler and require an extraordinary use of the child’s inner resources and coping mechanisms. If your work day is long, think about whether you can combine preschool or daycare with some hours at home with a relative or sitter.


In other words, situations designed to provide your baby or toddler with the care of one or two or three consistent and loving people who will respond quickly to your baby or toddler’s needs and who will provide the facial and vocal mirroring and feedback, as well as the love, soothing and the stimulation that your baby or toddler needs, is optimal. 

Other questions

  • How long per day should my baby be in care?

Here there are also developmental considerations.

From around sixteen months to two and a half years of age, your baby’s developmental capacities begin to change.  At this age something important begins to happen.  Your baby can begin to remember you (or whomever the primary caregiver has been) when you/they are gone.  This is the beginning of what is called object constancy and this is what makes it possible for the baby to begin to have periods of time away from you (or the primary caretaker) without suffering too much.  

If your toddler can remember you when you are not there, this provides some of the soothing that they need in order to be independent from you.  At sixteen months this capacity is temporary – the ability to remember the primary caregiver when they are not present lasts only a few hours.  At two and a half it lasts a bit longer and at four your child can usually keep you in mind for a whole day.  This does not mean they will not miss you – but it does mean that they can survive without you and be OK.

  • What is optimal for my baby?  

It is optimal for your baby or toddler to be cared for by one or two or three consistent caregivers for the first year to two years of life – if possible – whether those caregivers are mother, father, grandmother, babysitter or daycare workers who are consistent and assigned only to a few babies at a time.  

  • What about when my baby is older?

At sixteen months to two years of age, added stimulation is helpful.  A full blown curriculum is NOT necessary.  Toddlers do not NEED to learn numbers or letters – but they DO benefit from a rich and stimulating environment where free play and socialization is encouraged.  A good day care can do this as can two to three hours a day of a play group, or preschool.

  • Can I mix and match child care arrangements according to the day of the week?

Try to keep each day the same.  OR have a couple of days of one schedule and a couple of an alternate schedule. But try NOT to have each day be different.  Babies and young children LOVE routine.  It makes them feel safe and secure. Three days a week of half day preschool and two days at home or with a babysitter is a good schedule for a two year old.  But one day of all day daycare, another day with grandma, another day of half day daycare, a fourth day at home and a fifth day with a family friend could feel disruptive and confusing for an infant or toddler.

         – How do I evaluate how my baby (or child) is doing once I have made my choice of childcare options? How do I tell if my child is having a negative reaction to a daycare, preschool or other childcare situation?

  1.  Look for signs of exhaustion including a greater degree than usual of fussiness, signs of tiredness even in the morning or at midday.  
  2. Look for signs of anger, dysregulation or confusion. 
  3. After the first three weeks of this arrangement does your child STILL seem tired, fussy, or confused?
  4. Is your child’s eating or sleep routine disrupted?
  5. Does your child cry for more than fifteen minutes after you leave?

These are signs that a change may need to be made in your arrangements for childcare. 

Of course it is normal for your baby or young child to cry when you drop them off at daycare or school.  They don’t want to leave you!   But how long the crying lasts is informative. Ask the worker or teacher how long your child cries. If it is for five to fifteen minutes, don’t worry.  But if it is for over an hour, this is of concern. Ask about your child’s mood for the rest of the day.  Do they seem happy? Content?  Or fussy and whiny? Watch their behavior and moods at home.  Has their attitude toward you changed since starting daycare or school or has it stayed the same? Again, this information will help you to decide whether the arrangement you have made is working or not.

The choice of how to best take care of children during the day is a hard one for working parents – especially those who do not have available family nearby.  Think about your needs AND the developmental needs of your baby or toddler – depending on their age and stage of development – as you decide.

Did you find this helpful? Or do you want to contribute to the debate?  Either way, leave a comment!