Day care

Day care

By Patricia Fosarelli, M.D.

Substitute care is the care a child receives from a person other than a
parent—a rela­tive, babysitter, nanny, au pair, neighbor, day-care
center teacher or director, or oper­ator of a family day-care home.

A day-care center is a facility that can care for a number of children,
from as few as a dozen to more than a hundred. Day­care centers are
either for-profit or non­profit, but all are subject to state regula­tions
regarding fire, safety, sanitation, and so on.

A day-care home is an actual private house in which up to 6 children can
receive care. Some states also have large day-care homes, which can
accommodate 7 to 12 chil­dren. In general, day-care homes are not
licensed, and a number of states do not reg­ulate them in any way.

In this country, 60 per cent to 75 per cent of the mothers of infants
and preschoolers are in the work force. Due to the present divorce rate,
the rising number of never- married mothers, and the number of women who
need to work for financial reasons, the number of working mothers is not
expected to decrease in the near future.

Postulated effects of day-care

The parent-child bond

Although many psychologists worried that children’s relationships with
day-care provid­ers would weaken their relationships with parents, this
apparently has not occurred. When children’s bonds with parents are
close and loving, there is no evidence that

they will bond more closely to substitute care providers. Children with
loving parents prefer them over all others. However, chil­dren who come
from families in which the parent-child bond is weak or destructive
might indeed prefer a more interested or kindly person.

Many parents think that if their children do not eagerly run to greet
them at the end of the day, they prefer the provider to the parent or
the day-care facility to home. This is not necessarily so. At certain
ages, chil­dren like to display a bit of bravado and act as if they are
fine without their parents. In the preschool years, it is an act, so
don’t be fooled!

Aggressiveness and assertiveness

In a number of studies, children who at­tended day-care programs were
likely to be noisier, verbal, and more assertive than children cared for
exclusively at home. This is not an unexpected finding. The rough-
and-tumble of a group day-care setting en­courages children to state
their needs, air their grievances, and defend their rights.

However, assertiveness is not aggressive­ness. Assertiveness means
standing up for one’s rights without interfering with an­other’s rights;
aggressiveness means getting what one wants irrespective of another
per­son’s rights, desires, or feelings. Having an assertive child is
positive; having an aggres­sive child is not. If a previously placid
child becomes aggressive after enrollment in a large day-care center, a
parent should sus­pect that the environment is too stimulating for the
child (the child needs to be with a

smaller group) or that the teacher is not adequately supervising the
group.

Change in sleep/eating/fears

Although children might normally experi­ence sleep or eating disruptions
in the first week or two of any major change in their routines (such as
attending day-care for the first time or changing from one center to
another), these should gradually improve after the first few days. A
stable, high- quality care arrangement should not exert any lasting or
even prolonged effects on a child’s sleep or eating. Children who have
secure, loving bonds with their parents and who attend a warm,
supportive day-care facility are not likely to be highly fearful.

Learning advantages

Some day-care center directors promote their facilities as giving
children a head start in life through their education programs. Studies
have shown that quality day-care centers and preschools benefit children
from disadvantaged homes more than children from affluent homes. This
seems to be be­cause children from affluent homes are al­ready receiving
the benefits of early educa­tion from parents, whereas children in
disadvantaged homes frequently do not hear positive messages about
education and do not have materials at home that facilitate learning.
However, disadvantaged children who are exposed to quality day care or
pre­school may not benefit in the long term if they later attend mediocre
elementary schools.

Pro-social behaviors

Children who are exposed to day care are more likely to be open to new
situations and to meeting new people than children raised solely at
home. However, day-care or pre­school attendance does not necessarily
pre­dict children’s ability to make friends, relate to adults, and handle
new situations in ele­mentary school and beyond.

Choosing a day-care center or day-care home

Many parents are confused about whether they should send their child to
a day-care

center or to a day-care home. What are the advantages (and
disadvantages) of each?

A day-care center is a larger facility; its physical plant is dedicated
to providing care for young children. Centers are licensed and must pass
minimum fire, safety, and health code regulations. The personnel in
centers frequently have degrees (or at least some training) in early
childhood education or development. A well-prepared staff in con­junction
with a well-maintained physical plant usually increases the likelihood
that the care children receive is of higher quality. However, there is a
price. Day-care centers are more expensive, because their profes­sional
staff requires appropriate wages and the overhead is high. Day-care
centers are stricter about their hours of operation, be­cause their care
givers want a standard work day. Day-care centers are also more likely
to exclude ill children and charge ex­tra when parents are delayed in
picking up their children. Finally, not all day-care cen­ters are of the
highest quality, and those of the highest quality are sometimes few and
far between.

Day-care homes are smaller care facilities. Since day-care homes are not
regulated in many states, there is no assurance that all the homes meet
minimal fire, safety, and health codes. Since they are also private
homes, the physical plant is not necessarily especially equipped for
child care. Although many day-care home providers have some training in
early childhood education or de­velopment, others have none.

Care in a day-care home is, on the aver­age, less expensive than in a
center. Over­head is low, and there is usually only one provider. Homes
are less likely to exclude ill children and less likely to penalize
parents for being late. They are also likely to be conveniently located
near the children’s own homes, necessitating less travel time and fewer
early-morning awakenings for sleepy children. Most providers of family
day-care homes are very dedicated people who truly wish to give the best
care.

Which type of care is better? There is no easy answer. A child will
thrive with a lov­ing provider regardless of whether that per­son is in a
center or home. Parents are usu­ally deeply interested in providing love
and

care for their children—and most child-care providers feel the same
way.

Parental finances, willingness to travel, and the types of care
facilities available in the community are prime considerations in
choosing the type of care. But the child’s needs are paramount. If the
child is quiet, dislikes large groups, enjoys having one person with
whom to relate, and is most comfortable in a home environment, a good
day-care home would be suitable. If the child is more gregarious, loves
new situa­tions, and likes meeting and being around lots of people, a
good day-care center would be appropriate.

What to look for in a care facility

Frequently, parents rush into making a decision because they did not
think that selecting care arrangements would be diffi­cult. Take time to
interview several provid­ers before making a choice. Unless you are sure
that you want a particular type of ar­rangement, investigate both centers
and homes.

Visit prospective centers and homes when children are present, if
possible. This might be more difficult to accomplish in a home, where
the provider’s attention will be di­vided between you and the children.
How­ever, it should be easy to arrange at a day­care center in which there
are several providers and a director.

Observe the attitudes of the center per­sonnel: Do they seem pleased to
be working with children? Do they demonstrate kind­ness, humor, and
affection? How do provid­ers handle minor and major misbehaviors; are
they gentle, but firm, disciplinarians?

Observe the attitudes of the children: Do they seem to like each other
and their teach­ers? Do they seem to be happy? In what activities are
they engaged? How frequently do they need to be reprimanded, and how do
they (both the guilty party and the group) respond to reprimands? What
kind of disci­pline is used? (Be sure to boycott any care provider who
reserves the right to inflict corporal punishment.)

As you walk through the day-care center (or the area of the day-care
home in which

the children spend their time), look care­fully. Does it seem clean and
appropriately lighted? Do you see any evidence of bugs or rodents (for
example, a mouse trap)? If the children’s play materials are not on
display, ask to see them. Do they appear clean, in good repair, and
appropriate for the ages of the children who attend?

Check also for the presence of a working fire extinguisher and working
smoke detec­tor; although the extinguisher might not be obvious in a
day-care home, a smoke detec­tor should be in plain view. Look for other
safety and health provisions: clearly marked exits (at centers), gates
on stairway en­trances (if applicable), caps on electrical outlets, sinks
that children can reach, appro­priate storage areas for food, separate
area (away from the children’s main play area) for food preparation,
harmful or dangerous products out of children’s reach (preferably locked
away), clean counter tops and eating surfaces, a separate area for
diaper changes (if applicable) that is not the same as or next to the
food preparation area, and a con­tainer, to which children have no
access, for disposing of dirty diapers and soiled tissues. Remember to
also walk through the yard or outdoor play area to assess its safety
(fenced-in, fence and gates in good repair, uncluttered area, grassy or
other “friendly” surface—not concrete, asphalt, gravel) and the
safety of outdoor play equipment (in good repair, age-appropriate).

Ask to see the center’s license (and its renewal date); it should be
prominently dis­played. If you live in a state that requires or
encourages family day-care home registra­tion, ask the owner if it is
registered.

As you interview the center director or the home care provider, keep the
following questions in mind:

1. What training have the provider(s) re­ceived to qualify them to
   operate a care facility? Does the provider take part in continuing
   education? How so?

2. How long has the center/home been in operation? Over time, how many
   chil­dren have been cared for?

3. How many children are enrolled now? What are the age ranges?

4. (For centers) How many teachers are there?

The answers to questions 3 and 4 will help you determine the
teacher-to-child ratio. Different states have different permissible
ratios, but education experts believe that optimal ratios are one
teacher or provider to two or three children for infants, one to three
or four for toddlers, and one to four or five for older preschoolers.
The ratio in a day-care home should be no more than one to six.

1. (For centers) Will my child have the same provider each day?

A child needs one predominant substitute­care provider in order to feel
secure.

1. How does the center or home respect your child’s likes and dislikes?

There should be enough leeway to respect basic, cherished likes and
dislikes.

1. Is parental involvement encouraged in the center or home activities?

In quality care arrangements, parental input is welcomed.

1. Are you permitted to drop in at the center or home anytime you wish,
   if your child is present?

You have the right to visit whenever your child is present in a center
or home.

1. Does the provider have a policy about determining to whom a child
   can be released if the usual parent cannot be there?

To prevent a child being released to a hostile relative or noncustodial
parent, the provider should have the names of the only people to whom a
child can be released. If a person’s name is not on that list, the child
is not released. Beware of the provider who lightly dismisses such a
request.

1. Is smoking prohibited at all times on the premises?

2. Are regular fire drills conducted with the children?

These should occur even in the smallest of day-care homes.

1. At which times are children and provid­ers) encouraged to wash their
   hands?

To minimize the spread of infections, chil­dren should wash their hands
before meals, after toileting, and after “dirty” play, espe­cially
outdoor play or play with animals. Staff should wash their hands before
meals, before meal preparation (if applicable), after toileting, after
changing diapers, after han­dling animals, and after outdoor activities.

1. To minimize the spread of infectious agents, does each child have an
   individ­ual cot or mat for naptime?

2. Are naptimes usually at the same time each day? For how long? How
   does the provider manage a child who refuses to sleep?

This is important because naps (timing and duration) can affect the way
a child sleeps at night; the same is true if there is fighting with a
child over naptime.

1. Are menus posted in advance? Can chil­dren bring food from home? How
   does the provider handle individual food aller­gies and intolerances?

Advance menu posting, so that the parent knows not to serve the same
meal for din­ner, is helpful. Although providers cannot be expected to
individualize each meal for each child, food allergies or intolerances
must be respected and substitute foods provided. Whether or not children
are able to bring foods from home depends on the ability of the center
to store food.

1. How does the provider manage children who will not eat?

If the provider handles a refusal to eat differently from parents, the
child might become confused and develop problems with meals at home. If
refusal to eat is met with punishment or humiliation, the child might
begin to act out at mealtimes, not only in day care but also at home.

1. What are the provider’s policies on chil­dren who suddenly become ill
   or injured while at the center or home?

The parent should be called immediately. If the parent cannot be
reached, there

should be a designated substitute who will be called to pick up the
child. An ill child should be isolated from the other children, but
still closely supervised by the provider. All centers and homes should
request a pre­authorization from parents for emergency medical care for
their children, so that needed care is not delayed while the parent is
being located or en route.

1. What is the provider’s policy on admit­ting mildly ill children or
   children with communicable conditions (such as ring­worm) who are not
   ill?

If the provider will not accept mildly ill children (for example, a cold
without fever), then you will need to have a contingency plan for such
occasions. To avoid spreading communicable diseases, centers and homes
should not admit children with treatable communicable conditions until
they are re­ceiving appropriate therapy.

1. Does the provider insist on proof that each child is current on
   immunizations for his or her age?

To prevent certain childhood diseases, immunization is enormously
important. Proof of immunization is mandatory in licensed centers; make
sure a prospective day-care home provider follows the rule, also.

1. Are the staff members in good enough physical and emotional health
   to ade­quately care for active preschoolers? Does the center director
   insist on peri­odic examinations by a physician and skin testing for
   tuberculosis for all staff members? Is the day-care home provider in
   good health, and does the provider have periodic examinations and
   skin testing for tuberculosis? Do other family members come in
   contact with the chil­dren? If so, they should observe the same
   precautions.

Obviously, you want a provider with the physical and emotional stamina
to care for your child. Periodic checkups help ensure this. Tuberculosis
testing is important be­cause the disease is present in many commu­nities.
It is spread from adults to children— not the other way around.

1. Does the provider keep a permanent record of each child’s (a)
   allergies, (b) medical problems, (c) medications, (d) physician’s
   name and telephone number, (e) parents’ telephone numbers at
   work, (f) relative’s or designated substitute’s telephone numbers
   (to be called in an emergency), (g) immunization record, and (h)
   preauthorization for emergency medical care?

2. Under what circumstances will the pro­vider administer medicine to
   your child?

Medications should only be administered with a doctor’s or your
permission. If you permit a provider to administer a medica­tion, be sure
to explain the appropriate dose for your child. Stay away from providers
who reserve the right to administer medica­tions at their own discretion,
without any clear-cut guidelines.

1. Does the staff know how to read a ther­mometer and how to administer
   basic first aid and CPR (cardiopulmonary re­suscitation)?

In an emergency, failure to know these might cost your child’s life!

1. Does the provider seem interested in the home lives of the children?
   Does the provider seem eager to share informa­tion about a child’s
   performance with the parents?

2. Finally, do you like this person?

In addition, always ask for names of refer­ences or other parents who
have used or are using the center, so that you can contact them.
Although providers might have to ask parents’ permission to release
telephone numbers, be suspicious of any provider who flatly refuses to
give you any names.

Evaluating your child-care arrangement

Once you have chosen a care arrangement, how do you know whether it’s
working out? First of all, trust your instincts. If it seems that you
and the care provider disagree frequently, especially about child-care
deci­sions, it might be prudent to change provid-

ers. If you decide that you can’t live with some of the provider’s
policies (or the lack of them), it might also be time to look for care
elsewhere. Your child will be able to tell if you really don’t like or
trust the provider, and this knowledge will interfere with the
child-provider relationship.

Many children experience brief sleep or eating disturbances as they
begin a new care arrangement. If these do not improve in your child,
meet with the provider. If the provider is too lax (or too rigid) about
nap­time, your child’s sleep at night could be altered. If the provider
is too lax (or too rigid) about mealtimes, your child might begin to act
out at meals, not only during day care but also at home. This is
especially true if you and the provider are at opposite ends of the
spectrum in your philosophies about mealtimes and discipline in general.

If your child develops new sleeping or eating disturbances, think about
any possi­ble changes in home life before blaming the provider. If
there are no changes at home, arrange a meeting with the provider. This
is especially important if your child develops new complaints about the
provider or the site. Always talk to your child about his or

her day at the provider’s center or home and what the child likes best
and least about being there. Take all comments seriously, and respect
your child’s opinions. If your child reports abuse, investigate
immediately.

If your child incurs numerous minor inju­ries at the center or home, the
site might not be safe or the provider might not be adequately
supervising the children. Talk to the provider about your concerns, but
do not be accusatory, especially if your child incurs a lot of minor
injuries at home, as well. Major injuries at a center or home, how­ever,
demand your immediate investigation.

Children get three to six colds per year. If you and your child’s doctor
believe that the child is getting more than a fair share of colds and
other illnesses, meet with the provider and talk to other parents to see
if their children are having the same problem. If they are, the center
or home might lack proper hygienic measures.

Most child-care providers are deeply inter­ested in loving and caring for
children. Most parents feel the same way. Together, pro­viders and
parents can provide an optimal environment for children’s physical,
mental, and emotional growth.