I also would not count on medical care in Nicaragua being equivalent to that in the U.S. I speak from experience on which I'd rather not elaborate.
Do you and your wife plan to have any more kids? Don't have them (or even get pregnant) in Nicaragua. Abortion is illegal in Nicaragua, but in a highly draconian way. If, for example, your wife is pregnant with what turns out to be an ectopic pregnancy, begins massively hemmorhaging and is bleeding to death, doctors will let her die in her hospital bed because they will face legal consequences if they harm the (already doomed) fetus. Some doctors won't treat a pregnant woman for
anything, for fear they might inadvertently harm the unborn child.
https://sites.dartmouth.edu/corley_lacs20_fa16/2016/11/10/health-care-consequences-of-nicaraguas-abortion-ban/Schooling is hit and miss. The American Nicaraguan School is touted as the premier school in Nicaragua. Supposedly the language of learning is English. In reality, the Nicaraguan elite get their kids accepted into ANS whether or not they speak English and the class becomes bilingual or even mostly Spanish. Maybe not a problem if you want your kid to learn Spanish, but it does impact the skills the kids develop. One of the kids from the American Embassy attended ANS for three years (preschool, kindergarten and first grade). When her father was transferred back to the U.S. and she started second grade in the Washington, DC area, they discovered the child had never learned how to read (even though she had received good grades in Nicaragua). Another problem (maybe the major one) is again associated with the local rich kids. If your parents are from a prominent family, you can act with impunity. This means that the rich kids can bully other students, mouth off, and disrupt class with no repercussions. One teacher failed a student when he failed to complete any of the assignments during the entire year. That teacher then had to flee the country when the father of the student issued an extremely credible death threat. Of course the experience changes from year to year and even from grade to grade. Some people had good experiences. A couple of embassy families were so frustrated they withdrew their kids from ANS and home-schooled them instead.
I would vote for Granada over Leon. I would vote for Panama, Costa Rica or Argentina over Nicaragua.