Finding high-quality child care is very important but not always easy. Your choice will play a key role in your child's health and development. Read on for more information from the American Academy of Pediatrics (AAP) about child care options to help you in your search for what's best for your family.

Types of child care

Center-based care, family child care, and in-home care are 3 types of child care.

• Center-based care takes place in a location staffed by caregivers. Center-based care has many names—child care center, preschool, nursery school, child development program, or learning center. Center-based care also may have different sponsors, including churches, schools, colleges, universities, hospitals, social service agencies, Head Start, independent owners and businesses, and employers.

• Family child care takes place in the caregiver's home. Many family child care providers have young children of their own. They may care for children who are the same age as their own children or for children of different ages.

• In-home care takes place in the child's home. The caregiver comes to or lives in the home. For many families, this is very convenient because caregivers often can arrange their schedules to match your needs. Because your child stays at home, he does not have to adjust to a new setting. Your child may also be exposed to fewer illnesses because he will not be with groups of children. He may receive more individual attention, especially if the caregiver's main job is to care for your child. This type of caregiver is not monitored or supervised, and there is no formal licensure or regulation process.

Note for parents of children with special needs: Finding programs and caregivers to meet the needs of children with disabilities or other special needs can be challenging. Your child's doctor can help you and your child's caregiver plan for your child's special needs, development, activities, health, safety, and any problems that come up while you are using child care.

Questions for all caregivers

The right child care option for your family may be based on many factors, including work schedules, budget, and personal preferences. Answers to the following questions may help you in your search.

• Hours. What are the hours? What if you are late in picking up your child? How are vacations and holidays scheduled?

• Fees and services. What is the cost? How are payments made? Are there other services available in addition to child care? Is there an extra cost?

• Qualifications and training. What education, training, and experience does the child care provider(s) have? Is the child care provider certified in CPR?

• Discipline. Is the caregiver(s) policy on discipline the same as yours? Center-based care should have a discipline policy.

• Communication. How often does the child care provider give feedback about your child? Does the child care provider seem approachable?

• Transportation. Are the proper car safety seats, booster seats, and seat belts used? Center-based care should have a transportation policy.

• References. Does the caregiver have current references from parents you can contact?

Other questions for center-based care

• Policies. The center should have a written policy for each of the following areas: health standards, illness, medication, nutrition, ?discipline, transportation, media, and outdoor play.

• Licensing/accreditation. Is the center licensed or registered with the appropriate local government agencies? Are there any outstanding violations? Is the program currently accredited or in the process of becoming accredited?

• Health professional. Is there a qualified health professional, such as a doctor or nurse, for the program? (The national standard recommends that center-based infant-toddler programs should be visited by a health professional at least once a month, and all other child care programs should be visited at least once every 3 months.)

• Visiting policy. Can you visit the center before your child is enrolled? If your child is enrolled, can you visit the center anytime it is open? Can you see all the areas that your child will use? Are visitors screened or is their identification checked so that only approved adults can visit the center and pick up children?

• Qualifications and training. What type of additional training have the staff had during the past year? Do outside experts provide training? How long have the staff worked at the center? How much experience do they have with children of your child's age?

• Staffing. Are there enough trained adults available on a regular basis? What happens if staff are ill or on vacation? Are children supervised by sight and sound at all times, even when they are sleeping? Are children cared for in small groups? Are activities proper for their age group? Is there a daily schedule? Do the child-staff ratios and the size of groups of children fall within nationally recognized standards? For example, in a room with 4 children aged 13 to 35 months, there should be 1 trained caregiver. In a room with 5 to 8 children aged 13 to 35 months, there should be 2 trained caregivers. There should be no more than 8 children aged 13 to 35 months in a room. (See chart.)

Other questions for family child caregivers

• Others in the home. Who lives in or visits the home (children, teens, and adults)? Are they family, what are their backgrounds, and how may they interact with your child?

• Number of children. What is the total number of children being cared for? The AAP recommends that a family child care home should not have more than 6 children per adult caregiver, including the caregiver's own children. (Some states allow more children when at least 2 adults are available at all times in larger family child care homes.) The total number of children should be fewer when infants and toddlers are included. No caregiver who works alone should care for more than 2 children younger than 2 years.

• Staffing. Does the caregiver plan to leave the home during the day to go to the store or drive children to school? If so, find out what the plan is for who will care for your child during this time. Because there usually is only one adult, backup care in an emergency situation must be nearby. In some areas, caregivers belong to a network of family child care providers who may provide training, shared toys, and backup help.

• Qualifications and training. Look for caregivers who are licensed or registered with the state. These caregivers will have unannounced visits by an inspector. Some family child care providers have earned accreditation as well. Does the caregiver continue to receive training?

• Environment. Is there an outdoor play area? Is the home free from hazards, such as lead and mold? Are there any pets?

Guidelines for in-home caregivers

When you are interviewing in-home caregivers it is important that your expectations are clear. Your caregiver will need to respect and follow your parenting rules and assigned duties. For example,

• Your child's schedule. Include such things as typical mealtimes, hand washing, toilet training, teeth brushing, and nap time.

• Discipline. Let your caregiver know what types of discipline you approve of and what rules and limits you have set for your child.

• Activities. Discuss reading, playtime, and fun ways to be active inside and outside. Be sure to talk about what types of outings are acceptable for your child. Let your caregiver know how long your child is allowed to watch TV or videos or play computer games or other media. The AAP strongly discour?ages TV viewing for children 2 years and younger, and encourages interactive play. For older children, the AAP recommends no more than 1 to 2 hours per day of educational, nonviolent programming.

• Duties. Write down and review what the caregiver will and will not do in your home. If your caregiver will also have housekeeping duties, stress that your child's needs must come first. Also discuss what you expect the caregiver to do if your child has a minor injury or if there is an emergency.

• Transportation. Be sure your caregiver knows how to use the proper car safety seat, booster seat, or seat belt for your child.

• Communication. The caregiver should give you a daily report of what occurred. (You may want to arrange for frequent, unannounced visits by a friend or family member who can observe how the caregiver interacts with your child.)

Note: You will need a backup plan for times when the caregiver is sick, needs time off, or goes on vacation. In some areas, child care resource and referral agencies or other community organizations can give you names of temporary in-home caregivers.

A checklist to help rate your choice

"Is This the Right Place for My Child? 38 Research-Based Indicators of High-Quality Child Care" is a checklist put together by Child Care Aware of America (formerly the National Association of Child Care Resource & Referral Agencies [NACCRRA]) that you can use to evaluate child care programs. This checklist is on the Child Care Aware of America Web site at http://www.naccrra.org/sites/default/files/publications/naccrra_publications/2012/15991003_38_indicators_checklist.pdf and available through a link from the American Academy of Pediatrics Healthy Child Care America Web site at www.healthychildcare.org/ResourcesFamilies.html. All of the questions are based on research about what is important to your child's health, safety, and development.

Planning for child care costs

Child care can be expensive, so families must budget ahead of time. While the cost may seem high, think about how little the caregiver is actually earning per hour for the responsibility of caring for your child. Be sure to budget for your backup care during those times when your child or caregiver is ill. You may qualify for state subsidies or assistance from your employer. Ask about

• Direct payment through cafeteria plans (a type of flexible benefit plan)

• Dependent-care spending accounts (tax savings)

• Voucher programs

• Employer discounts

High-quality child care is a critical investment for your child. When care is consistent, developmentally sound, and emotionally supportive, there is a positive effect on the child and family. In some areas your local child care resource and referral agency can help you find licensed child care or apply for subsidies. For more information, visit www.naccrra.org or www.childcareaware.org.

Preparing your child

Most infants, up to 7 months of age, adjust well to good child care. Older infants may get upset when left with strangers. They will need extra time and your support to get to know the caregiver and to understand that you will pick them up at the end of the day. Starting new child care is often harder on the parents than it is on the child.

Being prepared makes any new experience easier. You can help your child adjust to a new child care arrangement. Try the following:

• Arrange a visit with in-home caregivers while you are at home or when you need child care for a short time.

• Visit the center or home with your child before beginning care. Show your child that you like and trust the caregiver.

• Check with the caregiver or center staff about the best time of the month or year for children to begin attending the program.

• Allow your child to carry a reminder of home to child care. A family photograph or small toy can be helpful.

• Talk with your child about child care and the caregiver.

• Read books about child care. (Check with your local library.)

Sudden changes in caregivers may be upsetting to a child. This can happen even if the new care?giver is kind and competent. You may want to arrange a meeting with the new caregiver or ask your child's doctor for advice. Parents need to help caregivers and the child deal with any changes in the child's routine at home or child care.

When your child gets sick

Children sometimes get sick or are injured while in child care. Talk with your child's caregiver in advance so that you both know what to expect and are prepared. Make sure that your caregiver can always reach you. Confirm a plan for emergency care in advance.

Many times, mildly ill children are allowed to stay with their caregiver as long as they can participate in most of the activities and don't require more care than their caregiver can provide. If the child needs extra rest, there must be a place for her to rest and still be observed.

Sometimes children need medicine while they are at child care. Every state and program will have different rules about what is allowed. Prescription and over-the-counter medicines should be labeled with the child's name, dosage, and expiration date. The caregiver should have the parent's written permission to give the medicine, know how to give it safely, and properly record each dose. Depending on the regulations in your state, sometimes a doctor's note or instructions are required.

Resources

The following is a list of early education and child care resources. Check with your child's doctor or local child care resource and referral agency for resources in your community.