Childcare

Childcare Settings

Childcare settings vary widely and fall into 4 broad categories, listed here from the least to the most formal: (1) relative care; (2) in-home nonrelative care, such as nannies, babysitters, or au pairs; (3) family childcare, in which the caregiver provides care in her own home for up to 6 young children, often including children of mixed ages, siblings, or the provider's own children; and (4) center-based care, provided in nonresidential facilities for children grouped by age.

Parents more often use home-based care for infants and toddlers, partly because of greater preference, flexibility, and availability, and sometimes because of lower cost. Use of center-based childcare is greater among preschoolers (children 3-5 yr old). Childcare centers and early education programs are administered by a wide array of businesses and organizations, including for-profit independent companies and chains, religious organizations, public and private schools, nonprofit community organizations, cooperatives, and public agencies. Preschool programs (e.g., Head Start, prekindergarten ) also may play an important role in childcare. Although early education programs may have a greater focus on educational activities and often provide only limited hours of care daily, the health and safety issues involved with preschool programs are similar to those presented by other group childcare settings.

Childcare Licensing, Regulation, and Accreditation

Poor-quality childcare settings and unsafe environments that do not meet children's basic physical and emotional needs can result in neglect, toxic stress, injury, or even death. Licensing and regulatory requirements establish the minimum requirements necessary to protect the health and safety of children in childcare. For the most part, licensing standards mandate basic health and safety standards, such as sanitary practices, child and provider vaccinations, access to a healthcare professional, and facilities and equipment safety, as well as basic structural and caregiver characteristics, such as the ratio of children to staff, group sizes, and minimum caregiver education and training requirements. Most childcare centers and preschools and many family daycare providers are subject to state licensing and regulation . All states regulate centers, as does the District of Columbia, and most states regulate family childcare providers. *

* For the most recent state and territory licensing regulations, see https://childcareta.acf.hhs.gov/resource/state-and-territory-licensing-agencies-and-regulations .

Childcare programs that are subject to licensing must comply with their state's requirements to legally operate. Many early care and education providers are subject to monitoring by multiple agencies and organizations.

Many providers are legally exempt from licensing standards. However, the 2014 Child Care Development Block Grant (CCDBG) reauthorization required states and territories to expand their monitoring of legally exempt providers to protect the health and safety of children receiving subsidized childcare. Exemptions for various types of programs vary by state. The smallest homes (3-4 children in care) are typically license exempt, encompassing relative, friend, and neighbor caregivers as well as babysitters, nannies, and au pairs. These providers may fall outside of any regulatory scrutiny, and some may not even think of themselves as offering “childcare.” Fewer children (≥4) are cared for in large home-based settings, typically by nonrelatives. Depending on the state, small family childcare homes may be exempt if there are few children in care, and large/group family childcare homes may be exempt if they are open part-day. Unlike exemption rules for homecare providers, which typically are based on size, centers are often exempted if overseen by other organizations such as schools, churches, or local governments, and thus have some external oversight. Many of these entities provide part-day or part-week Head Start or preschool programs, and about half the states also explicitly exempt such part-time programs.

Homes and centers that fall under state-licensing guidelines face different requirements, which can have a direct impact on the quality of children's experiences. Size differs greatly between the 2 types of contexts, and such size differences are built into regulations in terms of the maximum number of children who can be cared for in a group and the number of adults that must be present. The most common state-required maximum group size in centers is 8 for infants, 12 for toddlers, and 20 for preschoolers; centers may have numerous classrooms of these sizes. For centers, regulations explicitly state an allowable ratio of children to adults. The most common ratios are 4 : 1 for infants, 6 : 1 for toddlers, and 10 : 1 for preschoolers, meaning that typically there would be 2 adults in a group. However, other states permit ratios that are 5 : 1 or 6 : 1 for infants ≤9 mo of age. Furthermore, most states' child/staff ratio requirements increase as children age; for children 27 mo old, only a handful of states have ratios of 4 : 1.

States license homes in 2 categories, small and large, with typical maximums of 6 and 12, respectively (including the provider's own children). More than 75% of licensed homes fall within the small category. Thus the total size of a typical home is smaller than just 1 classroom in a center. States less often explicitly lay out child/adult ratios for homes, given that many homes involve one provider caring for all the children. Some states restrict the number of younger children who may be in care or explicitly provide ratios (especially for large homes), although these restrictions vary greatly across states.

Health and safety conditions may be unsatisfactory in unlicensed settings. In most states, licensing and regulatory standards have been found to be inadequate to promote optimal child development, and in many states, standards are so low as to endanger child health and safety. Therefore, even licensed providers may be providing care at quality levels far below professional recommendations. A small portion of providers become accredited by National Association for the Education of Young Children (NAEYC), National Association for Family Child Care (NAFCC), or other organizations by voluntarily meeting high-quality, developmentally appropriate, professionally recommended standards. The accreditation process goes well beyond health and safety practices and structural and caregiver characteristics, to examine the quality of child–caregiver interactions, which are crucial for child development, as described in the next section. Evidence indicates that childcare programs that complete voluntary accreditation through NAEYC improve in quality and provide an environment that better facilitates children's overall development. Only 10% of childcare centers and 1% of family childcare homes are accredited. This is partly the result of a lack of knowledge, resources, and incentives for providers to improve quality, but also because of expenses providers incur in the process of becoming accredited.

State childcare licensing agencies are playing a larger role in various initiatives designed to improve the quality of childcare, working through the infrastructure of the early care and education system. Several states have quality initiatives called quality ratings and improvement systems (QRIS), such as tiered quality strategies (e.g., tiered reimbursement systems for participating providers who achieve levels of quality beyond basic licensing requirements), public funding to facilitate accreditation, professional development systems, and program assessments and technical assistance.