These are the topics we'll cover in this section:
In-Home Care
Family Child Care
Child-Care Centers
Tips for Child Care
Finding Child Care You Trust
Child-Care Safety Concerns
What to Tell Your Caregiver
In-Home Care
You can arrange for someone to come to your home and take care of your baby. That person may work only during the hours you're gone or may live with you. You can find such a caregiver by asking for recommendations from your friends, reading ads in local (especially parenting) newspapers or going through agencies that specialize in child care.
Advantages to in-home care:
It's convenient.
Your baby stays in familiar surroundings.
Your baby receives more individual attention.
No special arrangements are needed when your baby is sick.
Your baby is not exposed to many other children's germs.
The caregiver may be willing to help with household chores.
Disadvantages to in-home care are:
As an employer, you must meet minimum wage, Social Security, worker's compensation and tax-reporting requirements. Such arrangements may be expensive.
Competition may develop for your child's affection and control of his behavior.
Because the caregiver is alone with your child most of the time, you have limited knowledge of how well she or he is doing the job.
If the caregiver becomes ill, has a family crisis or wants a sudden vacation, you may need to find other care on short notice.
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Family Child Care
Many people offer informal care in their homes, often while caring for their own children or grandchildren. Such care is usually less expensive and more flexible than formal day-care centers. Regulations for family-care settings vary from state to state; contact your local health department for information.
Family child-care advantages:
• There are usually no more than six children (fewer, if some are infants), which means a good adult-to-child ratio.
• Your child is in the comfort of a home, and may be able to participate in normal household activities.
• Other children are present, providing playmates and social interaction.
• Arrangements often are flexible and can accommodate special needs and interests.
Family child-care disadvantages:
• It's difficult to observe the day-to-day care; for example, some settings use TV as a baby sitter rather than provide appropriately stimulating toys and activities.
• It may be difficult to obtain references, as children may not stay in the same family-care setting for long.
• Many family-care providers work without advice or supervision from other adults.
• Some states have set no, or only minimal, regulations for family child-care homes.
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Child-Care Centers
Formal day-care programs are the fastest-growing types of part-time care in the United States. They usually care for ten or more children, and often operate in a church, community center, or school. The center can be part of a chain, an independent for-profit center or a nonprofit program linked to a religious community center. Many companies now provide child-care centers for employees at or near the work site.
Child-care center advantages:
• It is easier to obtain information about them because they are regulated and inspected.
• Many have programs designed to meet the developmental needs of young children.
• Most have several caregivers, so you aren't dependent on one person.
• Staff members often are better paid, usually have more training and work under supervision.
Child-care center disadvantages:
• Although states set health and safety standards for child-care centers, regulations and licensing vary for different types of centers.
• Even with good intentions of the staff, hygiene practices and exposure to other children can lead to more illness.
• Good centers have long waiting lists.
• Your child may receive less individual attention because there are more children and a bigger staff.
Questions to Ask Child-Care Centers
• What are the hiring requirements for the staff? Is there high staff turnover?
• Does the center take infants?
• What is the ratio of staff to children and how many children are in each group? According to the American Academy of Pediatrics (AAP), the ideal staff/child ratio is one staff member for each three infants or toddlers up to age 2 years (six kids in a group); one to four for ages 2 to 3 years (12 kids in a group); and one to eight for ages 3 to 6 years (16 kids in a group).
• What happens on a typical day?
• What are the goals of the program?
• Are parents welcome to drop in unannounced at any time? If the answer is no, don't use the center.
• Are there separate areas for food preparation and diaper changing?
• Is the food-preparation area clean and are foods properly stored?
• Does the center have a valid license and current health certificate?
• What is the policy on immunizations for children?
• How does the center handle illnesses?
• What are the costs? Do you have to pay for days your child is not at the center (for example, when on vacation or ill)? What happens if you run late?
• Is there a minimum or maximum number of hours for using the center?
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Tips for Child Care
When you are exploring child-care arrangements, you are looking for someone you can trust to care for your baby. You want a clean, healthy, safe environment. And you want to be able to communicate clearly and regularly with the caregiver(s).
Regardless of the type of care you choose, you should:
• Check all references, including licensing and inspection status where applicable.
• Talk to parents who have used the person's or facility's services.
• Watch the caregiver(s) interact with your baby and/or other children.
• Determine how many children are being cared for at various times of the day, and the ratio of adults to children.
• Make sure that there is no smoking during your child's care.
• Find out about alternative arrangements if the caregiver is ill.
• Drop in unannounced to check on the quality of care.
• Ask how the person/center would handle an emergency situation involving the children.
• Make sure the setting is as safe as your home.
• Discuss the policy regarding sick children.
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Finding Child Care You Trust
You must feel comfortable with and trust the person(s) you choose to care for your baby. The AAP suggests that a good caregiver should:
• Enjoy being with babies and young children
• Spend plenty of time talking to and playing with your child
• Help your baby find interesting things to see and touch
• Provide opportunities for your baby to play with toys that develop the senses (such as mobiles, rattles, crib gyms, nesting toys and blocks)
• Provide a safe environment for children who are beginning to crawl and walk
• Be trained in child development and first aid
• Properly care for your baby's physical needs, such as feeding and diapering
• Cooperate with you in toilet training your toddler
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Child-Care Safety Concerns
Keep safety in mind when you are evaluating a child-care home or facility. The AAP recommends the following safety features:
• Gates at the top and bottom of stairs
• Special toilet seats or toilets designed for children that can be cleaned easily after each use (potty chairs are not recommended for sanitary reasons)
• A clean, safe place to change diapers, with a hand-washing area close by
• Cribs with firm mattresses covered in heavy plastic
• Separate cribs and linens for each baby
• Safe outdoor play areas
• Toys that are safe and plentiful
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What to Tell Your Caregiver
Clear, ongoing communication is a vital part of good child care. Whether your baby is being cared for in your own home or someplace else, the caregiver should tell you about your baby's day, accomplishments and problems. In return, you should share some of the things that your baby does at home, and find ways to show your caregiver how much you appreciate her or his care and concern. Before you ever leave your baby, discuss the following information with your caregiver:
• Your workplace, hours, and phone numbers, plus details on the fastest way to reach you in a given situation; emergency names and numbers, including pediatrician(s), etc.
• What to do in an emergency, especially if you can't be reached at a critical time.
• Any health problems your baby may have, including allergies to milk, food, medications, bee stings, animals, etc.
• How you feel about various aspects of child rearing, such as feeding on demand, when a crying baby should be picked up, discipline, etc.
• Who is responsible for providing food and snacks, diapers, and other supplies, and who notifies whom when supplies are running low.
• Whether or not your child has permission to be transported in someone else's vehicle, and under what conditions. Insist on the proper use of car seats or seat belts.
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Selecting a Pediatrician
Selecting a pediatrician or family practice physician for your baby is a big step. Where do you begin to look? What should you expect in a baby doctor?
These are the topics we'll cover in this section:
Types of Doctors
Choosing a Pediatrician
Other Questions
Types of Doctors
There are two types of doctors specially trained to care for children:
• Pediatricians are graduates of a four-year medical school with three additional years of residency training solely in pediatrics. The initials FAAP after a pediatrician's name mean that he or she is a Fellow of the American Academy of Pediatrics and certified by the American Board of Pediatrics. To earn the FAAP designation, pediatricians must pass a difficult qualifying exam in advanced principles and practices of pediatric care for newborn infants, babies, toddlers, children and adolescents.
• Family Practice Physicians are also graduates of a four-year medical school and have completed three additional years of residency training. The training prepares these physicians to provide care for the majority of medical problems that children encounter. Since family physicians care for both children and adults, the entire family can see a single physician. To become certified by the American Board of Family Practice, family physicians must pass a challenging examination that tests, among other things, their knowledge of the proper assessment and care of children.
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Choosing a Pediatrician in Your Area
To choose a pediatrician or family practice physician in your area:
• Ask your obstetrician or your friends who are parents or call the referral service at the hospital nearest you.
• Set up an interview with each doctor during the final months of your pregnancy. You and the dad-to-be should try to attend so you both fully understand the doctor's policies and philosophy of care. During the interview, you might discuss topics such as circumcision (unless you know for certain you're having a girl), problems during pregnancy, infant feeding, general baby care, your return to work and family health history.
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Other Questions
Other questions to consider include:
| 1. |
How soon after birth will the doctor see your baby? |
| 2. |
What are the office hours? Are they compatible with your schedule? |
| 3. |
How often will the doctor see your baby for checkups and immunizations? |
| 4. |
How are routine telephone calls handled in the office? |
| 5. |
With which hospitals is the doctor affiliated? |
| 6. |
How are emergency calls handled during office hours? After office hours? |
| 7. |
Who "covers" the practice when a doctor is unavailable? Are there other doctors within the practice or in the community? |
| 8. |
Does the practice include services provided by a nurse practitioner or a trained physician's assistant? If so, what type of care/services will the practitioner provide? |
| 9. |
Will you likely receive visit(s) from a home health care nurse when you come home from the hospital? |
| 10. |
How much does routine care cost? Does the charge for routine visits include the cost of immunizations? What methods of payment are accepted? Is payment expected on the day of the visit? Does the doctor bill the insurance company directly? |
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Making Your Home Safe 
These are the topics we'll cover in this section:
Things to do Before Your Baby Arrives
Building Your Baby's Nursery
Things to do Before Your Baby Arrives
The following are some things you can do before your baby arrives to help keep your whole family safe and healthy. When you're decorating the nursery, don't forget safety and convenience items, such as a smoke alarm and lamp with a dimmer switch for nighttime feedings and diapering. Install smoke detectors throughout your home. Check them monthly and change the batteries according to instructions. Develop and practice a fire escape plan now and after the baby arrives. Make sure carpeting, tile and other floor coverings are tacked down to prevent tripping or slipping.
Add night lights in the bathroom, kitchen and hallways. Set the temperature of your water heater no higher than 120°F to avoid scalding your baby.
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Building Your Baby's Nursery
You'll make many choices when creating your baby's nursery. Consider these helpful tips for a safe and pleasant nursery:
• Use nontoxic paint for the nursery crib and other furniture. Keep the room well ventilated during and after painting. Finish all painting well before baby's expected date of delivery.
• Add a smoke alarm in the nursery and check all alarms in your home to make sure they are working according to the manufacturer's specifications.
• Crib slats should be no more than 2-3/8 inches apart; a baby's head may become trapped in a larger opening. Always keep the sides of the crib up. Do not place the crib right next to a window.
• The crib mattress should fit snugly so that your baby cannot get caught between the mattress and the side of the crib. If you can fit more than two fingers between the mattress and the sides or ends of the crib, the mattress is too small and needs to be replaced.
• Bedding for the crib should include a flannel-backed, waterproof mattress cover, two fitted sheets and a soft full crib-size blanket. Never use loose bedding, such as pillows or a thick comforter.
• If you are buying a changing table, make sure it has a guard rail and a safety strap to help prevent falls.
• Keep strings and cords (such as from a window blind) away from the crib.
• Never use plastic bags to protect the crib mattress.
• Install plastic covers on unused electrical outlets.
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