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With more women seeking employment outside the home, about 11 million children under the age of 5 years spend a significant amount of time in nonparental childcare (NPCC) arrangements.1 Political, cultural, and economic factors contribute to the increasing number of children in NPCC settings in the United States. In 2006, 67 million women were employed and 75% worked full-time.2 Changes in family structure influenced the economic needs of households. Currently, about 70% of children live with two married parents. Children living in mother-only households increased steadily to 23% and in father-only households to 5% in 2006.3 Preschool-age children of working mothers spend an average of 36 hours in childcare each week.1


Primary care clinicians need to understand NPCC options available to families, current research on the effect of NPCC on child development and behavior, how to counsel families on choosing quality childcare within the family budget, and how to advocate for quality childcare on a local and national level.4


Over 70% of children 5 years and younger with employed parents are in nonparental childcare (NPCC) arrangements.5 The primary types of care include (1) center-based care, such as childcare centers, daycare centers, preschools, prekindergarten, and Head Start programs; (2) home-based care, such as that provided in a nonrelative’s home or care provided by a nanny or babysitter who comes to the child’s home; and (3) school-age care, such as before- and after-school programs. NPCC can be for-profit or nonprofit, faith-based or nondenominational, private or public6 (Table 97-1).

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Table 97-1. Types of Nonparental Childcare7 

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