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
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).
Table 97-1. Types
of Nonparental Childcare7
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Table 97-1. Types
of Nonparental Childcare7
|Types of Care||Benefits||Barriers|
|Caregiver cares for child in child’s home (nannies, babysitters)||Child in familiar surroundings||Costly. Caregiver must make minimum wage, report taxes, and pay Social Security|
|Child receives individualized care and attention||May affect family privacy|
|Limited exposure to infectious disease||Caregiver may have limited training in child
development, health, and safety|
|Caregiver may be asked to provide light housework||Caregiver may have feelings of isolation|
|If caregiver is sick or suddenly unavailable,
parent must find replacement|
|Family Child Care|
|Caregiver cares for child in caregiver’s
home. May also care for children from his or her own family and
other families||Less expensive than in-home care||Limited social support and supervision
|Usually a small number of children and favorable
|May have limited training in
child development, health, and safety|
|Opportunity to socialize and play with other
|May not have developmentally appropriate
|Comfort of a home setting|
|May be flexible to meet individual child’s
needs||If caregiver gets sick or unavailable, parent
must find replacement|
|May be less likely to comply with state childcare
standards and policies|
|Childcare Center or Preschool|
|Caregivers or teachers care for child within
a group of children in a facility designed ...|
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