Choosing the Right Child Care

One of the questions I get the most from new moms is how to choose the right childcare. I'll start by saying that choosing a child care provider is almost as personalized and unique as choosing a partner; what's right for one family may not be the best for another. I think what can sometimes make it difficult to compare is that we frequently hear from a family that uses daycare and compare it to a family that uses a nanny - it's hard to compare these when the nanny family has never used daycare and the daycare family has never used a nanny.
I say all of this because I feel like we're in a pretty good position to truly compare almost all of the child care options. In Liv's short year and a half of life we have gone through me playing stay-at-home-mom, having a nanny in our home, using a small home daycare (one woman watching 3 babies), a large typical daycare, and finally, having family move in and provide live-in daycare. So short of maybe an au pair, we really have used virtually every type of childcare provider! I hope I can provide those of you who are trying to figure out what to do for child care with a relatively unbiased view of most of the different types available.
Nanny
our experience: We had a nanny taking care of Liv in our home between the time she was 9 and 11 months old (the summer entering our fourth year). I searched on care.com for potential nannies, liked what I saw as options in our area, and so went ahead and created a job posting. I sent most interested applicants a few follow up questions specific to their experience with babies of that age, their interests and goals, etc. and the ones who I liked the most through that interaction (professional and prompt in their emails, their experience sounded good, they gave a real answer and not a generic copy-paste they send to everyone) I then set up in person interviews with at a local cafe (where I brought Liv too)! The interview was a time for me to just get the vibe of a person, hear a little bit more about their experience, and see how helpful and comfortable they were with Liv. Make a long story short we found the right girl, and she was a Godsend while we had her. To save on costs (especially because we knew we only needed her for the summer), we hired a responsible college student who was getting her degree in early childhood education. Having a nanny was wonderful - they can come early so you have time to get ready for work, you can give individualized instructions as to what you like/what you're child likes, and (most helpful for us) they can be incredibly flexible with their schedules, so if yours is an unpredictable one, rest assured that someone will be taking care of your child when you wind up having to stay at work a little later than usual. She could even help with light housekeeping and keeping things in order, something that I really missed once we had Liv in daycare!
what to look for: One of the biggest drawbacks in my opinion about having a nanny is that kids could potentially miss out on social interaction with babies their age. Of course this can easily be addressed by having playdates and going out to story times at the library, etc. - while searching for a nanny find out how comfortable she is with the area and if she knows about these activities (or can be proactive and find some herself)! Also, make sure you hire someone you like. This person will be in your home, many times while you are still there, and the last thing you want is to feel like you don't want to be around them, even if they are great with your child. A lot of people worry about trust and security with a nanny, and I have to say, I'm not really one of those people. I never considered having a nanny-cam or anything of the sort, but I certainly trusted my intuition (especially when meeting with applicants - there were a few I wasn't too fond of for no particular reason, but I went with my gut). One thing that I found did put me at ease was that N or I could drop by the house at any time without warning and find them playing, or eating, or napping, etc. Make sure you hire a nanny who is ok with this, as it will certainly make you feel much better about what's going on when you're not home! It's key to speak to her references and get the low-down on what her previous families thought of her - if they're not raving about her, don't hire her! If they can only say she was "good" or she was "responsible," it could potentially be a warning flag of a not-so-stellar nanny - trust me, when you have a great nanny you will love her and will not be shy to tell the world how amazing she is (we love you Dahlia)!
Small home daycare
our experience: This is how we started with our childcare - we dropped Liv off every morning at a friend's house who also took care of two other babies (her own boys) and lived nearby the medical area. We had this arrangement from the time Liv was about 3.5 months up until almost 9 months. This was nice because we didn't have to bring toys or books or other things - she had everything in her home. She also was a mother herself, knew so much about what to expect (she was so helpful in starting Liv on solids, noticing when she had a tooth coming in, etc.) She got all of the babies on an amazing schedule, was able to go out on fun trips around the area to local parks and play groups (with a double stroller with a standing platform), and most of all Liv got to really learn from the boys (one was a couple months older than her, the other almost a year older). I must admit I still miss them playing together! I've spoken to other moms who used small daycares and they felt that the interaction was really optimal in that situation - the number of children was just enough to really know all of them well, but not enough to be constantly sick like in larger daycares! I think one of the biggest negatives of this arrangement was that (not having a car), the commute really got to be a lot some days, and after walking there and then to work and then there in the evening and back home I really was drained. This was obviously unique to our situation, but it was a valuable lesson in how the commute really does make a difference even when everything else is wonderful! (Colleen we miss you and the boys soooo much!)
what to look for: Look for well-reviewed small daycares - I lucked out in that my friend who I already trusted was able to do it, but some of the best places I've found when searching at other times have been through mom groups (many are on Facebook, here in Boston, GardenMoms is great). These reviews from other moms really go a long way! Visit the home and make sure you really check it out - everything should be baby-proofed, the toys and equipment should be clean, etc. Make sure the surrounding area/neighborhood is safe, and hopefully in a convenient location to you or your partner's job. Find out what their emergency plan is should anything ever happen - if it's just one person you want to make sure they're not taking on more than they could handle, if it's two or three it's still good to know that they have a protocol in place.
Large daycare establishment our experience: We finally transitioned Liv to the more typical daycare right before her first birthday and stayed there up until 18 months. We started in the infant movers room and then later transitioned to the toddlers room. We compared various daycares and took tours of the centers, and they were all incredibly similar (in Boston, especially in the Longwood Area, daycares are pretty top-notch and have waiting lists a mile long). We ended up choosing the one that was closest to our home (literally across the street from us). The transition was a harder one for me because I for some reason felt more guilty about daycare than I did about any other of our childcare situations. Part of me at first felt like I was dropping her off at a baby factory where they all just got left around to themselves and make sure they didn't choke on anything. Thankfully that feeling changed very quickly when Liv started growing close to her teachers there (Natalie we will forever be grateful for you) and would run to them in the morning. Dropoffs were still hard for a little while longer, but if I "left" and then peeked my head back around the corner she was already playing with her little friends, which always made my heart melt. The toddler room was an even more exciting transition for us because all of the kids were blossoming socially, and clearly being together was beneficial for them! I loved the sheet you'd get at the end of the day with a summary of activities, wet and dirty diapers, meals, etc. as well as the pictures and crafts from the day! It really was special! The teachers were incredible, and once we got to the toddler room we had the option of picking a bilingual class which I loved (I try to speak Spanish at home as much as possible, but because N can't, Liv doesn't get to hear the back and forth of conversation as much). (Gloria y Mildred, gracias por todo!) I think the biggest drawback to daycare for us, and part of the reason we had to seek something different, was the lack of flexibility. As we get ready to start intern year this summer (arguably for many the toughest year of residency), we really couldn't stick to the typical 7-5 or 8-6 schedule. Depending on what rotations we're on, some days we'll have to be in a 6am and might not get home until 8pm... and it all depends on what happens throughout the day. Daycare works much better when parents (or at least one parent) has a reliable and stable schedule - for us this just is not the case. Another drawback is that kids will get sick - throughout our time at daycare Liv almost always had a stuffy nose, a bit of a cough, colds, a GI bug, an ear infection, and pink eye. Honestly though (and being in medicine), we weren't too bothered by that (once the day or two of my poor Liv being miserable was over of course); it was all very minor and only priming up her immune system! But days she had a fever one of us had to pick her up and stay home, something that was feasible while still in medical school, but a little less so once we're interns. I'd say overall, we absolutely loved daycare, especially once we got to the toddler room. Had it not been for the scheduling, we would 100% still be there.

what to look for: Search for daycares in the area or near your job with good reviews. Take a tour of the facilities and see what the babies are up to! Good signs are always lots of arts and crafts hanging up, parents interacting positively with daycare staff, cleanliness, etc. Hopefully teachers are down on the ground interacting directly with children, not on their cell phones or only talking to other teachers. Don't get turned off by the sound of babies crying (unless they're all crying!) With the number of kids there, there will always be one who is hungry or upset, hopefully you will see someone attending to them quickly! Look for a daycare that provides daily communication as far as what went on throughout the day, this is really helpful in this setting since you can't just call or text like you can with the nanny or small daycare provider. Open door policies should stand at the facility (meaning you can come in whenever, not just at designated "drop off/pickup" times; some daycares even have live video monitoring throughout the day so you can observe remotely (I always found this a little creepy but honestly, if given the chance, I'd definitely check it)! Some more "official" things to check (that are pretty regulated here in Boston) are the teacher-to-child ratios, accreditation status, and teacher qualifications.

Family caregiver
our experience: This is what we have now, and we feel incredibly blessed. When we moved to a bigger place, N's mom moved in with us and has her own room and space in our home. Some families do it a little differently and take their child to their mom's house or something like that, so the live-in situation isn't the typical way this happens, but I love it! My parents were always working so our caretakers before we were school-age (and every summer until we were old enough to stay on our own) were my grandparents. Knowing how beneficial that was for me and my development (and my sense of family), I loved the thought of it for Liv, but it just wasn't feasible until just recently. It was hard for me taking Liv out of a daycare because she was clearly thriving there, but we also knew we needed something more flexible. We also were paying an insane amount of money monthly for childcare (Boston is notorious for being the most expensive place for childcare - let's just say that daycare was the cheapest of all of the childcare options we had, and we were paying just over $2,000/month. All of which was coming from school loan money). I think part of what I love most is seeing the relationship that Liv and her grammie have now - it's the absolute best. She's also really active with her - they go to playgroups, do arts and crafts, and puzzles and books; the last thing she's doing is sitting in front of the TV all day. The live-in part is even nicer because date nights can be relatively spontaneous again. We are definitely conscious of giving grammie her own time and respecting her time away from Liv, and she does the same for us. It really has been a win-win and will only become more critical/life-saving once we hit the crazy intern year schedules.

what to look for: Obviously you can't get too picky about family that may be available to take care of your child. The biggest key in making this relationship work is feeling completely comfortable communicating, making sure they still do plenty of activities with your child, and hopefully they can also get them socializing with other children. Although in complete honesty my grandparents did none of this with us - they fed us and loved us and kept us safe on the couch most of the time, and I turned out all right ;)

Some take home points on all of the various forms of childcare we've now used? As a new parent, you're likely going to be nervous about any option that doesn't involve you staying home taking care of your child. I even cried the first few times I left Liv with my own mom! This is completely normal (at least that's what I tell myself)! Along the same lines, though, remember to trust your intuition, and if something just feels wrong, hopefully you have other options that feel more comfortable for you and your family. Another huge lesson we've gained from all of this is that kids are incredibly flexible. I was worried that changing things so frequently could be difficult for Liv, or could somehow be doing harm. But she adjusted and thrived in every single setting we put her in. Now, as much as I think Liv is special, I'm pretty sure this will be true of most children. It really does take a village to raise a child, especially when both parents are working full-time, and that village looks a little different for every family. Find what works for you, and don't be afraid to change if you haven't found it yet. And rest assured that the best part of your day will be reuniting with your little one!