Intended for healthcare professionals

Career Focus

Choosing child care

BMJ 1998; 317 doi: (Published 28 November 1998) Cite this as: BMJ 1998;317:S2-7171

Access to high quality child care is essential for working parents. Colette Kelleher provides guidance on making choices about child care

  1. Colette Kelleher, Director
  1. Daycare Trust, 4 Wild Court, London WC2B 4AU

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    Increasing numbers of professional women are returning to work while their children are young. Choosing the best child care is, therefore, one of the most important decisions they will make both as parents and for their children. But for many parents, particularly those working unusual hours, finding child care that is flexible and meets their needs can be difficult. The choice between a nursery, nanny, or childminder can also be bewildering.

    The government recently announced its national childcare strategy with the aim of increasing the supply of affordable quality child care throughout the United Kingdom. The strategy is the most comprehensive attempt by any government to meet the childcare needs of parents and children. It includes investment in places at out of school clubs and a new childcare tax credit to help parents on lower incomes pay for child care. In welcoming the strategy, the national childcare charity Daycare Trust argues that expansion should not be at the expense of quality and urges the government to provide more encouragement for employers to support child care and family friendly policies.

    Choosing child care

    The person you choose to look after your child will be important and will form one of the major relationships in your child's life, one that sometimes endures to adulthood. The relationship between the child carer, child, and parent is intimate and professional. Parents look for child carers who are interested and involved with their child, loving and giving, responsible and firm. But they also look for people who respect the parent-child bond and who work to support both the child and the parent, not undermine or compete with the parent.

    Visit before you decide

    It is important to visit several childcare providers before you decide who to choose. Try to visit when there are children around but also arrange a quiet time to discuss the details of the potential arrangement with the child carer.

    Commonsense questions give good clues of quality. Are the children relaxed and do they seem to be enjoying themselves? Are the staff listening to the children and are they joining in with the children's activities? Do the staff seem friendly and proud of their work? Is the building pleasant, clean, and welcoming? Is there a fun and safe space outside to play?

    Are different cultures positively represented in the toys, books, and wall displays? Do children and staff represent the ethnic and cultural groups that live locally? Are there lots of fun toys and activities for children? Is the area child centred, with child sized furniture and with wall displays that children have made themselves? Are you and your children welcomed by staff and by the children? The answer to all these questions will be “Yes” with good quality childcare.

    Ten questions to ask when you visit prospective child carers are:

    • How long have you been working with children?

    • Have you done any training?

    • Do you like this job? Why?

    • What other children will be with my child? (for nurseries and playgroups: do you operate a keyworker scheme?)

    • How do you spend the day and how will the other children's schedules fit with my child?

    • Where will my child rest?

    • Do you make outside visits and trips? Where to?

    • What sorts of meals do you give the children?

    • Can I see your registration certificate? (nannies are not registered)

    • Do you keep records about the children's progress? How will we exchange information and communicate?

    Add your own questions and don't be afraid to ask them. Good childcare workers will expect this and will also expect to show you the rooms and outside space that your child will use. Ask for at least two references from other parents and follow them up. Prepare questions for your visit.

    Organise a settling in period for your child before you go back to work. Encourage your home based carer to start a network of friends with children. Equip a nanny to provide interesting play for your child - sand, paint, clay or dough, and aprons - and show the nanny local parks and children's services. Don't ignore a child's difficulties if he or she seems unhappy with the child carer or is not thriving, and investigate further. Acknowledge the child's feelings and seek advice from the child carer or your health visitor or under-8s adviser in the your local authority.

    Express your appreciation to your child's carers. Don't forget that looking after a child is a demanding and vitally important job. Don't skimp on pay and conditions if you want to hold on to your nanny or childminders.

    Nannies need careful recruitment

    Nannies are employed by parents to look after children in their own home. They offer a personal form of child care tailored to the needs of your family. Contracts between parents and nannies formalise the arrangements. For doctors working unusual and long hours, nannies can be more flexible than nurseries and playgroups. Children can build a strong relationship with one carer, and you can provide the toys and meals you want in your own home.

    There are no legal requirements for a person applying for a job as a nanny. Unlike nurseries and childminders, which are registered by local authorities, nannies are not regulated or checked by anybody other than you, the employer. You must satisfy yourself that the nanny is safe, competent, and has a suitable personality. Interview potential nannies and always take up references.

    At least half of all childcare staff in Britain, including many nannies are working without the benefit of specialist training. Experience is helpful, but training makes the biggest difference to children. Child carers need training to build up knowledge of child development, to plan children's learning, and work well with families.

    Building the relationship

    It is in the best interests of the child that the parent has a positive relationship with the child's carer. This will require the gradual building up of trust. To avoid unnecessary problems and difficulties, it is important that parents are clear about their expectations of the child carer. It is best to clarify issues about pay and holiday times as well as sharing information about style of child rearing at the outset.

    It can be useful to draw up a contract or agreement between you and your child carer. This can be the basis of initial discussions with the child carer and a useful reference point if difficulties arise. Many nurseries, childminders, and other childcare providers will have contracts of their own.

    As a busy professional, you must be honest about your requirements. Don't give your child carer times of care that it will be impossible for you to keep. Let your child carer know of any days you are likely to be late. Make contingency arrangements if you have to work late or are delayed - for example, you may offer your child carer extra pay for overtime or may have an arrangement with a relative or friend to pick your child up. You should arrange for your carer to meet anyone who may collect your child on your behalf and give written authority for this arrangement.

    Paying for child care

    Parents in Britain pay the highest childcare bills in Europe, meeting more than 90% of the costs. Families with two children - one pre-school and one needing care after school and during school holidays - typically face childcare bills of £6,000 a year. This is more than average spending on housing or food.

    Typical costs of child care per child are:

    • Childminder for pre-school child, £60-£120 for a full time place

    • Private nursery, £80-£180 a week

    • Nanny, £90-£280 a week

    • Out of school club, £15-£40 a week

    • Holiday play scheme, £40-£90 a week

    Making contingencies

    Every parent using child care will tell you that it is almost inevitable that your childcare system will break down at some point. Your childminder might fall ill, your child may be ill, or your nursery may be flooded. It will help if you plan ahead and make contingency plans well in advance of any crises that may occur. Try to have a list of alternative carers who your child knows well, who can fill the gap when your normal arrangement breaks down.

    Here are some ideas for developing such a network:

    • Family or friends might help out, perhaps on an exchange basis

    • Alternative childminders or nannies could take over - ask your carer to set up a contingency network

    • An emergency nanny can be hired by the day, via a nanny agency

    You may also need to take time out from work at short notice. It is helpful to reserve some annual leave for emergencies, and some employers provide dependency leave.

    Child care works

    Although most leading employers in Britain recognise the need to support staff with children, very few actually provide their employees with practical help such as childcare vouchers or cash allowances, workplace nurseries, holiday play schemes, or information about finding child care.

    There is a strong case for employers investing in child care - in terms of reduced recruitment costs, improved retention of staff, and recouping investment in training. Other benefits for employers include higher morale and lower absenteeism and stress rates, as childcare support enables employees to work to their full potential. A growing number of NHS trusts and health authorities are beginning to tackle these issues and address the needs of their predominantly female workforce.

    Further information and advice

    • National childcare helpline 0171 405 5617

    • Publications:

      Check Out Childcare, a guide for parents looking for child care, £5

      ChildWise, a free quarterly newsletter for parents

      Families that Work, a guide for employers about child care and family friendly options, £10

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