My Baby Care

From baby bottles and bedding to development and sleep, WebMD's Baby Center helps parents know what newborns need during the first year.

. Gather your supplies. The first step is to be prepared. Gather up a couple of diapers, wipes, ointments.

Anything you'd need to change the baby. For safety reasons, you don't want to be searching for something with a wiggly baby waiting for you.

I also always open a wipe or two and have it unfolded and laid out ready to use. Lay the baby down. Most people have a specific area to change baby. This can be a changing table or changing pad. If you have a table, be sure to use the strap for baby's safety.

Never leave baby unattended while changing him or her. Unfasten the, but don't pull it out from under the baby yet. This allows for some margin of safety in case the cold air inspires baby to let go. Hold on! Grasp the baby's ankles and gently lift their bottom-up and begin to wash their bottom with the wipes. If the area is heavily soiled you can use the front part of the old diaper to remove part of the mess. As you finish with each wipe, gently place in under the baby (clean side up) for easier cleanup.

When the baby's skin is clean, pull the diaper and wipes out from under baby and set it aside. Fresh & Clean Place the new, clean diaper under baby and secure the fasteners. If you still have a newborn, you might need to fold down the top of the diaper to make. Don't be afraid to pull the diaper on snuggly.

If you have it on too loosely. Well, you can imagine the mess that makes!. Clean up! After putting the baby's clothes back on, take the old diaper and use the fasteners to make it into a small ball, crisscrossing the fasteners. Place it in the diaper pail or trash. I always keep a container of liquid disinfectant near my changing table to use on my hands. Then I handed the baby off to someone else or lay her down and wash my hands at the sink. Gather your supplies. Being prepared is usually the first step with anything having to do with a baby!

So, gather a towel, washcloth, any soaps or lotions you intend to use. In the bathroom. It doesn't matter what form of the tub you're using, whether it's the regular bathtub, a baby bathtub or container, the water needs to be shallow and just the right temperature, about 100 degrees Fahrenheit. Many people suggest testing the water with your wrist, an area of more sensitive skin. You also want to ensure that whatever room you are in is warm enough and free of drafts. Strip Tease Talk to your baby as you remove their clothing.

Hold them close and make them feel secure. If you have a baby who absolutely hates to be naked, try to do a sponge bath for the first few weeks, and slowly undress them and wrap them in a towel, and only uncover the part you're currently washing. Fresh & Clean Place the baby in the tub, but always hold on with one hand for safety. Use your other hand, or any small helpers, to take the washcloth and begin washing the baby.

Remember to start with the face and neck and do the diaper area last. Many soaps for baby can be used in their hair.

You also have the option of not using soap on baby's delicate skin. All done! Once the baby is washed, wrap him or her in a towel and leave the bath stuff for a clean up later. Use the towel to dry baby off.

You can, if you desire, use lotion on the baby after a bath, though it's not necessary for most babies. Put a clean diaper and outfit on the baby. Once the baby is sleeping or with someone else, you can then clean up the bath equipment. As with everything, there is always more than one way to do it! While the above is the traditional way that many people use to bathe their babies, there are alternatives. A great one to use is to actually bring the baby into the bath with you.

They love skin-to-skin contact. You simply cradle the baby on your lap and bathe them. When you're done, you can either hand the baby off to another adult and finish your bath or get out and take care of the baby. This is also a great technique for babies who are having trouble latching onto the breast. The water and skin contact can be enough to help them relax and nurse more effectively.

Choose a position. You can choose any you wish to nurse in, whether that be a seated or laying down position. It should be one that gives you the best feeding position for your baby and their needs. This may vary with the baby's age, your comfort level and even the time of day. Many people use the cradle hold, with mom seated upright, holding the baby like a cradle. This allows you to hold the baby with one hand and use the other to support or move your breast.

Need a lift? No matter what position you decide on, get some support! To help you hold the baby up will save strain on your neck and back. Ask for help from others if you're just learning. Baby Placement A good latch is one of the most important parts of breastfeeding comfortably. This directly goes back to a good position of the baby.

Your baby should be belly to belly with you and chin to the breast. If the baby is twisted or has their head turned it can make it not only more difficult for them to get milk, but it can make your nipples sore. Latch! Use your one hand to cup the breast and offer it to the baby. Baby should open his or her mouth wide enough to take a good portion of the areola tissue (a darker portion of the breast) into the mouth. As baby does this pull them closer to the breast and watch them nurse. What to look for! While the baby is nursing you want to look for a few things to ensure all is well.

The baby should have their lips flared around the breast. If you pull the lower lip down a bit (while they are nursing) the tongue should be curled around the breast. You can also usually hear baby swallowing and watch their ears wiggling when actively nursing. Get ready! Have or formula at the temperature your baby prefers. This can even be room temperature. It is important that you do not microwave bottles, as this will cause hot spots that can burn your baby, even though you may have tested the liquid.

Get a grip. Hold the baby on your lap with their head in the crook of your arm. Be sure to switch sides, as you would with breastfeeding to provide them with adequate stimulation of both sides of their brain. Go for it! As the baby turns to root and opens their mouth, insert the bottle nipple into the mouth. The nipple should be filled with fluid. A half-filled nipple will cause the baby to swallow too much air which can cause gas later. To end a feeding or remove the bottle, simply pull the bottle from the baby's mouth.

Some extra tips for bottle feeding include not using half-used bottles. If the baby doesn't finish a bottle you can't save it. In small amounts, like 2 ounces. Or fix formula in similar amounts. This prevents waste. You should also never prop a bottle.

This can cause the baby to choke and deprives them of the physical contact they crave. Breast milk will keep in your refrigerator for three days, and 3-6 months in the freezer. The formula lasts about 2 days in the refrigerator. It's also important not to water down the formula to stretch it. This can cause your baby to become inadequately nourished and ill. Cradle Hold Cradling a baby is quite natural and simple.

Place the baby's head in the crook of one of your arms and wrap your other arm around the baby or hold the original arm with the second arm. This is a great position for talking to a baby or looking at them. Many babies sleep very well in this position.

It's also a good beginners position, particularly for younger kids or siblings. Belly Hold This is a great position for gassy babies! Lay baby chest down over one of your forearms. Use your other arm to lay across baby's back to hold them securely.

You can also do this across your lap or use it for burping. A variation is to place the supporting hand between the baby's legs for a more secure grip. I find this depends on how long your arms are!. Hip Hold Once baby has some good head and neck control, is a great, one-armed technique. Sit baby on one of your hip bones facing outward and wrap the same side arm around baby's waist.

It was 5:30 in the morning when Kenya Mire looked down at her baby girl, Kendyll, who was curled up tight on a foldaway crib. “Night, night,” Kendyll had just murmured in her quiet, serious way. At 20 months, she was picking up all sorts of words, like “baby,” the name of the doll she kept nearby, and “Bryce,” the name of her big brother. She hadn’t slept much that night, and Mire thought about calling in late to work so Kendyll could get more rest. But it was only Mire’s second day at a new job she badly needed, as a receptionist at a Houston oil company. Mire, who was 30, with an open face and wide smile, was intent on making a good impression.

The best she could do was give Kendyll an extra hour to nap and prepare some warm milk for her breakfast.When Kendyll got up, Mire dressed her in a purple shirt that matched her own—purple was Kendyll’s favorite color—and put a pair of purple-striped stretch pants in her backpack. It was a challenge to get Kendyll to sit still for the hour it took to unbraid and re-braid her dark hair, and on such a hectic morning, Mire didn’t even try. At around 7 a.m., they got into the car and drove to Kendyll’s new day care.The place was called “Jackie’s Child Care,” but there wasn’t anyone named Jackie who worked there.

The proprietor was Jessica Tata, an energetic 22-year-old registered with the state of Texas to look after children in the wood-paneled house she rented on a quiet, middle-class street. Her regulars included Elias, a chunky 16-month-old with a bowlegged walk, and 19-month-old Elizabeth, who always jumped into her mom’s lap when it was time to drop her off. As Mire walked back to her car that warm February morning in 2011, she noticed Kendyll hovering at the entrance—a little sleepy, a little curious, gazing at the scene inside. Mire felt uneasy about leaving, especially since it was only Kendyll’s second day there and she didn’t know Tata that well.

Shortly after, she called Tata to check in, and Tata reassured her that Kendyll was doing just fine.Just after lunch, Mire’s cell phone lit up. The number was Tata’s, but she didn’t recognize the voice.

“There’s been a fire,” a woman said. “They’ve taken all the kids to the hospital, for smoke, as a precaution.” Mire tried not to panic; she clutched at the word “precaution.” Her phone buzzed again, this time with a text message from a friend: “What day care did you say Kendyll goes to?” Mire called the friend, who was watching live TV coverage of a burning Houston day care.

Black smoke was billowing from windows and holes in the roof; firemen were running out of the house, cradling limp babies in their arms. One little girl had braided hair and a purple shirt, her friend told her.

She looked like Kendyll. Mire ran to her car.

I can’t panic, she kept telling herself as she drove through heavy traffic and later past ambulances and fire engines. I just have to get there. Trusting your child with someone else is one of the hardest things that a parent has to do—and in the United States, it’s harder still, because American day care is a mess. About 8.2 million kids—about 40 percent of children under five—spend at least part of their week in the care of somebody other than a parent. Most of them are in centers, although a sizable minority attend home day cares like the one run by Jessica Tata. In other countries, such services are subsidized and well-regulated.

In the United States, despite the fact that work and family life has changed profoundly in recent decades, we lack anything resembling an actual child care system. Excellent day cares are available, of course, if you have the money to pay for them and the luck to secure a spot. But the overall quality is wildly uneven and barely monitored, and at the lower end, it’s Dickensian.This situation is especially disturbing because, over the past two decades, researchers have developed an entirely new understanding of the first few years of life. This period affects the architecture of a child’s brain in ways that indelibly shape intellectual abilities and behavior. Kids who grow up in nurturing, interactive environments tend to develop the skills they need to thrive as adults—like learning how to calm down after a setback or how to focus on a problem long enough to solve it. Kids who grow up without that kind of attention tend to lack impulse control and have more emotional outbursts.

Later on, they are more likely to struggle in school or with the law. They also have more physical health problems. Numerous studies show that all children, especially those from low-income homes, benefit greatly from sound child care. The key ingredients are quite simple—starting with plenty of caregivers, who ideally have some expertise in child development. By these metrics, American day care performs abysmally. A 2007 survey by the deemed the majority of operations to be “fair” or “poor”—only 10 percent provided high-quality care. Experts recommend a ratio of one caregiver for every three infants between six and 18 months, but just one-third of children are in settings that meet that standard.

Depending on the state, some providers may need only minimal or no training in safety, health, or child development. And because child care is so poorly paid, it doesn’t attract the highly skilled.

In 2011, the median annual salary for a child care worker was $19,430, less than a parking lot attendant or a janitor., the director of the Center for the Study of Child Care Employment at the University of California–Berkeley, told me, “We’ve got decades of research, and it suggests most child care and early childhood education in this country is mediocre at best.”At the same time, day care is a for many families—more expensive than rent in 22 states. In the priciest, Massachusetts, it costs an average family $15,000 a year to place an infant full-time in a licensed center. In California, the cost is equivalent to 40 percent of the median income for a single mother. Only minimal assistance is available to offset these expenses. The very poorest families receive a tax credit worth up to $1,050 a year per child. Some low-income families can also get subsidies or vouchers, but in most states the waiting lists for them are long.

And so many parents put their kids in whatever they can find and whatever they can afford, hoping it will be good enough.One indicator of the importance that the United States places on child care is how little official information the country bothers to collect about it. There are no regular surveys of quality and no national database of safety problems.

One of the only serious studies, by Julia Wrigley and Joanna Dreby, appeared in the American Sociological Review in 2005. The researchers cobbled together a database of fatalities from state records, court documents, and media reports. On the surface, they said, day care appears “quite safe,” but looking closer, they discovered “striking differences.” The death rate for infants in home settings—whether in their own houses with a nanny or in home day cares—was seven times higher than in centers. The most common causes included drowning, violence—typically, caregivers shaking babies—and fire.Statistics on Sudden Infant Death Syndrome (SIDS) are also revealing., an advocacy group, calculated that, proportionally, about 9 percent of all reported SIDS deaths should take place in child care. The actual number is twice that.

And while overall SIDS fatalities declined after a nationwide education campaign, the death rate in child care held steady.Fatalities in child care remain relatively rare, but not as rare as they should be. Louis Post-Dispatch reporter Nancy Cambria documented 45 deaths between 2007 and 2010. One was three-month-old William Pratt, who died from blunt trauma after a caregiver threw him on a couch because she was frustrated with him. In 2012, a toddler named Juan Carlos Cardenas wandered off at an Indiana church day care.

Nobody was watching him when he fell, face-first, into a baptismal pool and drowned. Kenya Mire was an only child and hated it, and perhaps that’s why she liked kids so much.

After finishing high school, in 1999, she started training to be a medical assistant, hoping to work in a maternity ward. “I was just so interested in the idea of pregnancy,” she says in her clear, measured way. “I always wanted to be that person where I was in the room with them from the time when they came in up through when they had the baby. I wanted to be the person that you told your story to.”When she was 22, however, Mire had to put her plans on hold, because she was pregnant herself.

She and the father weren’t together and her morning sickness got so bad she had to quit her job in a restaurant kitchen and move in with her mom. Despite all that, she felt “worry-free,” she says. “I was just so excited to have a child.” Eight years later, when she got pregnant again, it was different. This time, she knew how hard it would be.

Kenya Mire and her son Bryce Courtesy of Kenya MireWhen Mire went back to work, she put Kendyll in the same day care where she’d sent her son, Bryce: Grandma’s Place—a bright, cheery operation with a professional staff. But Grandma’s Place was expensive. Even with the subsidies Texas provides to low-income mothers, Mire had to pay $200 a week from her $12.50-an-hour job at a water utility company.

Then the recession hit, and Mire lost the job. She had to pull Kendyll from the center.For the next two years, Mire worked as the hostess at a steak house for five hours a night, earning $10 an hour. Every day, she also checked in with several temping agencies. She relied on her mother and friends for child care, which meant she often had to pass up last-minute opportunities because she couldn’t find anyone to look after Kendyll.

At one point, she scraped up the money to send Kendyll to a KinderCare franchise, but eventually fell behind on the payments and had to withdraw her. Once, she quit a customer-service job because she had nowhere for Kendyll to go. When she was offered the oil company position, Mire felt like stability was finally within reach. “This was a really good opportunity,” she told me emphatically. “They were starting me on $12.50, and if I became permanent, they would move to like $13.” But in order to take the job, she needed child care.First, Mire tried KinderCare again, but they wouldn’t take Kendyll until Mire paid her debt; when she did, there were no openings. She called about a dozen centers, all of which were either too expensive or had no available slots.

Mire thought she might have to turn down the job. “I just kind of broke down, because it seemed like nothing was going right, everything was just falling apart,” she says. “I sat in my car for about thirty minutes. I was just like, I don’t even know what to do anymore.

Because I want to start this job, but I literally don’t have nowhere for Kendyll to go.”Then a solution materialized. Mire’s mother was shopping at Target when a woman named Jessica Tata handed her a business card for her home day care. Mire quickly called Tata, who said she could take another toddler.

And the state subsidies—would Tata accept those? Yes, she said, she did it all the time.Still, Mire was hesitant to leave Kendyll in a home day care—she’d never done that before. When she and Kendyll went to check out Jackie’s, she noticed dirty dishes piled up on the kitchen counters. Over the next two hours, she plied Tata with questions, about everything from her experience to her education methods.

Tata’s answers eased her anxiety. “She seemed like she understood the struggle of single parents and trying to work and take care of kids at the same time,” Mire recalls. “She just seemed very open and honest, really.” Mire liked the fact that Tata promised to teach the children Christian values through Bible reading and prayer.

Most important, she seemed warm with children. Kendyll was usually wary in strange settings, but she left her mother’s side and started playing with the other kids. Maybe the arrangement wasn’t ideal, Mire thought, but it would be OK for now.Mire’s dilemma was one that American parents, particularly single mothers, have struggled with for generations. The United States has always been profoundly uncomfortable with the idea of supporting child care outside the home, for reasons that inevitably trace back to beliefs over the proper role of women and mothers.

At no point has a well-organized public day care system ever been considered the social ideal. “Children are dying. I can’t see anything.

I can’t even get there and get them. I can’t see anything. My kids are dying. Please hurry. Oh my god!”The first day cares were established during the Industrial Revolution, as increasing numbers of women in cities had to work. Jane Addams, the Progressive Era activist, was horrified to learn that all over Chicago, children were being left alone in tenement homes, morning till night. “The first three crippled children we encountered in the neighborhood had all been injured while their mothers were at work,” she wrote in her 1910 memoir,.

“One had fallen out of a third-story window, another had been burned, and the third had a curved spine due to the fact that for three years he had been tied all day long to the leg of the kitchen table, only released at noon by his older brother who hastily ran in from a neighboring factory to share his lunch with him.”Addams and other do-gooders created “day nurseries,” although in many cities they were little more than baby farms. Geraldine Youcha writes in that a survey from that era by Chicago authorities “found children unclean and crowded into one small room without any playthings, and several nurseries in which the ‘superintendent’ did not even know the last names and addresses of some of the children.”. The prevailing assumption at the time was that child care outside the home was deeply inferior to a mother’s care.

At best, it was regarded as a useful tool to “Americanize” the children of recent immigrants. Even Addams believed the optimal solution was government subsidies that would allow single mothers to look after their own children. (“With all of the efforts made by modern society to nurture and educate the young, how stupid it is to permit the mothers of young children to spend themselves in the coarser work of the world!” she wrote.) Toward that end, progressive states created widows’ pensions, which were eventually expanded by the New Deal. Decades later, most people would know this kind of assistance simply as “welfare.”Arguably the best child care system America has ever had emerged during World War II, when women stepped in to fill the jobs of absent soldiers. For the first time, women were employed outside the home in a manner that society approved of, or at least tolerated. But many of these women had nowhere to leave their small children. They resorted to desperate measures—locking kids in the car in the factory parking lot, with the windows cracked open and blankets stretched across the back seats.

This created the only moment in American politics when child care was ever a national priority. In 1940, Congress passed the Lanham Act, which created a system of government-run centers that served more than 100,000 children from families of all incomes.After the war, children’s advocates wanted to keep the centers open. But lawmakers saw them only as a wartime contingency—and if day care enabled women to keep their factory jobs, veterans would have a harder time finding work. The Lanham Act was allowed to lapse.The federal government didn’t get back into the child care business until the 1960s, with the creation of Head Start, which was narrowly targeted to support low-income children. A broader bill, designed to help working mothers by providing care to all kids who needed it, passed Congress a few years later. But President Nixon vetoed the legislation, saying he didn’t want the government getting mixed up with “communal” child-rearing arrangements. Other than some increases in government funding for child tax credits and subsidies, federal child care policy has hardly changed in the last few decades.

Photo by Darren BraunBut family life has changed immeasurably. In 1975, most American families had a male breadwinner and a female homemaker, compared with one in five today. Around two-thirds of mothers of young children now work outside the home.Meanwhile, the idea that it is preferable to support low-income women to stay home with their children has become toxic in American politics.

Since the passage of welfare reform in 1996, single mothers no longer get cash benefits unless they have a job or demonstrate progress toward getting one. Millions of women with meager resources who would have qualified under the old welfare regime must find somewhere for their young children to go while they’re at work.Day care, in other words, has become a permanent reality, although the public conversation barely reflects that fact. The issue of child care is either neglected as a “women’s issue” or obsessed over in mommy-wars debates about the virtues of day care versus stay-at-home moms.

Whether out of reluctance to acknowledge a fundamental change in the conception of parenthood—especially motherhood—or out of a fear of expanding the role of government in family life, we still haven’t come to terms with the shift of women from the home to the workplace.On the day of the fire, as her house filled with smoke, Jessica Tata called 911. In the recording of the call, she is screaming: “Children are dying.

I can’t see anything. I can’t even get there and get them. I can’t see anything. My kids are dying. Please hurry.

Tata grew up in west Houston, the odd one out in a high-achieving Nigerian family. While her siblings excelled at academics and sports, Tata spent some time in juvenile detention, as well as a special school for troubled youth. At one point, she admitted to a charge of delinquent arson for starting a fire in a school bathroom.But when Tata was around 16, her family saw a radical change in her. She became a dedicated Christian and started volunteering at her church’s day care.

Her parents wanted her to go to college, like most of her brothers and sisters, but Tata decided to open a day care in her two-bedroom apartment.In 2010, Tata started a bigger operation, Jackie’s Child Care, which she registered with the state. She divided the lower floor of her house into different areas—mats on the tile floor for naptime, a classroom area with little desks, a play area with Legos and musical instruments.

For the kids’ lunch, she often cooked corn dogs or catfish. Tata liked to keep her older brother, Ron, posted on their progress, proudly describing the best speller or a child who had learned a new word. “I felt like she was trying to impress us all, like, Hey, you people thought I wouldn’t go to college and I wouldn’t be successful, but look at me now,” he recalled. “ I have this day care. I have these kids. I have everything that I dreamed of.” Emergency personnel outside Jessica Tata’s day care.

AP Photo/Houston Chronicle, Michael PaulsenWhen the first-responders arrived at the scene, Tata told them she had been in the bathroom when a pan of heated oil caught fire on the stove and that she ran outside when she couldn’t find any of the kids. A neighbor was trying to console a distraught Tata when she noticed that the children and the firefighters carrying them outside were covered in black soot. But Tata’s white blouse, cherry-red vest, and matching knit beret were clean. Other neighbors reported that they had seen her run out the door screaming, but, seconds before, some had also seen her drive up to the house, with nobody in her van. Later, a fire department investigator found a bag from Target behind the front door, with a receipt issued around the time of the fire.Afterward—apparently the very next night—Tata returned to the charred remains of her home, retrieved her passport, and caught a flight to Nigeria.

Interpol agents would eventually take her into custody, and at one point, Tata spoke with the mother of one of her charges on the phone. “I’m so sorry, Ms. Betty,” she said.As questions about Tata accumulated, many of them in coverage by the Houston Chronicle, people started asking why authorities had allowed her to run a home day care in the first place.

After all, she had a criminal record, even though Texas regulations state that children must not be supervised by anyone with “a history of criminal activity, abuse, or neglect.”I put the question to Sue Lahmeyer, former district director of licensing for the Texas Department of Family and Protective Services (DFPS). Her office was responsible for monitoring 6,000 child care providers in and around Houston, including Tata.

Lahmeyer, a transplanted New Yorker who spent some 30 years working on services for children and families, explained how little power inspectors have to make sure kids are getting safe, quality care. In Texas, a person only needs a high school qualification or equivalent to operate a home day care. (That includes online degrees.) As for Tata’s juvenile record, she hadn’t disclosed it on her application, and a computer background check hadn’t uncovered it. In 2007, the agency had ordered Tata to close the day care in her apartment, because she was operating without a proper license.

But, under the law, that didn’t disqualify her from obtaining permission to start a new business.Caregivers are also required to attend a state-sanctioned education session. According to a trainer, Tata had wandered in and out of the classroom, put her head down on the table, and spent much of the time texting.

But since the law only requires applicants to show up, Tata had satisfied the requirement.By national standards, Texas child care regulations are typical—better than average in some respects, worse in others. That is to say, they are painfully minimal. “You know, when we walk into some of these places, they’re meeting the letter of the standards,” Lahmeyer says. “But it’s like a warehouse for children. You know it when, as the inspector, you are the most interesting thing the kids have seen all day.

They attach themselves to you and are trying to engage because there’s nothing else going on for them.”Like most states, Texas inspects child care centers at least once a year, but only has the manpower to visit home day cares every two. Even egregious violations don’t always lead to shutdowns. Sometimes, that’s because parents, lacking alternatives, fight to keep notorious places open. An inspector named Carol McGinnis told me she’d recently visited a center in “total disarray,” with “feces smeared on the walls.” Nevertheless, if the agency closed it, McGinnis expected some parents would resist, because it was one of the few places offering care on weekends.

On other occasions, the process of closing a day care can be torturous. Lahmeyer recalled one place that racked up repeated violations over two years before a judge would shut it down. “I can tell you there’s a fair number of cases that we lost because the judge decided, No child’s died yet, so they stay open,” Lahmeyer says.All too often, it takes an incident to force a closure. Last November, for instance, DFPS closed a center after a caregiver left a nine-month-old infant alone on a changing table without a belt. The baby fell onto a concrete floor, sustaining a serious skull injury. In addition to the caregiver, DFPS cited the director for failing to “contact the parents the next day when a ‘mushy’ bump was observed on the infant’s head.” I asked McGinnis how many of the area’s providers she’d trust with her own child.

She answered promptly: “Twenty percent.”It took Kenya Mire about 25 minutes to get to the hospital, where she found a frantic scene. Parents were desperately seeking information; staffers were having trouble identifying the kids. Even then, Mire says: “I didn’t expect it to be to the extreme. I still was kind of hoping it was OK.” But then a nurse came into the waiting area holding a pair of purple striped stretch pants, covered in soot and cut into pieces. Mire practically had to be pulled into the emergency room.

When they brought her in, she saw Kendyll laid out on a table like a doll. A doctor was pumping her chest, hard.

Then a nurse pulled her aside and told her there was nothing more they could do.Four of the seven children at the day care died that day. Elizabeth died before her mother, Betty Ukera Kajoh, a teacher who met Tata through church, made it to the hospital. Elias was in a special breathing chamber, expelling smoke from his lungs, by the time his mom, Keshia Brown, finished a training session for a new job at a grocery store and learned about the fire.

He died the next day in Keshia’s arms. A growing number of economists have become convinced that a comprehensive child care system is not only a worthwhile investment, but also an essential one. James Heckman, the Nobel-winning economist, that, in the best early childhood programs, every dollar that society invests yields between $7 and $12 in benefits. When children grow up to become productive members of the workforce, they feed more money into the economy and pay more taxes. They also cost the state less—for trips to the E.R., special education, incarceration, unemployment benefits, and other expenses that have been linked to inadequate nurturing in the earliest years of life. Two Fed economists concluded in a report that “the most efficient means to boost the productivity of the workforce 15 to 20 years down the road is to invest in today’s youngest children” and that such spending would yield “a much higher return than most government-funded economic development initiatives.”In a July 2012, Fed Chairman Ben Bernanke made the case that significant investment in early childhood would deliver even broader gains to the U.S.

“Notably, a portion of these economic returns accrues to the children themselves and their families,” he said, “but studies show that the rest of society enjoys the majority of the benefits.” Right now, too many Americans make major choices about work or finances based on the scarcity or cost of child care. Sometimes, this means women curtail their careers because it’s cheaper to stay home or take a more flexible job than to pay for full-time care. Sometimes, a person of limited means pours a significant portion of their income into day care, which limits their ability to build a financial foundation for the future.

When parents can find safe, affordable child care, they are more likely to realize their full economic potential. Their employers gain, too: Numerous studies show that access to quality day care increases productivity significantly.This year, President Barack Obama has put forward what he calls a ” proposal. It would provide states with matching funds, so that they could set up their own programs for three- and four-year-olds, while modestly increasing subsidies for infant and toddler care. This plan would cost $75 billion over ten years, financed by higher cigarette taxes, which means it will meet serious political resistance. But the concept has support from key Democrats like House Minority Leader Nancy Pelosi, who has spoken of “doing for child care what we did for health care.”Since the 1930s, with the introduction of Social Security, the United States has constructed—slowly, haphazardly, often painfully—a welfare state. Pensions, public housing, health care—piece by piece, the government created protections for citizens that the market doesn’t always provide.

Child care is the major unfinished part of that project. The lack of quality, affordable day care is arguably the most significant barrier to full equality for women in the workplace. It makes it more likely that children born in poverty will remain there.

That’s why other developed countries made child care a collective responsibility long ago.In November 2012, Tata went on trial for multiple charges, including felony murder. Family and former clients talked about her love of children. A nurse named Eudora Walcott said Tata was the first caregiver who didn’t make her grandson scream. “The person I know was always there for the kids,” she recalled.

But Tata herself never took the stand. (She also declined interview requests for this article.)A young woman who’d worked with Tata briefly in 2010 testified that Tata sometimes left her alone with a dozen kids for hours at a time and that when she arrived in the morning, the place occasionally had “diapers on the floor, throw up under the playpen.” A seven-year-old girl told jurors that Tata once took the older kids to McDonald’s while the younger ones slept at home. A neighbor described several occasions when she’d knocked on Tata’s door and nobody answered, even though she could hear children inside.The prosecutor, Steve Baldassano, played surveillance video taken at Target during the fire that showed Tata browsing the aisles and then stopping by a Starbucks. A manager testified that he asked Tata to take a customer survey, but she told him she didn’t have time—because she had something on the stove and little kids were at home, sleeping.Tata’s attorney, Mike DeGeurin, didn’t dispute that she had left the kids alone.

But while Tata was guilty of bad judgment, he said, she hadn’t meant to hurt anyone. “It was a terrible accident,” DeGeurin told the court. “What it’s not is murder.” The next day, the jury found Tata guilty. She is now serving an 80-year sentence in a state prison.Mire also testified, but when the trial was over, she felt disappointed, like there were more things she wanted to say.

“I wanted to come to her face-to-face and be like, What happened?” she says. “I could look at babies now, not even my baby, and I’m still just like, it’s a comfort feeling to know that something so precious is here. You cherish that. You keep that close. You can look at a baby or child and just see their innocence. Even when they do something bad, there’s still innocence to that.“So when you hear a story where people have done neglective things to that kind of innocence, it’s heartbreaking because I don’t fathom it. I just can’t imagine what she was thinking.”Nearly a year after the fire, Mire got a steady job at the same hospital where Kendyll died.

Oddly, the experience has provided her with a measure of peace. Some of the nurses in the emergency room remembered Mire, and when firefighters brought in patients, some of them recognized her, too. They talked to her about the day of the fire, and Mire learned that, by the time Kendyll reached the hospital, she had already passed away. “They think that she was sleeping and the smoke just put her in a deeper sleep,” she says. “It was kind of like a comfort, because I was able to get answers that I needed.” For months, she said, she had been tormented by the thought that her daughter had died alone and in pain. “It scared me to death because I always wondered if she was awake, if she was in the crib crying for me. I just didn’t want her to feel like I left her there.”.

Nursery schools had their own, largely separate evolution—primarily as places where more affluent families could send their young children for enrichment. Over time, the lines between early childhood education and childcare have blurred. The day care fire got extensive coverage in local media. The best stories, by T he Houston Chronicle, included an award-winning, of the day by reporters Susan Carroll and Claudia Feldman. One reason to think that assessment may be right: Data collected by the Houston-based suggests that 46 percent of caregivers in the area’s licensed centers, and 69 percent in registered or licensed home day cares, have only “minimal” training. The DFPS staff that I met said that they do their best to use training and inspections as opportunities to teach providers about quality and safety, above and beyond the minimum guidelines. But they seemed frustrated that, given their authority and resources, they could not do more.

The other two young children at the day care that day also suffered serious injuries.