Day care centers are supposed to give parents peace of mind when they can't be with their kids. But they could end up giving parents lots of headaches.

1. "When your kid naps, so do we."
Leslie Thurman was at work when she got a call no parent could prepare for: Garrison, her eight-week-old son, had stopped breathing at his day care center. Although paramedics got Garrison's heart beating again, he died the next day. An autopsy later determined the cause of death as apnea, which occurred when the baby was placed on his stomach for a nap. The Thurmans sued Applebrook Country Day School in Ringgold, Ga., and were awarded $1 million by a Catoosa County Superior Court jury in a wrongful death lawsuit last September. "The mother assumed that they would place the child correctly," says Renzo S. Wiggins, the Thurmans' attorney. "Unfortunately, that was an incorrect assumption." The day care center has appealed the verdict.

This case helped spur Georgia to add a regulation requiring that infants be placed on their backs at group and family day care centers. But that's not the case everywhere — even though it's been estimated that 20% of Sudden Infant Death Syndrome (SIDS) cases occur in day care centers. A 2000 study by Rachel Moon, a pediatrician at Children's National Medical Center in Washington, D.C., found that 25% of licensed child care centers in the Washington metro area were unaware of the American Academy of Pediatrics' 1992 recommendation that infants be placed in the nonprone position while sleeping. Moon's study also showed that 28% still positioned infants prone. "You'd think it would be common knowledge by now, (but) we're bumping up against a lot of tradition," Moon says.

2. "We'll make your kid really sick..."
Day care centers are supposed to give working parents a chance to do just that — work. Pat Murphy wishes she were that lucky. The Oradell, N.J., mother missed so much office time — a full week out of the month sometimes — caring for her two sons who were sickened by germs picked up at day care centers, that her absences started to raise her boss's eyebrows. Both boys, Liam (now age three) and Conor (now two), contracted their first ear infections before they were three months old, and both needed tubes put in their ears by nine months. The family's doctor classified the infections as day care-related. "They were sick constantly," says Murphy, who finally pulled her sons out of the center and hired a nanny.

There's no getting around it: Day care centers are germ depositories. Get a large group of kids together and your child can expect a marked increase in colds, ear infections and upper respiratory infections. Says pediatrician Cathryn Tobin, author of The Parent's Problem Solver, "I see some day care kids twice as much as other children not in day care." How come? Blame poor sanitation, plus toy-sharing. Nicole Queen, a child care consultant and former day care director, says that at the Maryland centers where she was employed caregivers were required to clean toys with bleach and air dry them every two weeks. "Only a couple of centers I worked at did that," she says. What can you do? Be scrupulous about sanitation. Pay attention to how caregivers handle toys and bottles, change diapers and clean the facility.

3. "...especially during chicken pox season."
With the warmer weather, it's not just earaches your kids — and you — have to worry about. It's chicken pox time, and day care centers can help pass the virus along faster than you can say tic-tac-toe. A 2001 chicken pox outbreak that infected 23 kids in a Philadelphia preschool was attributed to a child whose parents had chosen not to vaccinate. While immunization rates are generally rising, "it's an increasing concern that some parents are choosing not to have their kids vaccinated," says Karl Heath, a registered nurse with the Philadelphia Department of Public Health.

For day care providers, it's not a simple issue when it comes to vaccinations. Day care owner Gale Walker, who oversees more than 300 kids at her Children of the Rainbow centers in San Diego, has just one child who isn't fully immunized. Walker allows him because he is the child of an employee who chose a religious exemption. Still, she's hesitant to allow more exempted children in her care because "some childhood diseases can be very detrimental, not just to children but to everybody."

4. "We have safety issues."
Day care centers may be fun for kids — but they're dangerous, too. The hazards range from the simple — recalled toys or unsafe playground surfacing — to the flagrant. Don Keenan, an Atlanta lawyer who specializes in negligence cases involving children, says he's seen cases dealing with day care injuries more than double in the past decade. Keenan is most troubled by the "alarming increase in intentional injuries; that is, sexual predators or child abuse."

Case in point: In March 2002, a Nevada district court sentenced Gary Hanneman, a former day care worker at the Children City Learning Center in Reno, to multiple prison terms for molesting nine children at the center. Videotapes of his acts were included as evidence. Several of the victims' families have filed civil suits against both Hanneman, who is appealing the original verdict, and the day care center. "He had access to more than 200 children," says Sherry Bowers, an attorney for several of the families. "There were many red flags that should have put (the center) on notice that it had a problem." Brian Brown, an attorney representing the center, says, "At this point we've denied responsibility."

5. "Our employees come and go..."
Ann Douglas, author of The Unofficial Guide to Childcare, puts the turnover rate at day care centers at "a mind-boggling 30% per year." You can blame low salaries for part of the problem. The U.S. Bureau of Labor Statistics tags the average hourly wage for child care workers at just $7.86, or $16,350 a year.

Unfortunately, your kid may pay the price for such haphazard treatment long after he has moved out of day care. According to a 1999 study by a team of researchers from the University of North Carolina at Chapel Hill, the University of Colorado at Denver, UCLA and Yale, children who had closer relationships with their child care teachers had better classroom behavior and social skills through early elementary school. That's one reason Douglas recommends that you seek out a center known for retaining top employees.

6. "...and those who stay get little training."
The average cost for a four-year-old in a child care center is $4,000 to $6,000 a year. Too bad the investment often garners suspect help. Thirty states, including Arizona, New York and Pennsylvania, let individuals become teachers in licensed day care centers without any prior training, according to child care licensing regulations compiled by Wheelock College Institute for Leadership and Career Initiatives.

The training deficit gets worse: In Maryland an individual can work with children as an aide at 16 years of age with no training whatsoever. (Maryland licensing officials stress that all aides are closely supervised.) Studies have shown that the education level of a caregiver is a major predictor of quality care. For a state-by-state list of child care regulations, click on Products at the National Center for Early Development & Learning's Web site (www.ncedl.org).

7. "You work crazy hours? Too bad."
How many times has your eight-hour day turned into a 12-hour one? Or has your boss called an emergency meeting — for 5:45 p.m.? Too often to count. But if you have a kid in day care, such delays can be costly: Many providers charge late fees — up to $1 a minute — for parents who miss their scheduled pickup time.

A YMCA survey on child care in the U.S., conducted last August, revealed that more than two out of three parents lack programs in their community that offer extended-hour child care — a situation that can be extremely hard on parents working nontraditional hours, such as evenings and weekends. Like Wendy Walls. A room coordinator for Medical City Dallas Hospital, Walls works two 16-hour shifts on weekends so she can be off during the week to care for her son. But for six years she was unable to find a local center that covered her work schedule and was forced to shuttle her son among friends and family. "Having to rely on other people was very stressful," she says. Last August, Walls finally found professional care at Children's Choice Learning Centers, a company specializing in 24-hour care.

8. "The only license we have is a driver's license."
Restaurants need a license. Barber shops need a license. But don't be surprised if your day care center lacks any state certification. Many centers, such as some faith-based programs and health club nurseries, legally operate without licenses. Yet even if your child's day care provider is licensed, that doesn't ensure that it offers a high-quality program. "All (that does) is establish a minimum floor below which a facility should not go," says Faith Wohl, president of Child Care Action Campaign.

State licensing agencies set minimum standards designed to reduce the risk of harm to children from injury, unsafe buildings and the spread of disease. But because states decide on their own what those standards are, requirements for things such as group size, staff-to-child ratio and maintenance of environments vary widely. In New York the child-to-staff ratio for four-year-olds is 8-to-1; in Texas it's 20-to-1. A better indicator of a center's quality is voluntary accreditation by either the National Association for the Education of Young Children or the National Association for Family Child Care. Both organizations set requirements, from age to training, that a center's employees must meet.

9. "My references mean nothing."
You might think that going the nanny route and bypassing day care centers will ensure consistent help. You just need to vet your prospective help via a few references and your worries are averted, right? Sorry, references aren't so foolproof. Many reference providers "do not know what the qualities of good care are and may be too invested in the situation" to be objective, says Julie Shields, author of How to Avoid the Mommy Trap.

What to do? Go beyond simply verifying obvious information, such as dates of employment, when checking references. Instead, ask such questions as "What is the aspect of this person or arrangement that you liked least?" and then listen for negative clues. "If a reference is very negative, that is probably more accurate than a very good one," Shields says. As an extra precaution, consider doing your own criminal background check, as Valencia, Calif., mom Dawn Walker did. Walker made her top nanny candidates give her their Social Security and driver's license numbers, then hired a company through the Internet to investigate her first choice. "It came back clean," she says, and "definitely gave me peace of mind." The cost? Less than $75.

10. "You're on vacation? Great — you'll never relax."
Be prepared for some angst if you want to sneak away on your summer vacation for a day trip or romantic dinner sans Junior. Securing child care in a hotel can be dicey. While on vacation in London, Fran Falkin and her husband arranged for a babysitter through their hotel to care for their son after they scored theater tickets. But the sitter never showed. The hotel management "finally scrounged around and found a maid who was free," Falkin says. "When we came home, (our son) was still awake, they were watching a movie we wouldn't have allowed him to watch, and the room reeked of smoke."

Fact is, just 14% of hotels that responded to an American Hotel & Lodging Association survey said they provided child care for guests. And among that small number of hotels, services can be skimpy. Very few babysitters provided by hotels, for example, "are trained in water safety and lifeguard techniques, and are actually permitted to take a child to a pool," says Kyle McCarthy, editor of Family Travel Forum's Web site.