We try to stick to a bedtime ritual by remembering the "4 B's":

• Kids under 2 years: Bath, Breast, Book, then Bed

• Kids 2 to 6 years: Bath, Brush (Teeth and Hair), Book, then Bed

Finding high-quality child care is very important but not always easy. Your choice will play a key role in your child's health and development. Read on for more information from the American Academy of Pediatrics (AAP) about child care options to help you in your search for what's best for your family.

Types of child care

Center-based care, family child care, and in-home care are 3 types of child care.

• Center-based care takes place in a location staffed by caregivers. Center-based care has many names—child care center, preschool, nursery school, child development program, or learning center. Center-based care also may have different sponsors, including churches, schools, colleges, universities, hospitals, social service agencies, Head Start, independent owners and businesses, and employers.

• Family child care takes place in the caregiver's home. Many family child care providers have young children of their own. They may care for children who are the same age as their own children or for children of different ages.

• In-home care takes place in the child's home. The caregiver comes to or lives in the home. For many families, this is very convenient because caregivers often can arrange their schedules to match your needs. Because your child stays at home, he does not have to adjust to a new setting. Your child may also be exposed to fewer illnesses because he will not be with groups of children. He may receive more individual attention, especially if the caregiver's main job is to care for your child. This type of caregiver is not monitored or supervised, and there is no formal licensure or regulation process.

Note for parents of children with special needs: Finding programs and caregivers to meet the needs of children with disabilities or other special needs can be challenging. Your child's doctor can help you and your child's caregiver plan for your child's special needs, development, activities, health, safety, and any problems that come up while you are using child care.

Questions for all caregivers

The right child care option for your family may be based on many factors, including work schedules, budget, and personal preferences. Answers to the following questions may help you in your search.

• Hours. What are the hours? What if you are late in picking up your child? How are vacations and holidays scheduled?

• Fees and services. What is the cost? How are payments made? Are there other services available in addition to child care? Is there an extra cost?

• Qualifications and training. What education, training, and experience does the child care provider(s) have? Is the child care provider certified in CPR?

• Discipline. Is the caregiver(s) policy on discipline the same as yours? Center-based care should have a discipline policy.

• Communication. How often does the child care provider give feedback about your child? Does the child care provider seem approachable?

• Transportation. Are the proper car safety seats, booster seats, and seat belts used? Center-based care should have a transportation policy.

• References. Does the caregiver have current references from parents you can contact?

Other questions for center-based care

• Policies. The center should have a written policy for each of the following areas: health standards, illness, medication, nutrition, ­discipline, transportation, media, and outdoor play.

• Licensing/accreditation. Is the center licensed or registered with the appropriate local government agencies? Are there any outstanding violations? Is the program currently accredited or in the process of becoming accredited?

• Health professional. Is there a qualified health professional, such as a doctor or nurse, for the program? (The national standard recommends that center-based infant-toddler programs should be visited by a health professional at least once a month, and all other child care programs should be visited at least once every 3 months.)

• Visiting policy. Can you visit the center before your child is enrolled? If your child is enrolled, can you visit the center anytime it is open? Can you see all the areas that your child will use? Are visitors screened or is their identification checked so that only approved adults can visit the center and pick up children?

• Qualifications and training. What type of additional training have the staff had during the past year? Do outside experts provide training? How long have the staff worked at the center? How much experience do they have with children of your child's age?

• Staffing. Are there enough trained adults available on a regular basis? What happens if staff are ill or on vacation? Are children supervised by sight and sound at all times, even when they are sleeping? Are children cared for in small groups? Are activities proper for their age group? Is there a daily schedule? Do the child-staff ratios and the size of groups of children fall within nationally recognized standards? For example, in a room with 4 children aged 13 to 35 months, there should be 1 trained caregiver. In a room with 5 to 8 children aged 13 to 35 months, there should be 2 trained caregivers. There should be no more than 8 children aged 13 to 35 months in a room.

  Other questions for family child caregivers

  • Others in the home. Who lives in or visits the home (children, teens, and adults)? Are they family, what are their backgrounds, and how may they interact with your child?

  • Number of children. What is the total number of children being cared for? The AAP recommends that a family child care home should not have more than 6 children per adult caregiver, including the caregiver's own children. (Some states allow more children when at least 2 adults are available at all times in larger family child care homes.) The total number of children should be fewer when infants and toddlers are included. No caregiver who works alone should care for more than 2 children younger than 2 years.

  • Staffing. Does the caregiver plan to leave the home during the day to go to the store or drive children to school? If so, find out what the plan is for who will care for your child during this time. Because there usually is only one adult, backup care in an emergency situation must be nearby. In some areas, caregivers belong to a network of family child care providers who may provide training, shared toys, and backup help.

  • Qualifications and training. Look for caregivers who are licensed or registered with the state. These caregivers will have unannounced visits by an inspector. Some family child care providers have earned accreditation as well. Does the caregiver continue to receive training?

  • Environment. Is there an outdoor play area? Is the home free from hazards, such as lead and mold? Are there any pets?

  Guidelines for in-home caregivers

  When you are interviewing in-home caregivers it is important that your expectations are clear. Your caregiver will need to respect and follow your parenting rules and assigned duties. For example,

  • Your child's schedule. Include such things as typical mealtimes, hand washing, toilet training, teeth brushing, and nap time.

  • Discipline. Let your caregiver know what types of discipline you approve of and what rules and limits you have set for your child.

  • Activities. Discuss reading, playtime, and fun ways to be active inside and outside. Be sure to talk about what types of outings are acceptable for your child. Let your caregiver know how long your child is allowed to watch TV or videos or play computer games or other media. The AAP strongly discour­ages TV viewing for children 2 years and younger, and encourages interactive play. For older children, the AAP recommends no more than 1 to 2 hours per day of educational, nonviolent programming.

  • Duties. Write down and review what the caregiver will and will not do in your home. If your caregiver will also have housekeeping duties, stress that your child's needs must come first. Also discuss what you expect the caregiver to do if your child has a minor injury or if there is an emergency.

  • Transportation. Be sure your caregiver knows how to use the proper car safety seat, booster seat, or seat belt for your child.

  • Communication. The caregiver should give you a daily report of what occurred. (You may want to arrange for frequent, unannounced visits by a friend or family member who can observe how the caregiver interacts with your child.)

  Note: You will need a backup plan for times when the caregiver is sick, needs time off, or goes on vacation. In some areas, child care resource and referral agencies or other community organizations can give you names of temporary in-home caregivers.

  A checklist to help rate your choice

  "Is This the Right Place for My Child? 38 Research-Based Indicators of High-Quality Child Care" is a checklist put together by Child Care Aware of America (formerly the National Association of Child Care Resource & Referral Agencies [NACCRRA]) that you can use to evaluate child care programs. This checklist is on the Child Care Aware of America Web site at http://www.naccrra.org/sites/default/files/publications/naccrra_publications/2012/15991003_38_indicators_checklist.pdf and available through a link from the American Academy of Pediatrics Healthy Child Care America Web site at www.healthychildcare.org/ResourcesFamilies.html . All of the questions are based on research about what is important to your child's health, safety, and development.

  Planning for child care costs

  Child care can be expensive, so families must budget ahead of time. While the cost may seem high, think about how little the caregiver is actually earning per hour for the responsibility of caring for your child. Be sure to budget for your backup care during those times when your child or caregiver is ill. You may qualify for state subsidies or assistance from your employer. Ask about

  • Direct payment through cafeteria plans (a type of flexible benefit plan)

  • Dependent-care spending accounts (tax savings)

  • Voucher programs

  • Employer discounts

  High-quality child care is a critical investment for your child. When care is consistent, developmentally sound, and emotionally supportive, there is a positive effect on the child and family. In some areas your local child care resource and referral agency can help you find licensed child care or apply for subsidies. For more information, visit www.naccrra.org or www.childcareaware.org .

  Preparing your child

  Most infants, up to 7 months of age, adjust well to good child care. Older infants may get upset when left with strangers. They will need extra time and your support to get to know the caregiver and to understand that you will pick them up at the end of the day. Starting new child care is often harder on the parents than it is on the child.

  Being prepared makes any new experience easier. You can help your child adjust to a new child care arrangement. Try the following:

  • Arrange a visit with in-home caregivers while you are at home or when you need child care for a short time.

  • Visit the center or home with your child before beginning care. Show your child that you like and trust the caregiver.

  • Check with the caregiver or center staff about the best time of the month or year for children to begin attending the program.

  • Allow your child to carry a reminder of home to child care. A family photograph or small toy can be helpful.

  • Talk with your child about child care and the caregiver.

  • Read books about child care. (Check with your local library.)

  Sudden changes in caregivers may be upsetting to a child. This can happen even if the new care­giver is kind and competent. You may want to arrange a meeting with the new caregiver or ask your child's doctor for advice. Parents need to help caregivers and the child deal with any changes in the child's routine at home or child care.

  When your child gets sick

  Children sometimes get sick or are injured while in child care. Talk with your child's caregiver in advance so that you both know what to expect and are prepared. Make sure that your caregiver can always reach you. Confirm a plan for emergency care in advance.

  Many times, mildly ill children are allowed to stay with their caregiver as long as they can participate in most of the activities and don't require more care than their caregiver can provide. If the child needs extra rest, there must be a place for her to rest and still be observed.

  Sometimes children need medicine while they are at child care. Every state and program will have different rules about what is allowed. Prescription and over-the-counter medicines should be labeled with the child's name, dosage, and expiration date. The caregiver should have the parent's written permission to give the medicine, know how to give it safely, and properly record each dose. Depending on the regulations in your state, sometimes a doctor's note or instructions are required.

  Resources

  The following is a list of early education and child care resources. Check with your child's doctor or local child care resource and referral agency for resources in your community.

  Web sites

  AAP Healthy Child Care America Early Education and Child Care Initiatives

  This AAP site has a useful parent section and links to all the other Web sites listed here.

  888/227-5409

  www.healthychildcare.org

  Child Care Aware of America (formerly National Association of Child Care Resource & Referral Agencies [NACCRRA])

  703/341-4100 or 800/424-2246

  www.naccrra.org or www.childcareaware.org

  National Association for the Education of Young Children (NAEYC)

  800/424-2460

  www.naeyc.org

  National Association for Family Child Care (NAFCC)

  801/886-2322

  www.nafcc.org

  National Resource Center for Health and Safety in Child Care and Early Education (NRC)

  800/598-KIDS (800/598-5437)

  http://nrckids.org

  Books from the American Academy of Pediatrics

  Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Early Care and Education Programs

  Caring for Your Baby and Young Child: Birth to Age 5

  Caring for Your School-Age Child: Ages 5 to 12

  Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide

  Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide

  Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this publication. Phone numbers and Web site addresses are as current as possible, but may change at any time.

  Copyright © 2009 AAP Feed run on: 9/23/2024 Article information last modified on: 8/6/2023

At dinnertime, try stimulating conversation with your children by asking, "What one good thing happened to you today?" Let everyone - including Mom and Dad - take turns answering. This question is better than "How was school?" or other similar questions that children tend to answer with a simple word, like "okay," which quickly ends the conversation.

When children do not seem to pay attention or listen to what you are saying, you may find yourself repeating everything you ask, often raising your voice with each repetition. Instead, the first time that you calmly make your request, make sure that your child has direct eye contact with you. Then, ask him to repeat what you said so that you know he understood. Sometimes, this will prevent the familiar cycle of repeating yourself! Kathleen Traylor, M.D.

On some days, disciplining your children seems to go smoothly; on other days, it seems to be a complete disaster. If you are at your wit's end, tired, and literally ready to scream, think of a person that you respect, and then pretend that he/she is watching you. It is amazing how this can help you to handle the situation more calmly and effectively, rather than being angry and losing your cool. Kathleen Traylor, M.D.

Children can be miserable with many common illnesses, but viral stomach flu can be particularly miserable for both the child (who feels so poorly) and the parent (who must clean up another episode of vomiting or diarrhea). Since vomiting is a given of childhood, try to add humor to it. Pick out a bucket or other similar container. Then, give it a name (e.g., the purple puke bucket) that children will find funny and will brighten their spirits. Use the bucket solely for this essential and honorable task, and you will know what it means when your child yells for it!

Most rules can, and should, be discussed within a family. In many homes, a rule not up for discussion is that there are no rewards for crying. For example, your child really wants something, and it is refused. Then, your child starts to cry, often very dramatically. As soon as the tears start, the child gives up any negotiating power. Calmly saying, "I'm sorry, we can't even discuss this now," will quickly take the steam out of the crying tactic.

Rewarding children for doing the right thing, for good behavior, or for doing something positive can be a powerful strategy for parents. Sometimes, though, we may feel as though we are bribing our children—that is true if you choose to look at it that way. If you remind yourself to always call it positive reinforcement, rather than bribery, it works, and you feel good about it!

Parents often are very curious about predicting their child's adult height. You can try to estimate it using one of the following methods: (1) Review your child's height growth curve with your pediatrician once your child is older than 2 years, and extrapolate it out to 18 years of age on the growth curve. (2) Try this: Girls are half of their adult height at 18 months of age, while boys are half of their adult height at 24 months of age. (3) If you like mathematical formulas, calculate this: For girls, take the father's height in inches and subtract 2.5 inches; then, add it to the mother's height in inches, and divide this sum by 2 to get a predicted height in inches. For boys, take the mother's height in inches and add 2.5 inches; then, add it to the father's height in inches, and divide this sum by 2 to get a predicted height in inches.

When reading to toddlers, have them name the items on each page of familiar books, rather than you naming the items. If your child has a favorite book, try to pick a different theme each time you read the book. For example, go through and point out all the animals; the next time, point out the colors; the next time, talk about the shapes; and so on. This keeps the child endlessly learning, and you stay interested too! Kathleen Traylor, M.D.

Sibling squabbles are almost a right of passage of childhood. The next time your children are fighting over a toy, a game, or a food, pause before getting angry. Then, calmly take away the prized item and positively tell the children that they can have it back once they have solved their differences. Seeing the children look at each other - trying to decide if they should actually figure it out together or if they should just part their ways and go do something else - is actually rewarding as a parent. Your children may even surprise you by deciding among themselves to share or take turns!

Some parents may not be comfortable talking with their children about sex and sexuality. However, if children aren't getting the facts about sex and sexuality from their parents, they could be getting incorrect information from their friends or the media. Media rarely show responsible sexual behavior or offer correct information about abstinence, sexual intercourse, birth control, or the risks of pregnancy and sexually transmitted infections (STIs).

Here is information from the American Academy of Pediatrics to help parents talk with their children about sex and sexuality.

Parents Are the Best Teachers

Talking about sex and sexuality gives you a chance to share your values and beliefs with your children. Your children need to know there is always a reliable, honest source they can turn to for answers—you. You can teach your children about relationships, love, commitment, and respect. When your children feel loved and respected by you, they are more likely to turn to you for answers and advice.

Teachable Moments

You can find teachable moments in everyday events. For example, talk about body parts and what's "private" during bath time. A pregnancy or birth in the family is a good time to discuss how babies are conceived and born. Watching TV with your children may also be a good time to discuss an on-screen relationship.

Use these teachable moments when they happen. Start by asking what your children already know. Let them guide the talk and ask questions. Let them know you're comfortable answering, so they feel comfortable asking.

General Talking Tips

When your children begin to ask questions, keep the following tips in mind:

• Talk openly, and let your children know they can ask you about anything.

• Try not to laugh, even if the question is cute. Your children might feel ashamed if you laugh.

• Try not to appear overly embarrassed or serious about the matter.

• Answer in simple, age-appropriate terms. Answer the question, but don't go on to add unnecessary details.

• Use proper names for all body parts.

• See if your children want or need to know more. Follow up your answers by asking, "Does that answer your question?"

• Listen to your children's responses and reactions.

• Be prepared to repeat yourself.

If you are uneasy talking about sex or answering certain questions, be honest about that too. You may want to ask a relative, a close family friend, or your children's doctor to help explain things.

Talking With Preschool and School-aged Children

The questions your children ask and your answers will depend on each child's age and ability to understand. Here are common questions and issues for different age groups.

Preschool children

"How did I get in your tummy?"

"Where was I before I got in your tummy?"

"How did I get out?"

"Where do babies come from?"

"How come girls don't have a penis?"

18 months to 3 years of age—Children in this age group begin to learn about their own body. It is important to teach your children the proper names for body parts. Making up names for body parts may give the idea that there is something bad about the proper name. Also, teach your children which parts are private (parts covered by a bathing suit).

4 to 5 years of age—Children in this age group may begin to show an interest in basic sexuality. It's normal for children to touch their own genitals (private parts) or to be curious about what other people's genitals look like. Children may also engage in sexual play, like pulling their pants down or pulling other children's pants down to reveal their genitals. However, children need to learn that

• It's not appropriate to show their genitals in public.

• It's not appropriate to touch anyone else's genitals.

• No other person, including even close friends and relatives, may touch their genitals. The exceptions are doctors and nurses during physical exams with the parent's permission and parents when they are trying to find the cause of any pain in the genital area.

By the time children are school aged, they should know the following:

• Proper names and functions of body parts (including the womb or uterus where a baby grows—not "mom's tummy")

• Physical differences between people with male and female body parts

School-aged children

"Who can have a baby?"

"Why do some people get erections?"

"What is a period?"

"How do people have sexual intercourse?"

"Why do some kids have 2 mommies or 2 daddies?"

5 to 7 years of age—Children in this age group may become interested in what takes place sexually between adults. Their questions will become more complex as they try to understand the connection between sexuality and making babies. They may come up with their own explanations about how the body works or where babies come from. They may also turn to their friends for answers. Lessons and values they learn about healthy sexual relations at this age will stay with them as adults.

8 to 9 years of age—Children in this age group may become interested in learning more about relationships. For example, they may become interested in how their parents met and fell in love. As questions about romance, love, and marriage arise, they may ask questions about different types of relationships, including homosexual relationships. Use this time to discuss your family's thoughts about relationships . At this age, children will be going through many changes that will prepare them for puberty. Teaching your children to be sexually responsible is one of the most important lessons.

As children approach puberty, they should know about

• The body parts related to sex and their functions

• How babies are conceived and born

• Puberty and how the body will change

• Menstruation (All children can benefit from this information.)

• Sexual intercourse

• Birth control

• STIs, how they are spread, and how to protect themselves

• Masturbation

• Homosexuality

• Family and personal guidelines

• Gender identity

About Masturbation

Up to the age of 5 or 6 years, masturbation is quite common. Around age 6, children become more socially aware and may feel embarrassed about touching themselves in public. Make sure your children understand that masturbation is a private activity, not a public one. Masturbation in private may continue and is normal.

There are times when frequent masturbation can point to a problem. It could be a sign that a child is under a lot of stress. In rare cases, it could even be a sign of sexual abuse. If masturbation becomes a problem, talk with your children's doctor.

Visit HealthyChildren.org for more information.

Disclaimer

The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.

In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

AAP Feed run on: 9/23/2024 Article information last modified on: 8/6/2023

Trampolines are popular among children and teens and even among some adults. Though it may be fun to jump and do somersaults on a trampoline, landing wrong can cause serious, permanent injuries. Injuries can occur even when a trampoline has a net and padding and parents are watching. Read on for more information from the American Academy of Pediatrics (AAP) about common trampoline injuries and how they occur.

Common injuries

Thousands of people are injured on trampolines each year. Most of these injuries happen on home trampolines. Children younger than 6 years are at greatest risk of injury. Common injuries include

• Broken bones (Sometimes surgery is needed.)

• Concussions and other head injuries

• Sprains/strains

• Bruises, scrapes, and cuts

• Head and neck injuries (which can lead to permanent paralysis or death)

How injuries occur

Most trampoline injuries occur when there is more than one person using a trampoline. Children can get hurt when they

• Land wrong while jumping.

• Land wrong while flipping and doing somersaults (this should not be allowed because of the risk of head and neck injuries).

• Try stunts.

• Strike or are struck by another person.

• Fall or jump off the trampoline.

• Land on the springs or frame.

What you can do to keep your children safe

Don't buy a trampoline for your home! Trampolines may be popular and a fun way to get exercise, but there are safer ways to encourage your children to be physically active, such as playing catch, riding a bike (don't forget a bike helmet), or playing a team sport. The AAP recommends that mini and full-sized trampolines never be used at home, in routine gym classes, or on playgrounds. They should only be used in supervised training programs for gymnastics, diving, or other competitive sports. Only one person should be allowed on a trampoline at any given time.

If you choose to have a home trampoline, the AAP recommends the following safety precautions: adult supervision at all times, only one jumper on the trampoline at a time, and no somersaults should be performed. Also, trampolines should have adequate protective padding that is in good condition and appropriately placed. All equipment should be checked often and protective padding, the net enclosure, and any other parts should be repaired or replaced when damaged. Parents should check their homeowner's policy and obtain a rider to cover trampoline-related injuries if not included in the basic policy.

Copyright © 2008 AAP Feed run on: 9/23/2024 Article information last modified on: 8/6/2023

Protecting your Child from Gun Injury

• A home is safer without a handgun.

• in homes with guns, children are safest if:

  • Guns are stored unloaded and locked up or with a trigger lock; and

  • Bullets are stored and locked in another place.

• Even if you do not own a gun, you need to make sure that the homes your child visits are safe too.

C hildren love to explore. As they learn new skills, like crawling, walking, climbing, or running, there are more ways of getting into trouble! Much of this trouble will be small. But, if there is a gun in the house, a child's curiosity can lead to severe injury or death.

FACT : Nearly 40% of the homes with children in the United States have a gun.

FACT : Children as young as 3 years may be strong enough to pull the trigger on a handgun.

FACT : Every other day, on average, an American child under age 10 is killed or disabled with a gun.

When it comes to guns, parents can't be too careful!

Parents Need to ASK: Asking Saves Kids

Even if you do not own a gun, ask your neighbors, friends, and family if they do before your child visits their homes.

• if they don't, that's one less thing you have to worry about.

• if they do, keep your child away from homes where there are guns or where guns are not stored safely.

Sometimes it can be hard for a parent to ask about guns. One mother asks this way, "My child is very curious. Do you have guns or anything dangerous that he might get into?"

Some people may not agree with you, but it's important that you talk with them about your concerns. Here are some tips to make asking about guns easier:

• Bring up the topic when you are talking about other health and safety issues such as car seats, seat belts, pets, or allergies.

• Share facts about gun safety. You are not judging people, you just want to make sure your child is safe.

Commonly Asked Questions

"With so much violence, isn't it safer for me to have a handgun in my home to protect my family?"

No. In homes with handguns, it is much more likely that the handgun will be used to shoot a family member or friend than in self-defense.

Every year, thousands of Americans are seriously injured or killed when:

• A child finds a gun or is showing a friend the gun kept at home and, without meaning to, pulls the trigger.

• A depressed teenager or adult becomes suicidal.

• An argument between family members gets out of control.

• A friend or family member is mistaken for an intruder.

"Can't i just hide my gun and teach my child not to touch it?"

No. Children need better protection from guns.

• Exploring and playing are the ways children learn about the world.

• Any child's curiosity and urge to discover new things can overcome a parent's warnings. Young children simply do not understand how dangerous guns can be.

• Young children are not able to tell the difference between toy guns and real guns.

• Many TV shootings do not look dangerous or deadly.

• The only safe way to hide a gun is to lock it up.

In one mother's words:

"My brothers admitted as adults that, as children, they would go in my dad's room and take out the gun and play with it."

This family was lucky, but many others are not.