Early education and child care is instrumental in the emotional, developmental, learning and health outcomes of children and families. Choosing daycare is a very important decision. Here are some important areas to investigate how to choose a facility.

Daycare

Setting

Advantage and Disadvantage

Center-based care

Usually involves larger group settings.

• More social interactions with other children.
• Usually have clear health, safety, and caregiver training standards.
• More likelihood of catching a cold or other illness.
• Usually have higher child-staff ratio.

Family child care homes

Usually small group of children who receive services in the home of the caregiver.

• Have social interactions with other children.
• Less likelihood of catching a cold.
• Less clear health, safety, and caregiver training standards.

In-home care

Care provided by relatives, friends, neighbors, or live-in and come and go nannies.

• Less social interactions.
• Less likelihood of catching a cold.
• Usually low child-care giver ratio.
• Less clear health, safety, and caregiver training standards.

Is the facility fully licensed? All center-based facilities are inspected every year and require state licensure. The requirements for licensing generally ensure basic health and safety of a program but not necessarily high quality; state licensing requirements can be found online at http://nrc.uchsc.edu
• What is the experience/training of the caregivers? College degrees in early childhood education, child development associate’s credential, or ongoing in-service training.
• What is the attendant and staff turnover rate?
• Is there an adequate number of staff? The standard child-staff ratio andgroup size as recommended by the American Academy of pediatrics:

Child’s age

Child-staff ratio

0-12mo

3:1

6

13-30 mo

4:1

8

31-35 mo

5:1

10

3 yr

7:1

14

4-5yrs

8:1

16

6-8yrs

10:1

20

9-12

12:1

24

no child < 2 y

1 adult/6 children

1 child <2 y

1 adult/4 children

2 children <2 y

no other children are recommended

• What steps are taken to prevent the spread of illness amongst the children?
• When should a sick child stay home from the daycare facility? Does the facility have exclusion criteria that prevent acutely sick children from attending the center?
• Does the staff training include first aid and CPR?
• Policy for safe administration of medicines?
• Is a health assessment required before children enroll?
• Up-to-date immunizations of staffs and children required before enroll?
• Written emergency plan and updated contact information?
• Recommended hand washing times and routines?
• How often are the toys and equipment and facilities cleaned?

• Illness that prevents the child from participating comfortably in program activities.
  Illness that results in a need for care that is greater than the staff can provide.
• The condition suggesting possible severe illness: fever, lethargy, inexplicable irritability or persistent crying, uncontrolled coughing, wheezing, difficult breathing, or unusual signs for a child
• Persistent abdominal pain or intermittent pain associated with fever or other signs or symptoms

Medical condition

Readmission until …

Vomiting two or more times in the previous 24 hours

Vomiting resolves or a physician determines that the cause of the vomiting is not contagious and the child is not in danger of dehydration.

Mouth sores with drooling

Physician determines that the child is noninfectious.

Rash with fever or behavior change

A physician determines the illness is not a communicable disease.

Purulent conjunctivitis (pink eye with white or yellow eye discharge)

A physician exams and agrees for readmission

Head lice

After the first treatment.

Scabies

After treatment is initiated

Impetigo (Skin infection)

24 hours after initial antibiotic treatment.

Strep throat or other strep infections

24 hours after initial antibiotic treatment.

Tuberculosis

Physician or local health department authority states that child is noninfectious.

Varicella (Chickenpox)

All lesions have dried and crusted (usually 6 days after onset of rash).

Pertussis

5 days of appropriate antimicrobial therapy (which is to be given for a total of 14 days)

Mump

9 days after onset of parotid gland swelling.

Measles

4 days after onset of rash.

Hepatitis A virus (HAV) infection

1 week after onset of illness or jaundice (if symptoms are mild).

1. Committee on Early Childhood, Adoption, and Dependent Care, American Academy of Pediatrics (AAP). Quality Early Education and Child Care from Birth to Kindergarten. Pediatrics 2004:115:187-191.
2. Shope, TR, Aronson S. Improving the Health and Safety of Children in Nonparental Early Education and Child care. Pediatrics in Review. 2005;26:86-95.
3. Committee on Infectious Diseases, AAP. Red Book. 25 th ed.Elk Grove Village , IL : American Academy of Pediatrics.