As my children have grown older, my childcare needs have evolved from full-time nanny to afterschool care and a driver for afterschool activities. This results in yearly, and sometimes more frequent, shifts in sitters, with college students coming and going from semester to semester and season to season. Fortunately, my children have adapted well to each new personality, letting me know who works well and who needs to be replaced because my concern for their safety and happiness is always a priority. Although it is now a yearly aggravation, I am happy to have reached this point of significant cost savings in my family's childcare structure.
A Nanny or Daycare?
In a society in which approximately 66% of the households are dual income,1 and as a community-based pediatrician, it is not surprising that I am asked daily by parents of my patients why and how I hired a nanny and what I feel are the benefits and disadvantages of a nanny versus daycare. I usually relay that I did not have a choice at the time.
Being a resident physician with a husband who is a teacher and coach, there was not a daycare in the area that would accept our children at 6 am and care for them until 7 pm. As a result, we started with a nanny and continued with a nanny until all of our children were school aged.
However, I have recently observed how one of my colleagues, who started with daycare arrangements, has found that nanny care is best for her family after experiencing one daycare and two nannies.
Making this decision more complicated for new parents is the many permutations of both the daycare setting and nanny care, including private home daycare, community center daycare/preschool (ie, YMCA, Headstart), and chain daycares (ie, Bright Horizons). Nannies may be live in, day nannies, and nanny shares with other families. Ultimately, I advise the parents of my patients to do what is best for their family as a whole. Although there is no correct answer, there are a number of pros and cons, as well as medical data that suggest one form of childcare may result in better long-term health (Table 1).2
A Nanny Versus Daycare: Important Differences to Consider
Daycare Setting Options
There are two main types of daycares—group-based daycares and home-based daycares. Both are places where children are dropped off and cared for during working hours. Group daycares are state-licensed facilities that care for children of varying ages. In Illinois, this means that a representative from the Department of Child and Family Services (the entity in Illinois responsible for licensing daycare centers) has inspected the facility and found it to meet the minimum criteria for licensing. Cities and municipalities may impose additional specific criteria to meet their own licensing requirements. These licensing requirements are summarized and made available by each state's licensing body for review.
In a group-based daycare, children are grouped usually by age and cared for in small “classroom like” settings. Home daycares are run out of a care provider's home and usually have a much smaller group of children. A home daycare may or may not be licensed by the state and/or the city.
Daycares offer many advantages to working parents. First, the cost of daycare is usually less than that of a nanny. The average cost of center-based daycare for one full-time infant or toddler in the United States is $972 per month with the cost decreasing as the child becomes a preschooler ($667 per month).3 This compares to the national average gross weekly salary for a full-time “live-out” nanny at $705 per week and “live-in” nanny at $652 per week; this may be adjusted according to years of experience and location in the country.4 In addition, when hiring a full-time nanny, the US government then considers that family as an employer, resulting in a legal obligation to pay the nanny's social security taxes and provide other benefits.
Daycares provide consistency and reliability for both the child and the parents. The hours are convenient for most parents, often 11 to 12 hours per day. Also, children can attend the same daycare from early infancy through age 5 or 6 years. This allows for the development of relationships with caregivers and the daycare community, which is important for both the child and parents. An additional advantage is that daycare exposes children to each other from an early age. This early socialization teaches children the importance of sharing, taking turns, and learning how to play well with others. Furthermore, well-run daycares will often provide preschool education, and many also have expanded curriculums that include gym, music, and art. Finally, daycares may offer protective health benefits. Studies have shown that early exposure to illness leads to less incidence of asthma.2
However, there are also many downsides that can easily dissuade a parent from choosing daycare. Daycares follow rigid schedules that can be difficult to adhere to for some parents (ie, closed on federal holidays, daily hours not conducive to the parent's work schedule). Moreover, children are constantly exposed to germs and prohibited from attending daycare when ill. Parents are then forced to either take a day off of work or find alternative care. Daycares are usually large group settings, and this could potentially be stressful for some children. Also, children can pick up negative behaviors such as biting or hitting. Additionally, daycare workers can have high turnover rates, which can be difficult for some children who become attached to certain childcare providers.
Nanny Provider Options
Considering the above, nannies provide an excellent alternative to daycare. A nanny is hired to a tailored schedule based on the parents' specific needs. Because they care for children in the family's home, they can provide early morning care that will make the morning rush easier on parents. Children sleep in their own beds and maintain their own eating schedule. Most nannies will take care of sick children as well. This maintains a sense of comfort for the child while parents are out of the home. Furthermore, nannies will often help out with household chores such as light cleaning, laundry, and cooking. As children grow into toddlers and preschoolers, nannies can bring children to school, extracurricular activities, or do other activities that interest the child. Nannies are one consistent person with whom both a child and the parents can create a meaningful bond, many developing long-term family-like relationships.
Good nannies, however, do come at a price. The cost of a nanny, as previously mentioned, is often much more than daycare.3,4 If families can not find a nanny by word of mouth, it may cost them several thousands of dollars to work with a nanny agency. In addition to weekly pay and the legal and financial obligations, families are responsible for providing paid vacation days and sick days. This could force the family to pay double to cover the cost of back-up care if vacation schedules cannot be agreed upon. Moreover, nannies can have unexpected problems such as running late, car trouble, becoming ill, or suddenly quitting.
In addition, parents must trust the nanny to discipline their children. It can be challenging to find a balance with the nanny regarding parenting and discipline. It is extremely important that parents and the nanny have forthright discussions about their expectations in regards to childcare, discipline, and domestic duties at the beginning of their relationship. I recommend daily discussions with the nanny, checking in on how the day went and acknowledging any issues. In fact, it may take several tries to find the right nanny for the family. If a family is not satisfied with a nanny, they must go through the painful process of firing the current nanny and searching for a replacement.
Perhaps the most worrisome to many parents is that unlike a daycare, where there are several workers, there are no inherent checks and balances with a nanny. Infants and young children will not be able to express if there are any nefarious happenings in the home.
Well visits are an opportune time to help parents evaluate the care their children are receiving, making sure they are in a safe and thriving setting, and to assess whether as parents they are satisfied with the care. A discussion serves as an opportunity to help parents develop confidence in advocating for their children, to be able to better ask questions of their childcare provider, and feel comfortable making recommendations they feel are important to the care of their children. As a trusted advisor to many parents, it is important to be aware of the different forms of childcare available to parents, be able to discuss the pros and cons of each type of care, and guide the parents through the childcare experience. Equally important, however, is reassurance for parents that the right choice of childcare is unique to every family, and if a child is safe, thriving, and the family is happy as a whole then that is the right choice.
- Hodge SA, Lundeen A. America has become a nation of dual-income working couples. http://taxfoundation.org/blog/america-has-become-nation-dual-income-working-couples. Accessed January 19, 2016.
- Ball TM, Castro-Rodriguez JA, Griffith KA, Holberg CJ, Martinez FD, Wright AL. Siblings, day-care attendance, and the risk of asthma and wheezing during childhood. N Engl J Med. 2000;343(8):538–543. doi:10.1056/NEJM200008243430803 [CrossRef]
- Baby Center. Expert Advice. How much you'll spend on childcare. http://www.babycenter.com/0_how-much-youll-spend-on-childcare_1199776.bc. Accessed February 1, 2016.
- Tips for families and nannies. How much do I pay a nanny. https://www.nannies4hire.com/mobile/tips/1045-how-much-do-i-pay-a-nanny. Accessed January 19, 2016.
A Nanny Versus Daycare: Important Differences to Consider
|Reliable (open during working hours)
||Potential for tardiness (need for sick days)
|Will not take care of sick children
||Will take care of sick children with mild illness
||No supervision of nanny
|Licensed and regulated
|Requires drop offs/pick ups
||Convenient (watches child in home)
|Exposure to many illnesses
|Most will include some early childhood education/preschool
||Will need to also enroll in preschool
|Many will include diverse activities (gym times, music, art)
||Parent will need to separately enroll in any supplemental classes