The purpose of this qualitative study was to describe the process that employed mothers used to make child care decisions for children who became ill while enrolled in day care and the factors that influenced those decisions. Responding to an investigator-developed interview schedule, 20 married, employed mothers of preschoolers in day care each described a recent experience when her child was ill on a work day, her feelings, advantages and disadvantages of available options, preferences, job characteristics, and demographics. Inductive analysis of narrative data revealed themes of anxiety and decisional conflict between work and motherhood responsibilities and limited care options. These mothers usually cared for their sick children, sometimes sharing the duty with another caregiver. Data were categorized by actually selected and usually selected modes of care: mother; mother and father; mother and grandparent; mother and sitter; and mother and day care center. Influencing factors included: certainty and severity of illness, relative advantages and disadvantages of available options, job flexibility, and availability of paid leave. A model describing the decision-making process is proposed. While further research is needed, this model provides some guidance for nursing practice with families who face this dilemma and for evaluation of workplace policies.