1 . How well we care for your child depends on how you define care.

The quality of day-care centers of course varies greatly, and many do their jobs well but not all. A new study commissioned by the state of Georgia, for example, found that 67% of Georgia day-care center classrooms offer low-quality care for infants and toddlers. Children in these classrooms likely experience environments that are inadequate for their health and safety and do not promote their cognitive and social emotional development, according to the study's authors.

Among the problems: too few age-appropriate toys, language used to control children rather than teach them, multiple safety hazards and the lack or recommended health practices.

Early childhood education in general has never received the type of funding that kindergarten through 12 has, says Dr. Holly Robinson, commissioner of Bright from the Start: Georgia Department of Early Care and Education. Scientific research on early child development has raised eyebrows, she adds. A lot of people who had not realized how much takes place in the first five years are now more aware, so it s getting the amount of attention it should have for many decades.

Georgia has responded by using stimulus money to launch a slew of projects ranging from improving training to health standards -- to raise the quality of care for children.

2. We might send your kid home at the first sign of the sniffles or less.

Oradell, N.J., mother Pat Murphy missed so much office time caring for her two sons who were sent home from day-care centers, that her absences started to raise her boss s eyebrows. They were sick constantly, says Murphy, who finally pulled her sons out of the centers and hired a nanny.

The classic parental complaint about day-care centers is that they are germ incubators. But a study published in the April edition of the journal Pediatrics shows that day-care centers also tend to send kids home unnecessarily. Directors at 305 day-care centers were surveyed about how they would handle mild illnesses such as colds and itchy scalps. In 57% of the cases, the directors said they would send children home -- even though national guidelines issued by the American Academy of Pediatrics (AAP) and the American Public Health Association (APHA) didn t require such action. Such hyper-vigilance can create a burden for parents, who may have to take time off from work.

Containing the spread of germs is important, says Paulina Alvarado, director of Parents of Preschoolers Inc. in Bethesda, Md. You turn around for one instant and a child can take another child s pacifier and put it in their mouth, she says. Her center has a sick room where children can be separated if they don t feel well or are waiting for their parents to pick them up, but sends kids home when they have a fever of 100 degrees, or for vomiting. We are very cautious, but we understand parents need to have children in the school, and they can t always come and pick them up quickly, says Alvarado. But, if a child is feeling miserable, they need to be at home.

3. By the way, not all of our kids have been vaccinated.

Immunization rates are generally rising, and research underscores their efficacy: In one recent study by the Kaiser Permanente Institute for Health, children who weren t vaccinated were nine times more likely to get chickenpox than those who were vaccinated. Still, vaccines are a hot button topic with some parents, who prefer not to immunize their children. In states such as Texas and Massachusetts parents can get exemption from requirements for religious or medical reasons.

Parents worried that their child's classmates aren t immunized should stick with a licensed center; it will be required by law to have up-to-date immunization records, says Alvarado. Although states have differing standards, regulations typically cover measles, rubella, diphtheria, tetanus and polio.

4. We could make a better living taking care of your pet or watching your coat.

In the You Get What You Pay For category, there is a reason why the care at child-care centers isn t what should be: Staffers tend to be paid poorly. The average hourly wage for child-care workers is $9.79, and $8.82 for those who work in child day-care services specifically, according to the U.S. Bureau of Labor Statistics. It pays more to be a security guard or crossing guard -- $12.42 and $11.68 an hour, respectively. And child-care workers earned less than veterinary assistants and laboratory animal caretakers, who averaged $10.96 an hour. Locker room, coat room and dressing room attendants made an average $10.33 an hour.

5. We can t hold on to our staff . . .

Low wages and relatively meager benefits translate into substantial replacement needs, according to the Bureau of Labor Statistics. And the turnover can become problematic for junior. Kids tend to develop better under the care of a constant caregiver rather than a revolving cast of characters, according to a working paper from the Center of Developing Child at Harvard, last updated in 2009.

These are kids who need to be able to form emotional bonds, and need to be able to trust caring adults, says David Kirp, professor of public policy at the University of California, Berkeley. It s not as though the people who leave aren t caring; it s just the equivalent of a sweatshop. If you don t believe it, go to one of these and see what life is like. Alvarado agrees that the profession in general suffers a lot of turnover because of the pay and staff burnout.

6. . . . and those who stay may have less-than-ideal training.

At $8.82 an hour, you can t expect day-care workers to have degrees in childhood development or education. But you might hope they d at least have a high school degree. Turns out, even that would be expecting a lot. Nationally, only about 44% of workers in child care had a high school degree or less in 2008, according to the Bureau of Labor Statistics. In the Georgia study, 33% of lead teachers in the infant/toddler classes in the state's day-care centers had a high school diploma or less.

In response to the study s results, Georgia is implementing new education requirements. By the end of 2012, the state will require lead teachers in the infant/toddler classrooms to have a certification that can be received through its technical college system. For pre-K, Georgia will require assistant teachers to have a Child Development Credential (CDA) and lead teachers will be required to have a bachelor s degree.

It s been a challenge in the field for a very long time, says Andi Schleicher, executive director of the Child Day Care Association of St. Louis. States have been reluctant to set higher standards for training because they hear people can t afford to pay the salaries of potential employees who do have training, and it will drive up the cost of child care, she says. Because it s a low-paying job and an industry with a tight (if any) profit margin, a lot of centers also skimp on ongoing professional development.

In our low-income neighborhoods, often you have people who are nice folks who are trying really hard, but there s just not enough revenue to do anything, Schleicher says. They re not well maintained, they can barely pay minimum wage, and are always looking for free training.

7. We re not necessarily accredited.

States grant licenses to child-care centers, setting minimum standards to reduce the risk of injuries, unsafe buildings and disease. But standards vary greatly, and when it comes to group size, the child-to-staff ratio, and maintenance of environments, you ll find disparities. For example, in New York the child-to-staff ratio for four-year olds is 8-to-1; in Texas it s 18-to-1. Typically, the license is a minimum requirement. Accreditation, which is voluntary, is granted primarily through two trade groups, the National Association for the Education of Young Children and the National Association for Family Child Care. Both organizations set requirements, from age to training, that a center s employees must meet; you can search their web sites for accredited child-care facilities. How accredited a center is will reflect the quality of the institution, says Alvarado.

8. This is going to cost you.

A $16,000 annual tuition bill might sound reasonable if it were for college but for a year of preschool? In Massachusetts, the average tab for full-time care for an infant in a child-care center rose to $15,895 last year, up 12% since 2005, according to the National Association of Child Care Research and Referral Agencies (NACCRRA). Break that figure down, and it comes to more than the same families spent each month for food. If a family had two kids in full-time day care, the monthly fees exceeded the median rent cost. Minnesota and New York weren t far behind, according the study, with average annual fees for infant care at $12,800 and $ $13,630, respectively. (In comparison, a year s tuition at the University of Minnesota costs $11,466 a year for in-state residents. )

The costs may seem burdensome, but it takes that much, says Schleicher of the Child Day Care Association in St. Louis. If we suddenly said you re going to have to pay for elementary school, we d have the exact same dynamic. In fact, most of the for-profit centers are small businesses, and they are making a very slim and sometimes no profit -- maybe enough to pay their salary, and sometimes not even that, she says. The problem is child care doesn t fit with the model of a market economy, Schleichler says. Ideally if demand is high and supply is low, you should be able to charge more and be successful, and it doesn t work that way.

To improve parents access to affordable, high-quality care, NACCRRA has called on Congress to reauthorize grants like the Child Care and Development Block Grant (CCDBG). The grant assists low-income families, families receiving temporary public assistance, and those transitioning from public assistance in obtaining child care so they can work or attend training/education. It s the primary public source of child care funds to states to help pay for child care and improve the quality of care, according to the association.

9. Late fees aren t just for videos.

Delays can be costly: Many providers charge late fees for parents who miss their scheduled pickup time. La Petite Academy in Orangeburg, N.J., charges $15 for every 15 minutes parents are late picking up their children after 6 p.m. Other centers can charge as much as $5 a minute starting at 5:00 p.m.

The purpose of late fees is twofold, says Schleichler. First, it s revenue because the center has to pay the child care employee to be there after hours. And second, it s a deterrent. When you charge no late fees, parents will take advantage they ll run errands on the way home, she says.

Schleichler adds that most programs work with parents who have legitimate reasons for being late. They get that families sometimes have crises, their boss makes them stay late or their car breaks down, she says. Usually if it s a rare occasion and something happens, programs will waive fees, she says. Of course, not everyone does that, but it s really aimed at the chronically late parent.

10. We re not going to get better any time soon, because we don t have to

Apathy is at the macro level, says Berkeley s Kirp. In the last weekend of congressional negotiations around the health-care bill this spring, money for early-childhood education was eliminated.

The administration decided that the way it will get college loans in is to fold it into healthcare, and the way it s going to get early education in is to fold it into college loans, says Kirp, explaining the way amendments to the bill were structured. Health care is the whale, and college loans are the tuna -- and little kids are the minnow in the tuna in the whale. Who cares about the minnow? There we are.