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It often isn’t until caregivers start to look for child care that they realize the options are shockingly limited and the costs are exorbitant. 

Operating a child care program is very expensive, and — unlike in most other rich nations — the federal government doesn’t provide much help to providers or families. Hiring staff even at the lowest wages — child care teachers are some of the lowest-paid people in the country — means that tuition is more than many parents’ rent or mortgage payment.

That system creates a lot of volatility, with programs closing and others with months- and years-long waitlists. 

It’s an industry starved for resources, and because of that it also starves families of choice. 

“We don’t have meaningful choices for child care right now. We just don’t — unless you can pay high premiums,” said Nina Perez, the early childhood national campaign director at MomsRising, a national network of moms pushing for child care and other family policies. Families that can’t pay a lot are instead stuck with whatever day care they can get into or whichever provider they can afford. 

“As a parent and as a caregiver, you want to make the best decisions possible. We can’t do that without enough information or even enough options,” she said.

The child care system has evolved significantly in the past two decades. New research and regulations have altered the way centers and in-home day cares operate, and a changing economic landscape has increased demand for care as fewer parents stay home. 

What your parents did with you as a kid for child care may not even be a viable option for you now as an adult.

For those navigating this new landscape of child care “there is no guide, there’s no book, no how-to,” said Shannon Parola, a former nanny who has written her own child care guide for parents. “You’re stuck to Google, your best friend, your mom.” 

That’s why The 19th has spoken to experts across the country to form a guide that could help bridge the knowledge gap — and win back some of that choice. 

It’s impossible to foresee every danger or ask every right question. But if caregivers do their homework, they should have a good sense of whether a program or provider is safe, Parola said.

“Your parenting gut does not lead you wrong,” Parola said. “When you walk into a day care or a building or a person’s house, you know, ‘OK this is a safe environment, this is a clean environment.’ The anxiety is high but you should have some feeling in your gut that this is the right decision.”  

Here are some of the key questions to ask and what to look for when choosing child care: 

When should I start thinking about child care? 

Right away, if you think you’re going to need it.

Think of child care as essential as buying baby items or finalizing your family’s birth plan. It likely will be even more complicated and time-consuming than both of those things, and most centers have waitlists that extend months and even years. But if you give yourself plenty of time, you maximize the chances that you’ll be able to pick the program, provider or set-up that you prefer. You’ll likely feel more confident about your decision, too. 

What are the child care options I have? 

Child care center: Center-based care is the most popular option in the United States. Programs can take infants as young as 6 weeks of age up to preschool. Classrooms are governed by strict student-to-teacher ratios, licensing requirements and regulations. Compared with other options, child care centers will have larger numbers of children in each classroom, and children are typically grouped by age. 

Some centers, such as faith-based centers or centers in schools, may be exempt from licensing. 

Home-based provider: In-home care or family home care programs are the next most popular option. They’re run from residential homes and must adhere to many of the same licensing, inspection and safety requirements as center-based providers. Other adults who live in the home are also subject to background checks. 

Group sizes in home-based care are typically much smaller and costs to parents tend to also be lower. 

Each state has different thresholds for when a home-based day care provider needs to obtain a license or be regulated by the state. In some states, an in-home provider caring for one non-relative child needs to be licensed, while in other states the requirement doesn’t kick in until they are caring for more children. The highest thresholds are six children (Arkansas, Indiana, Iowa, Mississippi, New Jersey and North Dakota), seven (Idaho, Louisiana, Ohio and Utah) and as many as 13 (South Dakota).

Nannies: Nannies are typically the most expensive child care option, depending on how much care is needed. They can live with a family or come to them to provide care, and families can also opt to do a nanny share where several families participate and cover the cost. 

Typical nanny contracts include guaranteed weekly hours, overtime pay, time off (sick and vacation) and mileage reimbursements. Some include health insurance, bonuses and educational stipends. Parents can set up these contracts themselves, or hire a nanny through an agency. Keep in mind that nannies are considered household employees and so you will need to provide them a W-2. Here is a guide from Care.com. 

Au pairs: Au pairs are young adults who come to the United States under a visa program that allows them to live with a host family and care for their children for one to two years. Families must pay a weekly stipend and cover other expenses, such as room and board and food costs. Au pairs work no more than 45 hours a week and must receive at least two weeks of paid vacation every year and a complete weekend off a month. 

Au pairs are typically hired through an agency such as Au Pair in America or Cultural Care, which handle much of the onboarding, preparation and any ongoing needs. 

They are also subject to some regulation, particularly with smaller children. Au pairs must have at least 200 hours of experience with infants to care for a child younger than 2 and can’t care for a child under 3 months of age without the parent being present at all times. 

The program was designed as a cultural exchange between the au pair, who must be between the ages of 18 and 26, and the host family. But abuses in the system have led the U.S. State Department to this year consider changes that would significantly increase how much au pairs must be paid by the host family. In some states, au pairs are already subject to minimum wage laws. 

Other options: Churches and other religious institutions also offer child care, as well as part-time options often referred to as Mother’s Day Out or Mother’s Morning Out programs. 

Family, friend and neighbor care is also a more informal option that families can turn to, and in some states these providers can also receive subsidies to lower the cost for low-income children, which would make them subject to some of the same safety regulations such as background checks.

How do I choose the type of child care that’s best for my family? 

There are a number of considerations to take into account, including work schedules and the type of environment your child thrives in. How old is your child? Do you need care during the day or during nontraditional hours? Is a structured group environment better or does your child prefer a smaller group with more one-on-one care? Does your child have special needs? 

Take the time to tour the places you’re considering. Spend a half day there if you can. Consider a trial period if the day care provider offers it. 

But cost is one of the biggest drivers in the decision, Parola said. 

“It’s a tough conversation to have: What can we realistically afford each month for child care?” she said. “What I see mostly in my clients is, ‘We thought we could afford a nanny but realistically, we can’t.’” 

What if my child has a disability?

Parola, who has worked extensively with families who have children with disabilities, said nannies are often a good choice because of the flexibility and personalized attention. But nannies can be expensive. She suggests looking at hiring college students who are studying early education or specific therapies who may have additional skills you’re looking for. 

In-home day cares may also be a better fit, and some larger centers may be able to work with a child with a disability. 

Local mom groups and special needs groups are a great place to look for recommendations. Parola suggests parents vet potential caregivers for specific work experience with children with disabilities, or specifically with your child’s diagnosis. 

How do I know how much a child care option costs? 

Online resources like Winnie.com offer estimates for centers, home-based providers and nannies. For nannies, several online wage calculators, like this one from Care.com, help give general estimates of going rates. For au pairs, State Department rules dictate that the minimum weekly stipend must be $195.75, on top of additional costs for boarding, food and transportation. 

Some providers, particularly centers, post the information online and others will give tuition details after inquiries. 

Infant care is the most expensive because it requires more staff, and costs go down the older a child is. Nationally, the average cost of child care in 2022 was $10,853 a year, according to the most recent analysis by Child Care Aware, a national child care advocacy organization. 

Tools like this one from MarketWatch allow you to get a rough estimate for your county based on 2018 census data that has been adjusted to 2022 inflation levels. 

Are there resources to help me find child care? 

Most states have at least one child care resource and referral agency designed to help parents find child care options. They can also help guide parents on what to look for in terms of safety and licensing and provide help for finding services for children with disabilities. Find the one nearest you here. 

Child Care Aware provides a complete list of state-by-state resources here. 

States also have dashboards that allow parents to search for providers near them. The dashboards include information on the individual programs, as well as inspection history, licensing status and any violations. 

When do I get on a waitlist for a child care center? 

In the first trimester of pregnancy, if possible. Once you’ve narrowed down which centers you like, get on waitlists for a couple early on. Never get on just one — have some backups, as well. Some programs will require a deposit to get on a waitlist. 

Since the pandemic, waitlists for child care centers have gotten even longer as centers have closed and demand has risen. It’s not uncommon to wait a year or more. 

Some programs have stopped keeping waitlists altogether and instead advertise online or on social media when a spot is open, offering it on a first-come, first-served basis. 

Families who already have a child in a program typically get priority on waitlists. 

After you get on the list, it’s OK to follow up every few months to see where you are on the list and when a spot might be available for you. Spots are most likely to open up at the start of the school year, when children are changing classrooms, or at the start of the calendar year, when programs might begin to shift kids around or some might leave after the holidays. 

What questions should I ask a program or provider? 

There are a whole host of potential questions to ask when you’re touring or learning about a program or provider. Child Care Aware has a full list of ideas depending on the child care setting. Here are some key questions to ask providers: 

Day-to-day operations:

• What does a typical day look like? 
• Is there a curriculum and, if so, how is it incorporated into the daily schedule? 
• Can parents or family members stop by anytime? 
• Are children taken outside on a regular basis? 
• If there are any potential hazards, such as a pool, how is it secured to ensure children are safe? 
• How is information about the child’s day shared? (Is there an app, a paper form, cameras, etc.)
• How do caregivers work with parents to incorporate the family’s culture and values into the classroom?
• What is the illness policy for when your child becomes sick? How long must they be out of child care?

Feeding:

• How are breast milk and formula stored? 
• Are infants fed on demand or on a schedule?
• If the program serves food, does it meet nutritional standards?
• How are new foods introduced to toddlers?
• What are the rules around bringing food from home? 

Sleep:

• Are all infants put to sleep on their backs on a firm sleep surface free of loose bedding and other objects?
• Are all child care staff, volunteers and substitutes trained on safe sleep practices to reduce the risk of Sudden Infant Death Syndrome (SIDS)?
• Do caregivers regularly check on infants and toddlers when they are sleeping?
• Are toddlers offered a nap every day at a regular hour?

Licensing, health and safety:

• Is the program licensed?
• When was it last inspected, and how often is it inspected?
• Have caregivers been trained on CPR and first aid, and are those certifications current?
• Are the caregivers trained on administering medication, and what is the process to ensure the right child receives the right amount of medication?
• Does the child care program have records proving that the other children enrolled are up-to-date on all of the required immunizations?
• Does the caregiver have a bachelor’s degree in a child-related field or has the caregiver worked in child care for at least one year?
• What is the ratio of children to caregivers, and how many kid are in each classroom?

How many kids should each caregiver be responsible for? What ratios should I look for?

The best practice recommendations from the American Academy of Pediatrics and the American Public Health Association for center-based care are: 

• 0 to 12 months: Three children per caregiver (3:1 ratio). Maximum classroom size of six children.
• 13 to 35 months: Four children per caregiver (4:1 ratio). Maximum classroom size of eight children.
• 3-year-olds: Seven children per caregiver (7:1 ratio). Maximum classroom size of 14 children.
• 4- and 5-year olds: Eight children per caregiver (8:1 ratio). Maximum classroom size of 16 children.

The recommendations for home-based providers are: 

• 0 to 12 months: Two children per caregiver (2:1 ratio). Maximum group size of six children.
• 13 to 23 months: Two children per caregiver (2:1 ratio). Maximum group size of eight children.
• 24 to 35 months: Three children per caregiver (3:1 ratio). Maximum group size of 12 children.
• 3-year-olds: Seven children per caregiver (7:1 ratio). Maximum group size of 12 children.
• 4- and 5-year olds: Eight children per caregiver (8:1 ratio). Maximum group size of 12 children.

Per the recommendations, in-home providers should count all children under the age of 6, including the provider’s own children, in the total number for the ratio. Programs with a mix of ages should have no more than two kids under the age of 2.

States may have slightly different guidelines from the recommendations, which day care providers may follow instead. Check to see your state’s rules.

How do I check a provider’s licensing and inspection history? 

Every state is required to provide a website for families to check their provider’s inspection history and licensing status. Those databases show the results of the most recent inspections, as well as details as to whether children have experienced serious injuries or abuse at centers or home-based day cares. The databases are also a good source of information on details about the program, including whether it offers subsidies. 

Every state but Hawaii has this database. Hawaii’s state database is still under development, but the state’s resource and referral agency has a database parents can access. It does not, however, include inspection or violation information.

Checking these databases is a crucial step in ascertaining the safety of a program. The pandemic slowed down the process of inspections at day cares, with more than 14,000 licensed facilities in 41 states behind on their inspections as of September. If a day care has been inspected recently, parents will be able to see if they were out of compliance with any regulations — details you can ask also about when you tour the facility. 

What are the background check requirements for providers? 

Though some do not, child care centers and in-home providers are required by federal law to run five background checks for all child care staff (including adults living in the home with home-based providers), as well as three interstate checks in any state the person resided in the prior five years. The checks must be completed within 45 days of when they were initiated. 

The checks include a national FBI criminal history check, national sex offender registry check,  in-state criminal history check, in-state sex offender registry check, in-state child abuse and neglect registry check, interstate criminal history check, interstate sex offender registry check, and interstate child abuse and neglect registry check. 

According to a 2022 report to Congress, only 24 states conduct all checks and adhere to the hiring practices under the law. At least 19 states are not requiring checks before staff work with children. The system has been faced with numerous challenges, including insufficient data systems and staff to process the requests, as well as substantial problems with the interstate checks. States may define offenses differently and may have privacy rules around sharing information with other states, which slows and sometimes completely halts the background checking process. 

Parents should ask their provider directly whether the background check requirements are being met by the individuals providing care. 

Au pairs get a background check through the visa and agency application process, and nannies hired through an agency usually get one as well. Parents can choose to run a background check on their nanny, too. The cost can range from $50 to $300.