Infectious diseases in day care: parallels between psychologically and physically healthy care.

A review of day care practices in the United States indicates a substantial increase since 1977 in out-of-home care for infants and toddlers, with a preponderance of care in unlicensed family day care homes. The effects of group care on infants and toddlers depend largely on the facility's success at meeting certain criteria for group size, staff-to-child ratio, and staff training. Parallels exist between providing psychologically healthy day care and minimizing the spread of infectious disease in day care facilities. Many of the same factors involved in providing psychologically safe day care are also involved in providing disease-free care. Financial and regulatory obstacles to high-quality care are considerable; however, supplementary child care for working parents is essential, and efforts to address such problems as infectious diseases must keep this perspective.