THE BEST CHILDCARES

 1. Look down. When you're visiting a potential site, pay attention to how the staff interacts with the children. Ideally, a caregiver should be on the floor playing with the kids or holding one on her lap. In their early years, babies need close, loving, interactive relationships with adults in order to thrive. That's why it's especially important that babies' first caregivers be warm and responsive, and that even in group care, infants and older babies get a healthy dose of one-on-one time. (Though individual states set their own staffing ratios for child-care facilities, the American Academy of Pediatrics specifically recommends a ratio of one adult for every three babies up to 24 months of age.)

2. Ask for a commitment. Babies need consistent, predictable care. It helps them to form a secure attachment to their caregivers, according to Debra K. Shatoff, a family therapist in private practice in St. Louis. If you're looking at an in-home caregiver, request that the person you're considering make a one-year commitment to the job. If you're considering a center, find out how long the current caregivers have been working there and how much turnover the center usually experiences.

3. Do a policy check. Find out whether you share parenting philosophies on topics such as discipline (Do the caregivers use time-outs, scoldings?); television (Is the TV on all day or used sparingly, if at all?); feeding (What snacks or drinks are provided for older babies?); sleeping (When are naps offered? How are fussy babies put to sleep?); and so forth. Inquire about the sick-child policy (What symptoms prevent a child from attending?). Also ask whether there's a backup plan should the family day-care provider or in-home caregiver get sick and be unable to work. The more questions you ask early on, the less likely you are to be unpleasantly surprised later.

4. Drop by and spy. While word-of-mouth referrals from other parents or trusted resources are important, you need to look at a place for yourself to assess whether it meets your needs. Of course, any child-care environment should be kept clean, childproofed, and well stocked with sturdy books and toys that are age-appropriate. Other details to consider: When older children share the space, toys with small parts (choking hazards) should be kept away from younger babies. Ideally, infants and babies should have their own area where they won't get "loved" too much by older toddlers. A room or separate area dedicated solely to swings and bouncers may look appealing at first glance, but keep in mind that growing babies need plenty of floor time to develop and strengthen their muscles. If possible, try to visit the same centers at different times of the day to get a sense of how the staff interacts with the children and what the routine is. You may want to consider popping in unannounced a few times after you've enrolled your child, just to see how things are going. Sometimes your visits will confirm that the place is right for you, but sometimes they'll be a real eye-opener.

5. Keep talking. Until your baby can talk, you will be relying on what the caregiver tells you about your child's day. Make sure you can communicate comfortably with each other. When you first hand off your child in the morning, you should tell the caregiver how your little one slept the night before, if he is teething, and whether he ate breakfast. At the end of the day you'll want to know similar information, such as the number of diapers he went through, when he napped, and if he seemed happy overall. It's always preferable to speak to the caregiver in person. If that's not possible, ask if there's a convenient time to phone, perhaps at nap time.

6. Problem-solve pronto. It's inevitable that you'll experience conflicts with your caregiver, both large and small. Address problems right away rather than ignoring them until they grow out of proportion. Some issues can be resolved quickly; others may require more discussion. Whatever the conflict, treat the caregiver in a respectful manner, but don't be afraid to speak up, says Deborah Borchers, MD, a pediatrician in private practice in Cincinnati. When broaching a difficult subject, ask the caregiver's opinion, and hear her out. As the parent, you have the final word with an in-home caregiver, but you're more likely to elicit cooperation if the caregiver knows she has been heard. For example, instead of demanding an earlier nap time to make bedtime easier, ask the caregiver if she has ideas about how to adjust your baby's schedule so he won't grow so overtired in the evening.

7. Trust your gut. Every parent knows when something doesn't feel quite right. You may be turned off by a center everyone in town raves about or clash with a highly recommended sitter. If that happens, keep searching. Babies deserve, and thrive under, good, nurturing care. If something just doesn't feel right about your situation, investigate other options.

8. Be open to change. You're not married to a particular person or situation, and if things don't work out, you can always make a switch. Yes, you want consistency for your baby, but that doesn't mean you can't alter arrangements. Babies are resilient; as long as they're having a positive experience with their new caregiver, they'll be just fine, points out Dr. Shatoff.
No matter what your work hours, you are still your child's essential caregiver -- the most consistent source of love and support in her life. Under your care and guidance, along with the help of your well-chosen caregivers, your baby will flourish and grow into a happy, healthy child.

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.