Starting childcare is a big step for your child and for you. Most children settle with time, especially with a gradual start, a predictable drop-off routine and educators who know their habits. Starting Blocks, from Australia's national childcare regulator ACECQA, says children who become very upset at drop-off often settle quickly and happily once the separation is over. The AAP adds that starting new childcare is often harder on parents than on the child.
Expect the first year to bring plenty of colds and tummy bugs, and check your local rules on illness, vaccination, breast milk and safe sleep before day one. This guide covers choosing care, settling in, drop-offs, illness, exclusion periods, vaccination rules in Australia, the UK and the US, feeding and sleep.
How do I choose childcare?
Look for a service where your child will be safe, known and cared for by the same few educators. Starting Blocks' guide to quality care suggests visiting at least once, and in Australia, checking the service's quality rating against the National Quality Standard. It also says quality services have clear procedures, good hygiene and exclude ill children when needed.
Questions Starting Blocks suggests asking:
- How will educators comfort my child if they become upset?
- Which educators will be my child's main carers?
- How will I hear about eating, sleeping and toileting each day?
- Can my child keep their home routine?
- How will educators guide my child's behaviour?
Add your own on safe sleep, breast milk and illness (see below). Timing matters too. The AAP's drop-off guide suggests, if possible, not starting care between 7 and 12 months, when stranger anxiety is common, or easing in gently if you do. KidsHealth suggests avoiding a start with an unfamiliar carer between 8 months and 1 year. If your timing can't move, a slower start helps. For planning feeds around work, see returning to work.
How do I help my child settle in?
- Visit together first. Starting Blocks suggests an orientation visit so your child can explore, meet educators and see you're comfortable there. KidsHealth suggests a few visits before a full-time schedule begins.
- Start small. Starting Blocks suggests shorter or fewer days at first, building up gradually. Short practice separations with grandparents or friends help too.
- Share your child's routines. Tell educators about sleep cues, how your child likes to be settled, feeding, comfort words and favourite activities. Starting Blocks suggests discussing interests, routines and rituals.
- Bring a piece of home. The AAP suggests a family photo or small toy, and Starting Blocks suggests a favourite toy or book. Zero to Three suggests giving educators something that reminds your child of you, like a shirt you've worn.
- Talk about it. The AAP suggests talking about the carer and reading books about childcare together.
- Reconnect at pick-up. Starting Blocks suggests giving your child your undivided attention and asking open questions about their day.
The AAP says most babies up to about 7 months adjust well to good care, while older babies and toddlers may need more time and support. Many families notice some extra clinginess or tiredness at home in the first weeks.
How do I make drop-off easier?
Short, warm and the same every day.
- Always say goodbye. Zero to Three says not to leave without saying goodbye, because sneaking away makes a child worry that you might leave at any time, and they might not trust that you'll return.
- Use a ritual. Zero to Three suggests a goodbye ritual you do every day, such as a kiss, a snuggle and a wave. KidsHealth suggests a pleasant, loving and firm goodbye.
- Be confident. Starting Blocks suggests saying goodbye confidently and reassuring your child that you, or someone else, will be back later.
- Then go. The AAP says once you've left, not to reappear unless you're ready to stay. KidsHealth says coming back will only make things worse.
- Time it well. KidsHealth suggests leaving after naps and meals, not when your child is tired or hungry.
KidsHealth says that by the time you get to your car, your child is likely to have calmed down and be playing. Ask the educators to text or call later if that helps you. For more on why goodbyes are hard and when separation worries need extra help, see separation anxiety.
Why is my child always sick after starting childcare?
It's very common. The AAP's guide on when to keep your child home says children in their first year of group care may have as many as 8 to 12 more colds than a child cared for at home, and that illness becomes less frequent in the second year as their immune system develops. It says a typical child has diarrhoea once or twice a year. The AAP's page on colds says most children have around 8 to 10 colds in their first two years, and those in childcare may have more.
What helps:
- Plan backup care and leave for the first months, so a sick day isn't a crisis.
- Keep your child's vaccinations up to date.
- Teach handwashing on arrival and before meals, and wash hands at pick-up.
- Expect a run of overlapping colds; see colds and congestion for care at home.
When should my child stay home, and for how long?
Your service will have an illness policy, so ask for it before day one. The AAP suggests keeping a child home if they have:
- a fever with a cough, runny nose or sore throat
- a fever above 38.3°C (101°F) with a change in behaviour or other symptoms
- vomited 2 or more times in the previous 24 hours
- diarrhoea that's looser and more frequent than usual, or leaks out of the nappy
- a rash with fever or behaviour changes, until a doctor says it isn't contagious
- an illness that stops them joining in, or needs more care than staff can give
The AAP says a child with a respiratory illness and fever can usually return once the fever has gone for at least 24 hours without fever medicine, and that a cough or cold without fever doesn't automatically mean staying home.
Exclusion periods for common illnesses
Rules for specific infections differ by country and sometimes by state. These are examples from NSW Health in Australia, which lists the NHMRC's Staying Healthy guidelines as a further source, and the UK Health Security Agency (UKHSA), whose guidance covers nurseries, childminders and preschools.
| Illness | NSW Health (AU) | UKHSA (UK) |
|---|---|---|
| Diarrhoea or vomiting | Until no loose poo for at least 48 hours | Until 2 days after it stops |
| Hand, foot and mouth | Until all blisters have dried | No exclusion |
| Conjunctivitis | Until eye discharge stops | No exclusion |
| Chickenpox | Until blisters dry, usually at least 5 days | 5 days from rash |
| Measles | At least 4 days after rash appears | 4 days from rash |
| Flu | Until well | Until better, no temperature |
| Impetigo | Until antibiotics started | Until scabbed, or 2 days of antibiotics |
Your service's own policy may be stricter. If your child has been diagnosed with something specific, ask your GP or health visitor when they can go back.
Does my child need to be vaccinated for childcare?
It depends on where you live.
Australia. NCIRS, Australia's national immunisation research centre, explains two layers. Under federal No Jab No Pay rules, your child must meet immunisation requirements if you get Family Tax Benefit Part A or childcare fee assistance, and vaccination objection isn't a valid exemption. State and territory No Jab No Play laws then set the rules for childcare:
| State or territory | To enrol or attend childcare |
|---|---|
| NSW | Fully immunised, on an approved catch-up program, or a medical reason not to vaccinate |
| SA | Fully immunised, on an approved catch-up program, or an approved exemption |
| Victoria | Up-to-date immunisation history statement to enrol; excluded only in an outbreak |
| Queensland | Services can refuse or cancel enrolment if a child isn't fully immunised |
| WA | Up to date or on a catch-up program; statement dated within 2 months |
| Tasmania, ACT, NT | Immunisation not required to attend; may be excluded in an outbreak |
You'll usually need an immunisation history statement from the Australian Immunisation Register. Rules change, so check your state health department and your service.
UK. Routine childhood vaccines are offered free on the NHS. The Scottish Government says vaccinations are not compulsory and aims to help people make informed choices. The UKHSA's guidance for education and childcare settings encourages settings to share vaccine information with parents, rather than setting vaccination as a condition of attending.
US. The CDC says states set vaccination requirements, and that these laws often apply to day care facilities as well as schools. All states allow medical exemptions, and some also allow religious or philosophical exemptions, so check your state's rules and your provider's policy.
Can my child have breast milk at childcare?
Yes. The Australian Breastfeeding Association (Australian Breastfeeding Association) says you can keep breastfeeding while your baby attends, you can provide expressed milk and your child's carer must feed it to your baby, and you can breastfeed or express at the centre. It also says it's against the law for a service to treat you unfairly because you're breastfeeding. Some parents breastfeed at drop-off and pick-up to reduce how much expressed milk they need.
The NHS guide to breastfeeding and going back to work suggests labelling and dating expressed milk so carers know which to use first, and having a trial run with childcare before you return to work. Tell educators how much your baby usually drinks while you're apart, how they like to be fed and their hunger cues, as the Australian Breastfeeding Association suggests. For storage times and transport, see storing breast milk and returning to work.
What should I check about safe sleep at childcare?
The AAP's safe sleep advice says childcare centres and family day care should have a written safe sleep policy, and that parents should ask about it and advocate for one. It says babies should always be placed on their backs to sleep, even for short naps.
Red Nose's safe sleep advice for educators in Australia says to always place babies on their back with their head and face uncovered, and that once a baby can roll from back to tummy and back again they can settle in their preferred position, after being placed on their back first and not swaddled. It says soft toys and comforters should be withheld under 7 months, and that prams and car capsules don't provide a safe, flat sleep surface.
Ask how sleeping children are supervised, where babies sleep, and what they sleep in. Tell educators whether your baby still uses a sleeping bag and how they settle. See safe sleep for the full checklist.
When to get help
Call 999 now if your child is struggling to breathe, has blue, grey or blotchy skin or lips, is floppy, difficult to wake or can't be woken, has a rash that doesn't fade when pressed, hasn't had a wee in 12 hours, or has a seizure. These come from the NHS guide to urgent help for under-5s and the NHS meningitis page, which adds a child who is floppy or more sleepy than usual. For temperatures and when they're urgent, see fever in babies.
Get medical help today (same-day GP or NHS 111) if your child is refusing drinks or having far fewer wet nappies, seems much more unwell than with a usual cold, or you're worried.
Talk to your GP or health visitor if illnesses seem unusually frequent, severe or slow to clear, or if your child is still very distressed at drop-off after several weeks, or is withdrawn or unhappy at home. If you're struggling with the return to work, your health visitor, or NHS 111 can help.
What's worth noting down?
In the first term, jot down sick days and symptoms, and how drop-offs and evenings go. A list of illnesses with dates shows your GP the real pattern if you're worried, and notes on drop-off help you and the educators see whether your child is settling.
