CHILD CARE, DAYCARE

Each weekday, approximately 13 million infants, toddlers, and preschoolers in the United States spend part of the day being cared for by someone other than their parents. This number represents three out of five young children in the United States. During the last decades of the twentieth century, increased employment of mothers outside the home significantly increased child-care demand.

Child care is provided by both not-for-profit and for-profit entities. Child care can be divided into two types: center-based child care (e.g., child-care centers, Head Start, preschool) and home child care (e.g., care in a provider's home, babysitter or nanny in the child's home, relative care).

Child care creates challenges and opportunities for public health. Increased use of child care has significantly changed the epidemiology of illnesses and injuries among young children. For example, children enrolled in child care have increased exposure to common, highly communicable childhood diseases such as common colds and other infections (e.g., respiratory tract infections, skin infections such as impetigo and ringworm, and intestinal tract infections). Common behaviors by infants and toddlers promote the spread of germs, such as sucking on fingers and toys. Child-care-associated illnesses have substantial economic impact through direct medical costs and lost workdays for both staff and parents.

However, quality center-based child care can also benefit public health by increasing the quality of nutrition, raising immunization rates, and stimulating child development. Out-of-home child care provides venues for teaching and reinforcing health-promotion and disease-prevention behaviors such as hand washing or exercise. In addition, child care can serve as a link connecting families to community health services such as immunizations, lead screenings, dental education, and injury and violence prevention.

Child care is regulated at the state level, and much variation exists between states. States regulate topics such as child/caregiver ratios, employee background checks, and caregiver training in early childhood development. In-home child-care providers are much less regulated than center-based child-care providers. For example, only eleven states require home child-care providers to have training in early childhood education prior to serving children.

BIBLIOGRAPHY

Capizzano, J.; Adams, G.; and Sonenstein, F. (2000). Child Care Arrangements for Children Under Five: Variation Across States. Washington, DC: The Urban Institute.

Centers for Disease Control and Prevention (1995). CDC Child Care Health and Safety Action Plan. Atlanta, GA: Author. Available at http://www.cdc.gov/nadad/hib/Child/child.htm.

Children's Defense Fund (1999). Overview of Child Care, Early Education, and School-Age Care, 1999 Key Facts, 1999. Washington, DC: Author.