Daycare vs. Nanny for clinical years in medical school--any advice appreciated!

[4Cats]

This is my first time starting a thread in the Lounge! After lurking for a while in here, I realize how much great advice you mamas have on all sorts of issues, so I’m here to benefit from some of your insights! I am an MD/PhD student mommy to a 10 month-old DS and am feeling confused about our upcoming decisions for childcare.

My DH and I are currently trying to decide whether to hire a nanny to care for our DS in lieu of continuing with the daycare he’s currently attending. This switch would occur in September (DS will be 13 months then), when I begin the first of 14 months of med school clinical rotations. Since November, DS has been in the hospital-affiliated daycare while I’ve finished up my PhD; currently we’re using the daycare while I finish writing some papers.

PROS to daycare:
Comfortably affordable for us
Known commodity, safe supervised environment, we already know/trust the caregivers

PROS to nanny:
Less hassle in mornings
Shorter door-to-door commute; translates into more time with DS
Not having to pick-up and drive DS while tired (early morning, after a long day, or post-call)
One-on-one care
Less illness—for both DS and us
More cooperation with our parenting choices (e.g., we try to stick to a vegetarian, mostly-organic diet at home (eating out is different ;); also, we’ve gotten pressure from the daycare for our choices to delay all solids till 7-8 months (driven by DS’s own readiness signs), and for our “slowness� in bringing DS up to speed with the other babies in all matters food-related).

The biggest CON to daycare has been the constant illness that has plagued our family over the last 7 months. If we are not outright sick, we are either getting or recovering from something. In the past 2 weeks, we’ve all had conjunctivitis (thankfully mild). Right now I have severe laryngitis and a fever and severe cough. Our extended family came down with a bad vomity illness at Thanksgiving, and I was really ill just days before my thesis defense last month. This is in addition to the bi-weekly colds we all seem to get.

Maybe some med student/resident/doctor mamas (or anyone else with insight) can give me some further insight, but I know I can’t be missing too many days on my med school rotations due to my or my child’s illness. My DH sees patients for a living, so he can’t easily cancel a whole day of patients to go get DS when daycare calls. All in all, DH has suffered the least of the 3 of us, but has missed some work due to his own illness (or when both DS and I were bedridden) in the past few months. I know med students are not at all “essential� to the daily rhythm in a hospital, but too much absence would obviously impact my learning and grades. And, looking ahead to residency, I know any missed days on one person’s part saddle the rest of the overworked team with their patients and responsibilities.

Ok, if you’re still reading thank you very much! So, the obvious choice based on all those cons would be a nanny. However, I can’t get over 2 major concerns about hiring a nanny. The first is financial. We’ve researched how we would find, screen, and pay our nanny, and the nanny we would want just barely fits into our budget (this is with major cuts to our budget—meals in restaurants, vacations, new clothes; we don’t have cable, Tivo, penchants for expensive electronics, etc…so those can’t be cut). I am looking for some insight and/or reassurance, especially from medical students/residents or from other people who work really long hours, that a nanny is a worthy financial stretch because it has helped both the family life and the career. Also, for anyone, were there any unknown costs to having a nanny—expenses you didn’t expect or budget for but ended up being necessary nonetheless?

My second biggest concerns with hiring a nanny come from my fear of what can happen “behind closed doors.� I’ve heard that most accidents in young children occur in their own homes while being taken care of by a non-parent. I guess that makes sense—I can imagine that there are more dangerous things even in a childproofed home than in a good daycare, and the parental instinct may be more important in that situation. I myself have a small phobia of driving a car (I’ve unfortunately known several people in fatal accidents); this fortunately doesn’t limit me much anymore, but the idea of letting a nanny drive my child in either my or her car would be a major issue with me. It wouldn’t be necessary as far as what I would expect the nanny to do (i.e., no grocery shopping required, etc…), but can I expect her to stay in the house all day with a baby/toddler when there are fun things to do out and about?

I feel very pressured to make the “right� decision, and we need to begin our nanny search very soon if we’re going that route. Once we give up our daycare slot, it is unlikely that we would get it back right away (I was on the waiting list for 8 months initially) if for some reason the nanny thing didn’t work out. Ideally, I want the best quality of life possible for my family—the best balance of sanity, time with each other, health, and financial stability as possible.

Sorry so long (I’ve been working on a thesis so I’m pretty long-winded ;)). Any opinions or insights are welcome!

Best,
Kristin
(down to 3 cats currently)

[Lovingliv]

Hey Kristin,
Congrats on your career achievments! There are some other moms on here in your own field...
I am a professional and work 3 days a week. My DH does drop off on those days (one day at my mom's, the other 2 at daycare)and he says it is HARD. BUT, I love the fact that there are many sets of eyes watching my child. I feel very safe knowing that if one teacher "loses" it, there is another ready and willing to take over.
I would wonder what was going on if she was being cared for by just one person in my home!
Good luck, I am sure what ever you decide will be the right decision for your little one! And welcome to the BBB.

[writermama]

No personal experience, but a friend of mine is a pediatrician and she has a nanny who she loves. Their family still has some issues with illness, because SHE brings things home from her patients, but I think it's fewer illnesses than one would expect with a daycare. Moreover, she likes the continuity of the 1 on 1 relationship with their nanny. She did have to interview many, many nannies (I'm thinking 10 or more) before she found the right one -- if you didn't find one you were really comfortable with, you could always choose to stick with daycare.

If you have parks and playgrounds within walking distance and other children to play with in the neighborhood, you could easily say "no car riding." But even if you don't, why not? Afterall if you hire her (or him) then you have a right to set the rules. If your rule is "stay in the house all day," then you have the right to expect the person you hire to do just that.

Good luck in your search and with your choice.

[mom_hanna]

Kristin,
This is not my experience, but my sister's. She is a resident right now, and they started out with a nanny (two kids, the older in daycare/preschool, the younger with a nanny) when she was 8 months. They switched to daycare at around a year due to: cost - daycare was much more affordable. Reliability - daycare doesn't call in sick, request days off, have family emergencies, etc. and they had multiple eyes watching their daughter. They were also having some "issues" regarding how the nanny structured their dd's day, where they went and how they got there (nanny drives her non-airconditioned car in 90 degree heat or she drives my sister's car and then the liability that goes with that). And social interaction - the daycare has given their dd lots of social time with other kids her age, which she loves. That said, they do get sick more often, but she hasn't seemed to have a problem with leaving to pick up a sick kid every now and then. And they get sick a lot less now - it took about 8 months but their dd seems to get sick a lot less - built up some immunity to all the little colds.

Whatever decision you make, just remember that is not irreversible. Yes, you may have to wait on a waiting list again to get back into daycare if you go the nanny route, but you may end up loving a nanny. If you go the daycare route and decide to switch to a nanny, you still can.

HTH at least a little.
Jennifer

[Zansu]

Here's my $0.02 as a WOHM and wife of a resident/fellow/attending.

Keep your DS in daycare. He's almost old enough to be done with the "kennel cough" they all seem to get the first year in DC. You're going to be bring home the germs, no matter who's taking care of him.

DC doesn't call in sick, or have personal crises, or car accidents. Knowing there's always going to be someone to watch your DS will reduce your stress during your clinical rotations.

You may also want to look into sick child care. It's a nanny service for the days when both you and DH have to be at work, and DS isn't cooperating. The hospital may have an arrangement with a service already.

[mommd]

OK, as someone who has just completed a year of medical school clinical rotations (only 8 months left!), I think I can offer some advice. My DD was 18 months old when I started roations, so a little older than your DC. I am lucky to have my Mom as a "nanny" for Ela while I'm gone. Things that work out well with someone being at your house:

1. You will be getting up early to start your rotations. You will not need to get your DC up and ready and bring them somewhere before you start. What time does your daycare open? Is it early enough to get your DC there?

2. You will not have the most predictable schedule. You will often have to stay later than expected. What time does your daycare close? What if you have to stay late, who will pick up your DC?

3. Call days. You will be at the hospital for 30-36 hours, depending on the rotation. Who will pcik up your DC on these days? When you get home you are going to want to sleep, so even if you are doing a rotation that lets you go home early the day after call, you are not going to be able to pick up your DC and entertain them after not having slept.

I have never had Ela in daycare, so I can't really comment on that side of things. But thinking about having to do one more thing in my already crazy schedule, ie taking her to and from daycare, I just don't know when I would find the time! It is nice just to go home and know that Ela is there waiting for me. Of course, it is my Mom, so I don't have the same concerns about someone I don't know caring for her.

Sorry this is long! If you need any other advice about rotations or anything, let me know! :)

[tarahsolazy]

I think for a daycare experience to be successful in your situation depends on your DH's schedule and its predictability. You should consider your schedule completely unpredictable during your clinical years, for the most part. If he is able to the majority of dropping off and picking up, or could easily do it when you're not able to (late surgery, long clinic, etc), I think that's fine. If he's a surgeon or ICU doc or something and can't reliably leave work at Xpm to get your son, daycare may be very stressful in that you'll need to be worried about how to get out in time.

However, I am an NICU attending in an academic center, and didn't have my kid during med school. So I am not speaking from personal experience, just from my residency and fellowship colleagues'.

My surgeon DH has dropped out of medicine to stay home, but until he decided to do that, we were thinking nanny. A neonatologist in an ECMO center and a general surgeon do not a reliable couple make, in terms of daycare pickup!

[kwc]

ITA agreement with Tarah. I didn't have my kids until just after finishing residency, but I still work with residents and med students, many with kids. The ones who were able to make daycare work all have spouses with more flexible hours/ schedules who can be responsible for dropoff/ pickup. Though my husband is not in medicine, he works very long hours so he is sometimes able to dropoff but rarely able to pick up. Even for me now in the outpatient setting, it is really stressful for me to try to make pickups, so we have opted to enroll DC #1 in a preschool near my parents' house so that they can help with pickup on bad days. DC#2 will be with a PT nanny.

I actually think as a clinical student, it would be easier for you to take the whole day off when your DC is sick than to try to pick up/ drop off... for example, you will need to do a certain number of admissions/ etc... and inevitably the interesting ones come in at 4:30. Somehow, everyone seems to understand when you have a total crisis (illness, etc.) but it's much harder to maintain the everyday "I have to be out of here at 5:01."

Another option would be a small licensed home daycare... often more flexible about the hours/ don't get upset if you are occasionally a bit late for pickup... we were doing this until recently.

Good luck!

[jhrabosk]

Hi Kristin! I'm not in the same boat as you career-wise, so I can't give any advice on that front, but I have been struggling with the same decision on the daycare vs. nanny.

I agree with the pp that this decision is not irreversible. In my case, and it sounds like yours is the same, the easier way to go about it is to try sticking with daycare first...you can always switch to a nanny later.

I think one of the biggest selling points for me in choosing to stick with daycare for the moment is the socialization factor. My DD LOVES other people...I think she's bored when she's home with me all day. :) And I only expect it to increase as she gets older. I also just trust the daycare environment more for the safety factor.

The financial aspect is a big one here as well. Finding the money to pay a nanny a fair wage would require some MAJOR cutbacks around here and I don't want to underpay anyone. Plus, I would give up a lot of things if it meant I could stay home, but we can't figure out how to make it work on one income. So, it may be selfish, but if I'm going to work my a** off to pay the bills, then I want to have a little extra left over for conveniences (cleaning lady, takeout food, etc) that will allow me extra time with my baby.

Hope that's helpful in some way...I know it's sort of scattered! Good luck with your decision!

[4Cats]

Thank you everyone so far for your thoughtful responses on these issues!

Our current daycare opens at 6 AM and closes at 6 PM but offers pre-arranged late care through 8 PM.

Fortunately DH's schedule (he's an optometrist) is quite predictable--he works from 8-5 usually. But the daycare is out of his way (we originally chose it with regards to my workplace--my lab which is in the hospital in which I'll be doing the majority of my rotations). He would need to leave our house at 7 AM in order to drop off DS and be at his office at 8 (as opposed to 15 minutes before if he goes directly). Depending where you live, an hour may not seem like a long commute, but for us it is! One of our concerns about daycare is that most of the onus of drop off/pick up would fall on DH, because I'll likely be leaving earlier/arriving home later. We tend to be quite disorganized in the morning. Having a nanny would minimize DH's commute time.

One of the PP's mentioned that the frequency of illness from daycare goes down after a year. Have other people found this to be true? This is one of our main issues--illness. Of course, I will be acquiring new bugs on my own from the hospital :(.

There is no sick child care affiliated with our daycare or hospital. My BIL works for Ford in MI, and in addition to having heavily subsidized daycare, if his DS is sick, they send out a "sick nanny" to his home for the day(s) needed. Nice(!), but I would still worry about having a stranger care for my child.

The one way we could have a back-up for the nanny is through either of the two local nanny agencies. For using the services of these agencies for nanny placement, they will send out a temporary nanny for the day (I am charged a daily fee then pay the substitute nanny by the hour) in case the nanny is sick/on vacation/emergency. I'm not sure what the turnaround time is (say the nanny calls you at 7 AM, I doubt the replacement would be there in a timely fashion).

I believe you can register and pay a fee with these agancies to have a temporary nanny sent out on short notice, say if we were using daycare and DS got ill. But again, I'm not sure of the turnaround.

I think it would be hard for me to allow a stranger to care for my DS when he's feeling bad, though.

Hmm....

I still have a lot of thinking to do.

Kristin

[MonicaH]

Congrats on finishing your PhD!

I agree with what the PPs have mentioned about flexibility of hours with a nanny. I have to say that not having to get my DD out of the house with me in the morning is a god send. And I am not doing a lot of clinical time during my fellowship right now, so I can only imagine with how it would be with more demanding hours.

I hate to mention something so gunner-ish, but I do think that the potentially inflexible hours that day care might impose on you could negatively impact your grades. One of the most important things when you're a 3rd year student is just being there to observe and jump in. Often not being around is taken as a sign of disinterest and grades might suffer. If you are thinking about a pretty competitive field or location for residency, you'll need really good grades. (although having a PhD will help you obviously)

Anyway, aren't you on the BBBStL group? PM me if you want to talk some more about WashU and about how we found our nanny.

Monica

[cara1]

It sounds like you already made your decision...to try a nanny.
A few other thoughts: No, illness from daycare does not necessarily decrease much after one year. My DD (20 mos) is still sick often. Since mid-May, I've averaged roughly one day home/week with a kid (my older is 4). But that is not typical. What is typical is that she is always coughing, sneezing, or something. Other than your peds rotation, you shouldn't be bringing home much from the hospital.

The other thing is that I think the benefit of daycare in terms of socialization really increases around 13 mos and the toddler years. The kids socialize, model other kids, talk, etc. I wanted to have that for my kids.

I agree with PP that as a student (as opposed to attending), impressions are everything. You need to be around and be seen. Yes, the onus will have to fall on your husband. It depends on whether that is a sacrifice you guys are willing to make.

Good luck with your touch decision. Remember neither decision is permanent. Since a daycare slot is tough to come by, though, why not try that first, and then switch to a nanny, rather than the other way around?

[ykc]

Sorry, overly wordy.

I had #1 in the middle of my 2nd year of residency, so a little later than where you are now, but we had many of the same issues. I think the PPs have all brought up good points. Our kids have always gone to large daycare centers. Our reasons/experience/thoughts (in no particular order):

#1- Didn't want to have to interview dozens and dozens of nannies and still be worried that I chose the one who presented well but had a short fuse or panicked in a crisis. (Of course, daycare providers can also panic, but in a center, there are more people around.)

#2- Daycare doesn't call in sick or go on vacation.

#3- Drop off and pick up is a pain, and it is *essential* to have a spouse whose schedule has some flexibility and/or predictability.

#4- Nannies are much more expensive for only one child, especially if you do things right and pay FICA and vacation time, etc. (We were a resident and a graduate student, so not exactly rolling in cash.) At two, it might be a wash-out, depending on where you live. Could be financially worth it with three or more. But we're still sticking with our daycare.

#5- A little peer pressure is a wonderful thing (for toddlers, that is). I have found that daycare actually provides a very structured environment for things like napping, potty training, eating at table, etc. That said, if your daycare doesn't cooperate with you on the choices you make, you may need to find another childcare alternative.

#6- Daycare provides my kids with activities that we don't get around to doing often enough, like arts & crafts, sensory play, taking walks, water play (we go to a Y daycare, so actually, preschoolers start swim lessons too). Hopefully, the right nanny would do these things too, but if you have concerns about letting her drive with your kid, this might be a bit problematic depending on what kinds of activities she'd like to do.

#7- Daycare is an automatic playdate every day.

#8- The rate of illness really does go down after the first year or so. My husband was sick constantly the first year we had kids (I am a pediatrician, so I am as immune as anyone can be), but it's gotten a lot better. There was a large study (don't remember if it was prospective, but I think it might have been) that looked at illness in children in different child care settings. Children in large daycare centers were ill more often at age 2 than children kept at home or in smaller settings. But by age 5, the numbers had flip-flopped. By age 10, the numbers were equal. As I point out to my patients' parents, it's less important if a kid misses daycare than if he/she misses school. Either way, one of the parents is usually missing work. (Just to be clear, I don't advocate daycare for everyone--I just point this out to the parents who are fretting that their kids' immune systems are being overtaxed by daycare.)

#9- One big con to daycare, which you've probably already experienced, but is a worse problem when you're on rotations: When your kid is mildly ill and has a temp, most places won't let you bring him/her back for 24 hrs after the fever has gone away. Keeping in mind that your kid was probably contagious before the fever or any other symptoms ever showed up, that's a completely idiotic rule, in my opinion. My old daycare let me bring in a doctor's note saying that my daughter had a viral illness and could receive Tylenol or Motrin as needed (and I promise that I got the note from my pediatrician). I haven't tried with this one.

I've been really pleased with the two daycare centers my children have attended. Not to say they are perfect, but unless you can clone yourself, a nanny probably wouldn't be perfect either. I know this seems very daycare biased, but that's just because that's what we've done. I think with the right nanny, you and your child would have a wonderful experience. We just couldn't stomach the amount of time, effort and money it would take to find that person vs. finding a good quality daycare.

Good luck with everything!

[lcl]

as an attending physician who has two children, i've tried both

my son was in daycare for three years until my DD was born. He was sick 4 months out of the year. my DH is not a physician but has long hrs as well. i mostly dropped off which is often stressful as i would get paged as well.

over the past year we have had 2 livin nannies, both who have caused much anxiety . one stayed for 1 month until we found out she had full blown clinical depression rendering her nonfunctional. another weve had for 9 months. we're ready to fire the second nanny as a lot happens when we're not home (have dropped in unexpected and found her either asleep with my 3 yo and 1 yo roaming the house or watching movies and ignoring the children, also taking our spare car for a spin per the neighbors while the baby was left home alone and she also does not have a license)

another idea is you can try an aupair which is much less $$

no easy solution...go with your gut. still trying to find the answer.

[denna]

IMO a nanny is the best thing. We have a nanny and love her! We started out wanting daycare but I love the one on one care my DS is getting and the reliability of our nanny.
About the calling in sick or emergencies that come up if you go threw an agency isnt there a way to have a back-up?!?
We didnt get our nanny through an agency so Im not sure. From my interpretation of your post it seems like you and your DH want a nanny. The PROs seem to be definitely in favor of a nanny.

About the nanny taking your child out in the car I think it is fair to ask her not too. She can still go out and take your DC on walks, etc. But I wouldnt want my DC in a car w/ anyone else either...our nanny only takes our son on walks and if she were to get sick we have a backup nanny who is our current nanny's good friend..and we both know and trust here.

I think that trust is my biggest issue and reliability. You are not going to have a good day at work if you arent comfortable w/ the care your child has. So get recommendations from friends etc..until you feel comfortable.

It shows alot that you are so concerned w/ this decision. And you want to take your time to make the right one.

Welcome to the boards and HAPPY POSTING!!!

Good Luck w/ this decision..please keep us posted...

Congrats on your degree by the way and your success in this career!

[SquamLake]

I also believe a nanny is the way to go. From reading previous posts, I find that we have been very lucky with our nanny. She has been with us almost a year now and has never called in sick, has never been in late, and has given us plenty of notice as to when she will need a vacation day. I will say that finding our nanny (we used craigslist) was not a pleasant experience and there was a lot of anxiety about letting a stranger stay at home alone with my child. We just went with our instincts and have not regretted our decision.

On another note, perhaps you could look into nanny sharing. We did a nanny share (from our home) for a few months, which we liked very much. Unfortunately, the family we nanny shared with moved out of town due to work relocation. Nanny share definitely cuts down on costs, and if you share with a family who already has an established relationship with their nanny, that might help alleviate some concerns you might have. Of course, there is still the illness factor, but not as huge as if in daycare. Plus, nanny share helps with the socialization component. Good luck with your decision. Certainly not an easy one.

[bubbaray]

I'm not in medicine, but am a professional with a highly demanding career and variable hours. My DH works set hours. We chose the licensed DC route. Generally, I drop off because my mornings are pretty flexible, its just later in the day/night when things get nutty some days.

I'm just really weirded out by having a stranger in my home, with no way to check up on what she is doing, KWIM? Licensed DCs (here at least) are subject to random inspections, and I keep in touch with our DCs licensing officer, so I will know if there is anything going on that I'm not comfortable with.

I was also NOT comfortable with a nanny driving my child anywhere and where we live, there are no children's activities within walking distance. That was a big motivator for me.

We've been really happy with our choice of DC for DD. She is getting a structured program (like a preschool), music lessons weekly, gym lessons, and socialization (we know virtually no one with little kids). That has been wonderful for her.

Does your hospital DC have flexible pickup/dropoff times? Extended hours? If so, I'd probably stay with that if it were me. Or, keep your child's spot there for an extra month or two to make sure the nanny works out. Here, it is virtually impossible to get into DCs at hospitals unless you are a hospital employee (working shifts), and even then, there are huge waiting lists.

Good luck with your decision!

Melissa

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