More than 50% of mothers with infants or preschoolers work outside the home. The main reason for working is financial need. Some mothers return to work because they enjoy it or need to stay up-to-date in a fast-changing career. The question of returning to work versus staying at home has no easy or correct answer. The decision is one that each mother must make based on her particular circumstances.

If you can provide your child with a consistent nurturing caretaker, there is no evidence that your return to work will cause your child any harm other than increased infections (but usually minor ones, such as colds). Young children of working mothers often have more opportunities to learn to trust other adults and to negotiate better with peers.

A mother needs 6 to 8 weeks at home after the birth of her baby to recover physically from childbirth and establish breast-feeding. A preferred maternity leave would extend to 4 months after the birth, at which time the mother will have developed greater confidence in her mothering skills. In addition, by 4 months, the baby should have formed a secure attachment to his mother and be sleeping through the night. Some authorities suggest that mothers should try to spend the first 2 or 3 years of their baby's life fully involved with child-rearing.

Several types of child care are available in most communities. During the first 2 years of life, children often do better with individual care or family day care because they need more cuddling and personal attention.

Having individual care in your own home is the preferred arrangement for infants. The care is usually provided by a grandmother or professional sitter. Often you will need to advertise for a sitter in the local newspaper. The applicant's references must be carefully checked, especially for characteristics that are important to you. Most professional sitters will stay in your home just while you are gone. but some are available as live-ins (nannies). Alternatively you can arrange for individual care in someone else's home. You will need to pack diapers, bottles, and toys, as well as transport your child to the sitter's home.

Family day care homes are an ideal compromise for many. In these settings, the day care provider cares for two to six children in her home. This type of day care is usually less expensive than center-based care. Disadvantages are that the children do not usually receive as much individual attention as when they are the only child, and many of these homes may not be licensed or monitored by the state.

A day care center may care for 30 or more children. Many children do not adapt well to these large centers until they are over 2 or 2-and-1/2 years old. Optimally, day care centers are located at the workplace, but this is uncommon in the U.S.  Day care centers are state licensed and must comply with certain standards. If you are looking for a day care center, assemble a list of centers by asking friends or by looking in the Yellow Pages under 'Child Care' or 'Day Nurseries and Child Care.  Don't make your final decision about a child care center until you have visited it and observed for at least half a day.

The most important factor in choosing a child care resource is finding a day care provider who understands and meets children's emotional needs. Choose someone who is warm. affectionate, and sympathetic; plays with the children; and has a sense of humor. Look for someone who listens to and complies with your style of child-rearing. Form a close partnership with your child's caregiver.

When you take your child to day care for the first day, plan on spending that day there. Let your child gradually reach out and become involved with the other children and the caregiver(s). On the second day, stay 5 or 10 minutes while your child makes the transition to interacting with the day care provider. If possible, leave a familiar toy or security object with your child. If the day care center is near your workplace, visit your child during the day. When you leave your child, do so with a cheerful attitude and let your child know you are leaving; don't sneak away.

Don't be surprised if your child is teary on the first days when you leave the day care provider. For the first week. your child may talk about not wanting to return. Remain firm in your decision and your child will gradually adapt to the change. Some children take as long as 1 or 2 months to adapt fully.

To lessen the burden consider working only part-time if it's financially acceptable. Perhaps you can share a job with another person, so that each of you works 20 hours a week. Or perhaps your employer will allow you to have a flexible schedule or to work at least some of the time in your home.

Research has shown that both the quality and quantity of time you spend with your child are important. Try to make breakfast a pleasant, unhurried occasion. Try to talk with your child during the commute to and from the child care provider. Use the 30 minutes before bedtime to discuss the day's events with your child at your child's pace. Set aside special half-days on weekends to do things with your child. Also remember that including your child in adult activities such as shopping. cooking, washing, and home repair is also quality time. You are providing enough input if your child is usually happy.

If you can afford it, hire a housekeeper. In any case try to simplify your home life. A spotless house must become a low priority. Do less cooking; make triple recipes and freeze leftovers. In addition, make a date for a night out with your spouse or a friend at least once a week; relaxation time is essential, not frivolous or wasteful.

It is imperative that spouses participate in the housework and child care. Responsibility for these tasks must be redistributed to prevent the mother from becoming overworked. For example, the father can help buy a son's clothing, take the children places, cook, and clean the house. School-age children can also be assigned some chores.

Find extra help if you are a single parent. Try to find a friend with a child close in age to yours. Share shopping, overnight and weekend visits, babysitting, and other responsibilities with your friend. Trading services in this way will save you money. Living with another single mother may be mutually beneficial. Consider joining an organization for single parents.

Caring for a sick child
The onset of illness can be a major disruption for the mother working outside the home. Many day care homes and centers will not care for sick children. Your options usually are staying home with your child, having your spouse take time off from work and stay home with your child, or having your child stay with a friend or relative who has agreed in advance to be a backup for illness care. Some agencies offer sick-care babysitters who will come to your home.

Do not send a sick child to day care if they are obviously contagious. Fever above 101°, vomiting, diarrhea, pinkeye, bothersome cough, or just feeling significantly ill should be reasons to keep a child away from day care. If you would feel uneasy having your own child spend all day with a child with similar symptoms, then do not send your child. Never send a child to day care who has a significant fever that you 'hide' with Tylenol or Motrin, etc. Make a pact with other mothers to not send contagious children to day care.

Adapted from B.D.Schmitt,M.D., author of "Your Child's Health," Bantam Books.