The take home message from the following, for those who don't have time to read the whole post: Don't be afraid to change childcare when your child's needs change...or if your care provider pisses you off. We've been flexible, and that has served our children well.
When Son was born, I was a resident and husband traveled most of the weeks of the year. I needed flexible child care, but we couldn't afford a live-in. We chose Lourdes, a wonderful grandmotherly woman from Ecuador who lived just a few blocks from the hospital. She had watched my niece and we were comfortable with her.
She spoke Spanish in her home and spent 99% of her day holding our baby. Whenever I picked him up, he was clean because she and gave him baths several times a week. When Daughter came along, I couldn't believe how much I had to bathe her. I didn't bathe Son more than a dozen times in his first two years of life.
I could call her at 6pm and tell her I had a patient in labor and wasn't sure when I'd be able to pick Son up and she'd say, "Mamacita, let me keep him overnight...please?" We never did that, because we are lucky to have so many friends and family members who would pick him up in our absence.
When he was two, we clearly saw that Lourdes was more a "baby" person than a kid person. We wanted a bit more structure. We switched him to a highly recommended preschool near the hospital. The owner, a Russian immigrant, ran a very, very tight ship. Son spent a lot (a lot!) of time in "time out" but seemed happy overall.
I, however, needed to grit my teeth and practice deep breathing when the teacher would critique my parenting in front of him, other children, other parents. I tolerated it because it was better to keep him in one place than to move him again. She saw every one of his age-appropriate rule infarctions as evidence that I, a "woman doctor" (which she said as though she was spitting the words) did not spend enough time with him.
Finally, after he had been there about 18 months, I asked her for a note of support for our adoption home study. She told me in front of Son that she couldn't recommend we bring another child into our family to neglect it like we had Son. That was it. We gave our notice and moved Son to my new hospital's award-winning child care center.
Having Son, and then Daughter, at the hospital was a dream come true. I occasionally wandered over to the center after lunch to say hello to them then went back to complete my rounds. Alas, the job ended (and for that I thank God on a daily basis!) and I couldn't leave them there.
We moved Son to a new preschool. He actually attended the first day it was open. It is run by a PhD in early childhood education who hires only teachers with baccalaureates in some related field - music, teaching, psychology. It is across the hall from an autism training center, and part of each day the regular kids and the autistic kids get together for activities. The new school is very small and currently there is a 3:1 child to teacher ratio any given day. When Son goes to kindergarten next year, he will benefit from the intensely individualized curriculum at this school.
Daughter, on the other hand, is too young for Son's school, though she'll start there when she is 2-1/2. Until then, she is happy in the home of a neighbor who runs a licensed child care. Daughter is one of five little girls under the age of 4. Our care providers (the neighbor and her sister) love her as though she is their own. There are plenty of toys and the environment is safe. We feel good that when we drop her off, she reaches out for these women, and when we pick her up, she reaches out for us.
We are, after all, the real constants in the lives of our children. We will never leave them, and we feel confident that they understand that. With my new job and husband's now-reduced travel schedule, we are usually home together with the children by 5:30. Will they remember the changes in their care providers? I doubt it. Will they remember that we were always there for them? I certainly hope so.