In the United States, the structure, espoused purpose, and quality of child care vary widely. Community programs that provide out-of-home care for infants and preschool children have evolved either with no community regulation or with a variety of different institutional or governmental supports and regulations.1 In general, infant and preschool programs are designed either to provide substitute care when parents work and/or to promote socialization and early education. Frequently, these programs serve children only for a portion of the day and for part of the week and year. Programs that primarily provide substitute care are usually called "day care." Included in this grouping are "family day care" and "large family day care," programs in which children are cared for in someone's home, and "center day care," programs in which children receive care in settings specifically intended for that purpose. The labels traditionally applied to early education programs are "nursery school" or "preschool." These labels are not necessarily mutually exclusive.
The American Academy of Pediatrics believes that education, in the broad sense, and the care of infant and preschool children are inseparable.1 In fact, the new terminology applied to these services for young children is "early childhood education/care programs." Young children are constantly learning while they play and while they engage in everyday activities.2,3 Also, young children in educational settings require "care" in the sense of needing to be comforted and to be instructed in the development of health behaviors such as hand washing and controlling their own excretions. In all settings, the safety of children should be assured.
