Nanny vs Daycare for hyperactive 18-months toddler?

I am having a hard time thinking about best childcare for my little dragon - 18 months old son - as I am returning to fulltime work soon.

I am looking for your experience sharing or advice on who can help with such decisions.

Short version: my son is hyperactive, fidgety, speech delayed, seems to have sensory processing issues (we are getting formal evaluations soon). Would daycare or fulltime nanny suit his needs better? Meaning: do these needs mean he will benefit from one-on-one nanny's attention or group scheduled setting will actually help to drain his energy and add structure?

Two attempts to start daycare haven't gone well so far. Should we push through the adjustment with the daycare like with sleep training? Or because of his needs it will be only hurtful e.g. destabilize him even more (if something like that is possible)?

What types of professionals can help coach on such decisions?

Long version:

As the common story goes in this group - my son has been overly fussy, poor sleeper, hyperactive since the very first week. He is now speech delayed and doesnt use gestures besides pointing yet, but understands speech well. He also shows signals of sensory processing issues - bites and loves roughhousing in fabrics, bites me and my clothes at every opportunity, seeks stimulation from running over bumps, gravel etc, plays only with push toys or heavy objects, runs non-stop.

We started daycare about a month ago for 1-2 hours every morning. On day 10 he got sick with stomach bug, and after a week of being very sick, became very clingy. It took another week to get him being more independent again. We started daycare again. Day 1 he seemed ok and then with every day he cried more and more while being there, not just at drop-off. The teachers seem to mean well, but can't find way to calm him down. So they just hold him or put him in a stroller and walk in circles. Daycare admin suggested leaving him for more hours at a time (like 3 hours) to "help him adjust". It's a professional daycare with a large group of toddlers and 3 or 4 toddlers per teacher ratio. I am looking into several smaller format home-based daycares.

We have 18 months check with pediatrician coming up and I am scheduling evaluations for SPD and speech delay. In the past pediatrician hasnt been helpful with guiding on such decisions as childcare.

A note on my personal experience: looking after him is and has been exhausting. It's been hard finding a nanny who can handle him and understand his mood changes. Seeing him in complete meltdown at daycare is heartbreaking and triggers crazy amount of mom guilt. I am jealous of parents with kids who can be outside and just sit somewhere with them, and their kid isnt trying to escape like a wet soap.

Parent Replies

Parents, want to reply to this question? Sign in to post.

My daughter was very much like your son at this age. Eventually learned that her enlarged tonsils were causing extreme sleep deprivation. Sleep deprivation and children is paradoxical. It makes children more hyperactive. Once we addressed this issue, my daughter’s behavior improved dramatically. She had motor, language, and learning delays which resolved in a couple months once her tonsils were removed. 

My son has a mild case of SPD that has already improved as he's gotten older (he's 5 years old now) so I can only semi-relate, but I will say that occupational therapy has been very helpful. Hopefully this is something that is referred to you as you get evaluated for SPD/speech delay. If you have Kaiser, you may find that OT options are limited (we got some good general advice from Kaiser OT, but we hit a wall at a certain point because Kaiser's OT is less helpful for behavioral challenges). I can recommend a private OT if that's something you'd be interested in. It's possible that an OT may be able to provide better advice in regards to daycare/nanny. 

While your son is too young for preschool, it's possible that some preschools may have in-house OT options; the preschool that my son is "graduating" from will have it next year, I think. Feel free to message me if you'd like. 

And I'm so sorry that you're going through this. 

I am so sorry you're having such a tough time. This is absolutely exhausting and you are right to look for more support. I think you need to look into more play-based daycares that are primarily outdoors or daycares where the staff are very well trained in childhood development. They will have more flexibility and bandwidth to support kids with different needs and mae sure he gets the right kind of stimulation. Putting him in a stroller or holding him all day is not going to cut it! Fewer kids in a smaller daycare may also be less stimulating for him. A really well-trained nanny would be an option but also probably very expensive. I agree with getting an evaluation for him and seeing if he qualifies for an aide that can join him at daycare. Good luck and hang in there! He is still quite young and it will get easier as e gets older. 

Hi there, I would say going with a nanny or a smaller group option if you can would be a better option . I think if he continues to cry and has difficulty adjusting that it’s a sign it’s not a fit. I’m so sorry, this stuff can be so hard to figure out! I would also ask the folks you see for testing and see if they can provide more info and guidance, and resources. Best of luck! 

I think a nanny would be better. The evaluation is likely to lead to intervention recommendations that a one-on-one caregiver can better provide. I think kids with these issues can learn the most from a bonded, attentive caregiver who encourages speech development and emotional regulation in a warm, child-centered way. This person can focus on providing the kind of support he needs without balancing the needs of a whole group of other kids. For example, speech-delayed toddlers often need to have their attention constantly refocused on your mouth when you form words. Like if he wants a drink you might hold the cup next to your mouth and say “cup” really clearly, with extra clear mouth movements, several times before you give it, leaving space for him to try to repeat. And he probably needs very attentive, consistent redirection for the biting and things like that. I can’t see a daycare worker having the bandwidth for providing that kind of support in the way he’s likely to need. A good nanny can establish a highly structured day (play time, clean up time, nap time, snack time, park time, etc). Toddlers generally need structure but you don’t need a daycare for that. In any case, his evaluation will help determine exactly what is most needed, but whatever the details, you are describing a child who needs a higher-than-average amount of stable, focused, individualized attention, and I do not think a group daycare is the best place to get it. And I’d be concerned that more failed daycare situations would reduce stability and raise his anxiety, making goals of better emotional regulation and improved communication harder to achieve. I think his eventual integration into a group setting will go better if he has more social skills and hasn’t been allowed to rack up a long history of failed school attempts that give him a negative association with it.

I hear the jealousy of seeing others that seem to have it easy. And in my experience, the sooner that you accept your child's needs, the better off you will both be. I normalized my child for a long time and in the end, it wasn't until I accepted her support needs that things started getting better. I've started living by the idea that if her behaviors are difficult it is because she is being put in a situation that she does not have the skills to handle. You may want to check out The Explosive Child by Ross W. Greene.

It seems like your instincts are telling you that the sensory environment is too much for him and the staff can't properly support him. The problem with sticking with daycare is that you'll soon be in a situation where you are going to have to choose between your work and the well-being of your kiddo if things don't improve. I personally would take all of this as a sign to work with a nanny or an environment that is designed for higher needs kids. There may not be an easy answer, because it may be the RIGHT daycare or the RIGHT nanny that will be what is good for him. Being as honest as possible about what he needs is important. I will also say that my daughter has had more transitions than necessary because schools have WANTED to support her and they have liked our family, but in actuality they have not been able to. Hindsight is 20/20 and I don't know if that is helpful to you at the beginning of your journey, but there it is.

He does not need to have an SPD diagnosis to benefit and start working with an OT. In my experience, it is hard to get OT completely covered by insurance anyway. I would start there along with the path to diagnosis. 

Also, please try not to be too hard on yourself. You are doing what you can in a tough situation. You are working to help him. It is a VERY hard age and it might be that he would be melting down in any case. He is young and you are already working to minimize them and to understand the triggers...these are good things.

This may be on your radar, already...but the characteristics that you are describing are also signs of autism. He is young for a diagnosis, but I'd suggest that you educate yourself and track it as a possibility. I was in denial because of the stigma and stereotypes, but getting that diagnosis (at an older age) was good for us and I wish I had done it earlier.

Best wishes to you.

Hi!  Please ask your child's pediatrician for an assessment for autism, and, while you are at it, contact the Regional Center of the East Bay (RCEB.org) for an (free?) evaluation.  When you son turns 3 years old he can be assessed by your local school district for free!  

Judging from how you describe your little one, it seems like he may be on the autism spectrum.  If he is on the spectrum, you will want to get early intervention.  Most commonly, the early intervention offered is ABA (Applied Behavior Analysis) Therapy.  It sounds like he may also need speech therapy...(as you said).

In my experience, doctors can be reluctant to offer assessment for autism because ABA Therapy is expensive!  However, I believe that medical insurance has to offer it.  You should educate yourself and demand an assessment.  The Regional Center is a government funded organization that offers life long services for individuals with developmental needs.  The local office is in San Leandro.  It is important that you son be assessed both by his doctor and the Regional Center.  

By the way, sensory processing disorder is not recognized either medically nor is it in the DSM.  It kind of doesn't really exist.  Many of the characteristics, however, are associated with ADHD or Autism.  

I wish you and your little one all the best!

(ps. I am a school/educational psychologist 10+ years experience working in the public schools including preschool assessment)

Oh, this sounds so hard. Childcare has been really difficult for us too. The drop-offs can be heartbreaking. I recommending reaching out to Katrinca Ford. She's an impressively skilled play therapist (MFT). She has helped me so much with understanding my daughter's needs and how to meet them. Katrinca has lots of experience with young children of all sorts. She taught pre-school before becoming a therapist. I think she'll have some insights into what type of daycare setting would work best for your little one. And I'm sure she'd have good guidance on how to parent this 'little dragon'. She's been really helpful to me and our family. You can call or email her 925-831-1926 or katrinca [at] familyplaytherapy.com

So sorry you are are going through these struggles.  The good news is; it will pass; you just need some real dedicated help and patience.  I have been there and know what its like to give up jobs, family, friends, companions, dreams- all in the name of our babies.  Things will not correct overnight and in all honesty you may face more challenges before things get better.  I have been there for six years and still fighting.  However,  I think its essential to place family first.  Look into any resources that would allow you to take care of your angel full time if that is  what you want.  I never  thought I could, but its the best decision I have made in my life.   i only have one child, but would have a 100 more if I could.  Don't be afraid and please don't feel alone.  There is always a way..... I am not quite sure how this all works with the communication but If you need to reach out to me, I would be happy to help when I can.  

It takes several villages to raise our wonderful little people. ...

Contact me if you need support