Your child is your most precious possession, and you want to ensure he or she is well-cared for. Whatever your feelings about going back to work after baby is born, the fact is most families will place their young child in some sort of childcare. Finding the right setting can be overwhelming, but there are multiple good options to choose from.

Family childcare programs

Most states require family childcare providers to be regulated if they care for more than four children. Criminal records checks are performed and homes are inspected annually. Some family childcares undergo voluntary accreditation with the National Association for Family Child Care (NAFCC), which requires them to meet higher standards and often involves ongoing training in child development. Benefits of a family childcare include keeping children in a home-like environment while giving them the opportunity to play and socialize with other children. While this often is the most affordable option, it's harder to monitor the quality of care the child receives, and there often is no substitute if the provider is sick or on vacation.

Childcare centers

All states require childcare centers to be licensed, which sets minimum health, safety and caregiver training standards. Some centers undergo voluntary accreditation with groups such as the National Association for the Education of Young Children (NAEYC), which, like the NAFCC, helps ensure high-quality care and ongoing professional development. Because of their larger size and staff, childcare centers are dependable and better able to offer organized activities or structured curricula to help children learn and develop. They are, however, typically more expensive, can be less flexible with hours, and can have lengthy waiting lists.


Most nannies hired through agencies have some training in caring for young children, but background checks often are limited to references from past employers. Because of the one-on-one relationship they develop with the children, nannies often become like another member of the family, although finding someone compatible and establishing trust can be difficult. While a highly qualified nanny can be hard to find, they give parents greater control over the child's care, and often can provide help around the house in addition to childcare. A nanny may be more flexible, but also may not have backup if they become sick or unavailable.

Au pairs

Although au pairs are hired through agencies, their childcare training and experience varies. Like nannies, they can be more convenient and flexible, providing one-on-one attention, and assisting with housework. However, they often are younger and far away from home – which may mean more energy and the addition of a new culture or language to the child's experience, but also can result in homesickness or difficulty adjusting for the au pair.

Friends or relatives

Many states do not regulate care provided by relatives, friends and neighbors, though a few require a criminal history check and/or child abuse and neglect clearance, and several require minimal training in health and safety. Families who use this type of care have established relationships with and feel comfortable entrusting their children with these providers even without regulations. While it can be harder to employ and set boundaries with friends or relatives, parents' schedules, budgets or transportation issues may limit alternate childcare options.

Stay-at-home parent

Sometimes after evaluating budget, personal goals, and the needs of the child, having a parent stay home turns out to be the best option. Parents may arrange to work different shifts, so one is always available to care for the children, or one may elect to stay home full-time. However, while the stay-at-home parent may not be earning money, caring for children and taking care of the house often is a full-time job. They too may become sick or need time off, so it's still important to consider other options for back-up childcare.

Before baby is born compile a list of childcare traits that are important to you and tour various places. Ask about qualifications and training, be sure staffing is appropriate, and check hours, fees, references and other policies. Are their methods of feeding, education and discipline compatible with what you want for your child? Above all, go with your gut. If you get a bad feeling, keep looking. You want to be confident with your choice.

For more information about childcare options, including checklists to help you rate your choices, go to healthychildren.org or childcareaware.org.■

Eleanor Eichman is a pediatrician at Sixteenth Street Community Health Centers.

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