These have implications for infection control and related healthcare issues, safety and protection of children and standards ­ setting, monitoring and evaluation.

How can parents make an informed choice about daycare? The key issues surrounding the choice of day care by working parents include nurturing environment, development of the child, effects of separation, affordability, convenience, accessibility and safety.

These issues have implications for the caregivers. The number of caregivers per group of children determines the quality of supervision provided. The level of training attained determines somewhat whether they are qualified to stimulate the development of the child.

The quality of daycare has an impact on the physical health, mental development and emotional security of the child. Cost and quality are concerns that compete in the choice of daycare. The access (transport) to/from the facility can also be a limitation. Other concerns for parents include when to start daycare, selecting the best alternative, ongoing evaluation of the centre, availability of care for sick children.

How can healthcare providers assist in the decision-making process? What should parents focus on in choosing a facility for their children? Indicators of an unsatisfactory daycare facility are:

• unfavourable comments from parents or friends
• child unhappy; not wanting to stay or go to daycare centre
• 'closed-door' operation - centre staff averse to parents dropping in to observe the operations of the facility
• unfriendly staff
• unsafe surroundings (not securely enclosed, potentially injurious objects lying around)
• untidy appearance
• 'too many children' for staff
• no clear curriculum; no policies governing the operation of the centre
• no evidence of certification and registration