• Hours. When is the center open? What if you are late in picking up your child? How are vacations and holidays scheduled?
• 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?
• Inspections/consultations. 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?
• Experience and training. What education, training, and experience do the staff have? What type of additional training has the staff had during the past year? Do outside experts provide training?
• Adequate 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?
  

  Do the child-staff ratios and the size of the groups of children fall within nationally recognized standards? For example, in a room with 4 children aged 13 to 30 months, there should be 1 trained caregiver. In a room with 5 to 8 children aged 13 to 30 months, there should be 2 trained caregivers. There should be no more than 8 children aged 13 to 30 months in a room. (See chart.)

• Health standards. Do children need a medical exam before they can enroll? Have staff been checked by a doctor to be sure that they are healthy? What are the policies when children are mildly ill?
• Quality. Are children cared for in small groups? Are activities proper for their age group? Is there a daily schedule? Is there daily indoor and outdoor play time? Can children watch TV and if so, what is watched and for how long?
• Policies. Check the center's written policies. What is the discipline policy? Do the children go on outings? If they travel by car, van, or bus, are the proper child safety seats, booster seats, and seat belts used? Is there someone besides the driver supervising the children during transport?
• Consistency. Are the program's policies on meals, discipline, and issues such as toilet training the same as yours? How long have the staff worked at the center? How much experience do they have with children of your child's age?
• Backup plans. What happens if your child is sick or the child care program is closed?
• Fees and services. What is the cost? How are payments made? Are there other services available in addition to child care? Do these cost extra?
• References. Ask for references and contact information from parents who use the program, as well as at least 1 parent whose child was in the program during the past year.
• Communication. Can you talk with staff on a regular basis? If there was something sensitive you needed to bring up, would you feel comfortable talking to them?

Published online: 3/08
Source: Choosing Quality Child Care: What's Best for Your Family? (Copyright © 2007 American Academy of Pediatrics, updated 11/07)

Healthcare professionals may order this publication in multi-copy packs.
Parents can find more information on this topic in Caring for Your Baby and Young Child: Birth to Age 5. To order a copy of this book visit the AAP Bookstore.

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The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.