Photo-Illustration: by The Cut; Photo: Getty Images

In the early days of the pandemic, most parents didn’t have a choice about child care. As the virus spread, many day cares and preschools closed entirely, leaving parents scrambling to balance work and taking care of young kids who were suddenly home all day. Now, a year and a half later, parents of children too young for primary school are still making decisions about child care in an ever-shifting framework. The vaccination rollout has reduced infection risk for child-care workers and the children they care for. Kids ages 5 to 11 are eligible for the COVID vaccine, and though the youngest children are still ineligible, experts say the risk of them getting very sick from COVID is low. Still, day-care centers and preschools are overwhelmingly privately run in the U.S., meaning that safety protocols vary widely, especially based on geographic area.

Which is all to say that, for many parents, navigating child-care decisions in a pandemic is still a source of significant stress. For many, keeping their kids at home while they try to work stopped feeling feasible a long time ago. How risky is it to send young, unvaccinated kids to day care or preschool? What about babies? And if you do decide to send them, what happens when there’s a COVID exposure — or if your kid is turned away simply for having a cold (which, for many young children, is a near-daily fact of life)? We talked to parents across the country about how they’re navigating child-care decisions right now.

At this point, kids under 5 are the only age group that can’t get the COVID-19 vaccine in the U.S. But according to the CDC, young kids, especially those between 1 and 9, remain at low risk of severe illness from COVID-19. We know that areas with higher vaccination rates for adults also have lower transmission rates among children, and that mask-wearing is an effective practice to limit spread of virus. Still, in many areas of the country, it’s not standard for day cares or preschools to mandate mask-wearing by staff who work closely with children — and for children under 5, mask-wearing isn’t always a realistic ask (and it isn’t recommended for children younger than 2). Meanwhile, vaccination rates for adults vary widely by state: As of November, in West Virginia, only 49 percent of adults have received at least one vaccine dose, while in Massachusetts, 80 percent of adults have had at least one dose.

With all this in mind, Dr. Tracey Wilkinson, assistant professor of pediatrics at Indiana University School of Medicine, encourages parents to weigh the risks and benefits to their own family. “There is no wrong or right that applies to everyone,” she said. While recognizing that the risk calculus will look different for every family, she urges parents not to discount the advantages of day care and preschool for young kids (and their families).

Day care and early childhood education provide tangible benefits, including socialization for kids and opportunities for emotional and physical development — and the benefit of parents getting a break. “Parents also need their own physical and mental space to have a sense of self and be energized for those harder parenting moments,” Wilkinson said. Parental stress can lead to social-emotional problems in preschool-age children — and inadequate options for child care due to the pandemic can certainly contribute to an environment of high stress in the home (more on that below). However, for other families, the risk of their child contracting COVID at day care or preschool might feel more stressful than keeping kids home despite the challenges.

If you’re weighing whether to send your kids to day care or preschool, Wilkinson recommends asking questions about whether staff is vaccinated, policies around mask-wearing, and time spent outdoors, all of which are known to decrease the risk of virus transmission.

In 2020, many parents rearranged their lives to keep their children at home, trying to avoid exposure to the virus at all costs. In the early months of the pandemic, Emily and her husband moved to Washington state. Her job had gone remote, he was the full-time caregiver for their two young children, and they felt lucky to be able to limit their family’s exposure to the virus.

Now, more than 18 months since the first wave of COVID-19 lockdowns hit the U.S., the isolation and demands of full-time caregiving for two preschool-age children has taken its toll — and no longer feels healthy for their family. Both of their children have autism, and their day-to-day care can be intense. Emily described her husband as “burned out beyond burned out,” especially since her employer brought staff back to the office this past summer. On top of that, Emily said she and her husband have observed developmental regressions in their children during the past year, when they barely left the house. They are now in the process of enrolling both kids in a developmental preschool. Because the preschool is state-run, and Washington state has enacted a vaccine mandate for all government employees, they felt a little more comfortable assuming the risk knowing that all the teachers interacting with their kids will be vaccinated.

Similarly, Sara, who lives in Virginia, began the pandemic focused wholly on preventing virus exposure. Like Emily, Sara initially felt grateful to have care for her two kids take place mostly at home, cutting down on risk. Then her older daughter was diagnosed with DiGeorge syndrome, a chromosomal disorder and primary immunodeficiency disease. The diagnosis meant Sara and her husband had to confront an unexpected paradox, weighing the risk of potential exposure, given their daughter’s diminished immune response, against the benefit of being in school given her developmental needs.

“My husband and I had to put on our serious-adult pants,” Sara said of deciding to send her daughter to preschool. “Preschool is very optional at this point, but we decided to keep her in the preschool because she is doing so well. Her anxiety has improved so much. And 18 months in …. how much longer can we reasonably wait? She’s only in this fragile developmental window for so long.”

For families who welcomed babies during the pandemic, making decisions about care can feel especially fraught. It’s natural to view new babies as vulnerable, and their immune systems are weaker for the first few months of life (after that, experts say they’re actually in the lowest risk group for getting infected). Even without a pandemic, arranging care for a young baby can be emotional — and COVID has added the concern that sending a baby outside the home might come with increased risk.

Erin, who lives in New York, said she considered keeping her 5-month-old daughter home when she went back to work, since her office was still fully remote. Ultimately, she decided the nature of her job would make having a baby around difficult. Her 3-year-old son had been attending day care for the past year, which reassured her. “They’ve done really well, with a single exposure this entire time. This gave me a lot of confidence about sending my baby.” (She also pointed out that she was lucky to have a five-month maternity leave, so her baby was older by the time she had to make the decision.)

Mike and his wife, who live in Boston, decided to send their son to day care when he was 6 months old. They ultimately felt less concerned about their baby getting sick and more worried about the potential effects of isolation on his development. “Our biggest fear was that he would lack the socialization provided by day care,” Mike said.

As new parents, day care has also helped them feel less isolated. They appreciate the sense of community they feel with the staff and other families who interact with their child, now 15 months, every day. They get reassurance that their son is meeting developmental milestones and can talk with other parents about the reality of caring for a child. “It sounds silly, but it helps just to take a look around and see what other people are sending their kids for lunch,” Mike said.

Finding a child-care provider that you trust to keep your child safe in any circumstance is key in mitigating anxieties around unvaccinated infants in care, said Wilkinson. “You trust them to keep your child safe during the day and always have their best interests in mind, while also making opportunities for growth and development.” She points out: “That is true every day, regardless of a pandemic.”

Pre-pandemic, most preschools and day cares had predictable and consistent illness policies: Kids with fever, diarrhea, or neon snot got bounced until they were at least 24 hours symptom-free. With COVID, the stakes are higher, and things are a lot more chaotic. Entire classrooms might shut down for a week or more based on exposure or infection. A sniffly child, previously a persistent fixture of day-care life, now raises eyebrows at drop-off. If your child picks up standard “day-care crud” like a cough or runny nose, they may be shunned for a week until symptoms resolve, only to immediately pick up a new non-COVID illness upon return and start the cycle anew.

Jackie, who lives in Chicago, described the acute terror that sets in when a child wakes up with a cough: “It’s a mix of ‘Oh shit, does my kid have COVID?’ and also ‘Oh shit, I am going to have to go back to working from home while taking care of a kid’ — which is PTSD-producing at this point.” The trauma of early pandemic life — the lawless feeling of attempting to work from home while locked in with kids indefinitely — is still close to the surface for parents. “You start to fear the chaos more than the exposure at this stage,” said Jackie.

Some day cares are tolerant of sniffles, but others have stricter policies. A child with a runny nose may not be allowed back without a negative COVID test, and in areas where rapid tests are not easily accessible, the lag time between a child getting sent home and test results could be a few days. Holly, who lives in Wisconsin, said she keeps her toddler home if he has a fever but has taken her chances when it’s a runny nose. “He was super snotty a few weeks back, and … I have to work!” she said. For most families, it isn’t realistic to have back-up care arrangements for several days or even weeks to account for colds or COVID-related closures.

Of course, for many parents, the nature of their jobs and financial situation means that child care was never a choice. Elaine lives in North Carolina and works 12-hour shifts as a 911 dispatcher; her husband works in food distribution. Neither of them have been able to do their jobs remotely. When their 4-year-old’s day care closed for three months at the beginning of the pandemic, they managed to get by between her husband taking time off work and grandparents pitching in to fill the gaps. “I have never had the option to stay home. My husband has never had the option to stay home,” Elaine said. She resents the idea “that taking the best care of your kid means having a job where you stay home and do your job on the computer.”

“I don’t have the option of being worried about child care,” she said. “I only have the option of being worried about not having child care.”