CHILD CARE Choosing the best child care is important for parents who work outside the home. Parents often stress and worry about making the "wrong decision". Study after study has shown that children can thrive in almost any setting as long as it is a loving and supportive one. Studies also confirm that the age a child begins daycare does not matter in the long term. There is no one best answer but the various options have different strengths and weaknesses.

Stay-at-Home Parent: For many parents, this is the most ideal and safest option. If you choose it, you will quickly realize that it is a full-time job-a very desirable one where you can nurture and observe first hand as your child grows and develops. Sometimes, parents find the 24/7, one-on-one experience without "adult interaction", somewhat draining. In retrospect, you will see that these early months fly by and your child is in pre-school before you know it.

Family Member/Nanny: This is a great middle ground for many families, who can go to work comfortably knowing that their child is still getting one-on-one attention. This option may take the most advanced planning to find the right person and to work out logistics and finances. The decision is very dependent on the caregiver and whether or not they drive, what to do if they become ill (back-up plan needed) and if their child-rearing philosophy conflicts with yours.

Group Day Care (Large or Small Groups): Most facilities are state-licensed and adhere to strict standards of safety and responsibility. This option provides lots of fun activities, new experiences and socialization. Along with all the fun however, comes many germs and at first, children may have frequent colds and viral syndromes. Most of these illnesses are benign and short-lived and there is something positive to be said for young children developing antibodies to common infections early and later avoid missing weeks of pre-school and elementary school. Remember, most facilities will not allow your child to attend when they are sick, so a back-up plan which allows a child to recuperate at home is necessary.

This is a brief discussion of just a few options and several others are possible. The key is to do early research, plan to visit group centers in person, always check references when appropriate and choose a plan which seems to best suit your family's needs.

CROUP
Croup is a viral infection which can cause swelling of the larynx (voice box) and the sudden onset of a barky cough (like a seal or puppy). Other symptoms may include a runny nose, fever and raspy breathing. Symptoms are often worse at night or in the early morning and may improve throughout the day. Typically, a child wakes up with a barky cough just a few hours after going to sleep for the night. A child may experience 2 or 3 difficult nights with these symptoms, which usually resolve within 3 to 5 days. Croup may occur at any age, but is more problematic for children under age three, because of their smaller airways. In older children or adults, the same virus may simply cause the common cold.

If your child wakes with a barky cough, first, try a steam shower. Bring the child into the bathroom, shut the door, turn on the hot water and let the room fill with steam. Sit with your child for 10-15 minutes while he breathes in the steam, being careful not to let him near the hot running water. This often helps to quiet the cough and noisy breathing associated with croup. You may have to repeat this more than once during the night.

If there is no improvement with steam, open a window or go outside and have the child breathe the cold night air for a few minutes. You may also give a dose of Tylenol or Motrin to reduce fever or relieve the sore throat which can accompany croup.

If the steam shower or exposure to cold air relieves the symptoms, and the child is breathing more comfortably, try to settle him back to sleep, while keeping the head somewhat elevated. In the morning, call the office and make an appointment to see the doctor. Although the child may improve by morning, he may still require medication to prevent the symptoms from recurring the following night. It is important for parents to remain calm and to try to keep your child calm. If he becomes frightened or upset, the symptoms may become more severe. If the child does not improve with steam or cold air, and continues to have difficulty breathing (i.e. fast or noisy breathing, pulling in of the neck area above the breastbone or between the ribs, or flaring of the nose), call the on-call physician at 203.323.1770. The doctor will advise you about what other measures to take including whether or not to go to the Emergency Room.

• Apply pressure to stop bleeding for at least 10 minutes.
• Wash wound with soap and water (but not if you think it needs to be sutured).
• Apply antibiotic ointment and band aid. Change 1 to 2 times per day until wound is completely scabbed over.
• Call us if signs of infection (redness, pus, increasing tenderness).

• Apply ice to area for 10-20 minutes at a time, several times per day.
• Call us if unable to bear weight on affected limb, unable to move limb, or severe pain.
• Bruises can sometimes last for several days or weeks.