• Are there enough adults to meet the children’s needs?
• Do the caregivers seem to enjoy caring for the children? Are there joyful interactions between the children and caregivers?
• Do the adults and the children often talk with each other? Are children encouraged to talk with each other?
• Do the children in the program seem happy? When a child cries or acts out, how does the caregiver respond?
• Is the noise level in the child care areas comfortable?
• Is the center or home bright, cheerful, clean, safe and well ventilated? Is all equipment clean, safe and in good working order?
• Is there a posted plan of activities being followed that includes large muscle play (ie, running, climbing), quiet play with toys the child chooses, time for reading and talking, rest, and snacks and meals?
• Is the indoor space large enough? Look for 50 square feet, measured wall-to-wall, per child.
• Is there a sleeping or quiet area large enough for all the children to rest during nap time? (There should be at least 3 feet of space between children unless each has a separate partitioned sleeping compartment.) Are there individual cribs, beds, cots or mats to sleep on? Do sleeping children stay within view of caregivers? Do caregivers place infants to sleep on their backs? Are cribs free of blankets, toys or other objects that could pose a hazard?
• Does each child have a place for her own belongings?
• Is there a clean diaper-changing area for infants and toddlers? Is a sink within the caregiver’s reach near the diaper-changing area?
• Are infants always fed in an upright position and, until they can sit by themselves for feeding, held by an adult? (No bottles should be allowed in bed or propped.)
• Is the food nutritious, well prepared, suitable for the age group and served in an appetizing way? Do you see posted menus, or are menus given to parents in advance? Do the menus match the food that is served?
• Are there enough safe toys easily within reach of children? Are the toys suited to the age group?
• Are dangerous toys and equipment such as baby walkers not used?
• Are toys that are mouthed by infants or toddlers sanitized before other children are allowed to play with them?
• Is there protective surfacing under all indoor and outdoor climbing equipment? Indoor climbing equipment requires the same types of impact-absorbing materials and fall zones as equipment installed outdoors.
• Are the outside play area and equipment free of sharp edges, pinch points, rocks, uneven surfaces and ditches? Is the area free of hazards such as high climbing equipment, tall slides, merry-go-rounds, trampolines, unprotected seesaws, and swings with wooden or plastic swing seats?
• Is equipment sized and planned for use by the age group using it and inaccessible to those who are too young or too little to use it safely? Is the equipment properly installed, well maintained and in good working order?
• Is there well-maintained impact-absorbing material such as soft sand, wood chips, smooth gravel or specially manufactured rubber mats under and extending at least 6 feet out from equipment?
• Is the outside play area completely surrounded by the building and fencing?
• Are the toilets and sinks clean and easy to reach? Can children reach clean towels, liquid soap and toilet paper?
• Do Caregivers and children wash their hands at the following times:
  • Upon arrival for the day?
  • When moving from one child care group to another?
  • Before and after eating, handling food or feeding a child?
  • Before giving medication to a child?
  • Before playing in water that is used by more than one person?
  • After playing in sandboxes?
  • After changing a diaper, using the toilet or helping a child use the toilet?
  • After handling any sort of bodily fluids, such as those from noses, mouths, cuts or sores?
  • After handling pets or other animals?
  • After cleaning or handling garbage?
• Does the facility use disposable paper towels to ensure that each child uses only his own towel?
• Are there sinks in each room (in centers), with separate sinks for food preparation and hand washing?
• Is the center or home free of secondhand tobacco smoke?

SOURCE: American Academy of Pediatrics (http://www.aap.org)

There are several types of child care. Be sure to consider your family needs, schedule and your child’s personality as you consider the type care that’s right for your child. Generally, there are three types of child care:

• In-home care — the caregiver comes into your home.
• Family child care — you take your child to the home of the caregiver.
• Center-based care — you take your child to a place that is organized and staffed specifically to care for a group or groups of children.

Selecting the right person to care for your child is another important aspect of choosing child care. Caregivers can be family members, people you knew before considering them as caregivers, or people with whom you will develop new relationships. Whatever type of care you choose, the relationship between you and your child’s caregiver will be an important part of your life. Plan to spend some time together with your caregiver and your child so that you can learn about each other.

It is important to check your caregiver’s background, training and references. The training of caregivers should include the following:

• Child development and early education (ie, the types of behavior that are typical for children your child’s age and the types of activities that will help your child learn and grow)
• Using positive, effective discipline (including how to handle challenging behavior)
• Recognizing signs of illness
• Cleanliness and safety standards to prevent illness and injury (including how to use the proper car seats, booster seats and seat belts for children in motor vehicles)
• First aid and proper response to choking and other emergencies
• How to evacuate the home or child care center safely in an emergency

One key to good child care is whether the caregiver can adapt to the needs of each child and family. Not all children of the same age are at the same level of development; each child has unique character traits. A good caregiver understands these personal and developmental differences and creates a program to meet each child’s needs. The type of child care that is best for your child may change as she grows older.

Finding programs and caregivers to meet the needs of children with disabilities or other special needs may be challenging. Inclusive programs usually work closely with parents and the child’s pediatrician to find the best ways to provide a safe and supportive environment for every child. Discuss your child’s needs with your pediatrician and caregiver to help your child function well in a positive environment.

Ask your pediatrician for advice about child care for your child. Your pediatrician can help you and your child’s caregiver plan for your child’s special needs, development activities suitable for his age, health, safety and any problems that come up while you are using child care.

Source: American Acedemy of Pediatrics (http://www.aap.org)

Your in-home caregiver needs to know exactly what you expect. Discuss the following issues specifically with prospective caregivers:

Activities and interactions that you want for your child, such as reading and playtime.

• How to use positive, effective discipline with your child, and what rules and limits you have set for your child.
• What the caregiver will and will not do in your home.
• Outings that are acceptable for your child and how to use the proper car safety seat, booster seat or seat belt for your child in motor vehicles.
• Limits for television, video games or other media. The American Academy of Pediatrics (AAP) does not recommend television for children younger than two years. For older children, the AAP recommends no more than one to two hours per day of educational, nonviolent programs.
• How and when the caregiver can contact you with questions or if there is an emergency.

The caregiver should provide you with a daily schedule of what is planned and a daily report of what occurred. However, it is hard to know for sure what the caregiver does when you are not there. You will want to arrange for frequent, unannounced visits by a friend or family member who can observe how the caregiver interacts with your child and tell you about it. Keep in mind that relationships with in-home caregivers tend to be very personal. At times you may function as both employer and friend or extended family for the caregiver.

Skilled in-home caregivers are difficult to find. You will need a backup plan for the times when the caregiver is sick, has a personal need for time off, or goes on vacation. In some areas, agencies may provide training, placement and supervision for in-home caregivers.

Source: American Academy of Pediatrics (http://www.aap.org)

The AAP recommends that a child care home should not have more than six children per adult caregiver, including the caregiver’s own children. (Some states allow more children when at least two 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 working alone should handle more than two children younger than 2 years.

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.

Family child care providers usually work alone. This makes it hard to judge their work. Look for caregivers who are licensed or registered with the state and, as a result, have unannounced visits by an inspector. Some family child care providers have earned accreditation as well.

Accreditation means that an outside observer has determined that the facility or home generally meets the criteria for high-quality child care. Family child care providers can be accredited through the National Association for Family Child Care (NAFCC). If they are not accredited, encourage your provider to contact NAFCC for more information.

Source: American Academy of Pediatrics (http:/www.aap.org)

Regardless of what type of center-based care you choose, there are some basic things to consider. Centers should be licensed and inspected regularly for health, safety, cleanliness, staffing and program content. (Some programs are exempt from state licensing.) Just because a center is licensed, do not assume it is regularly inspected. Check to see how often the center had announced and unannounced inspections in the past year and what was checked.

Keep in mind that state licensing regulations set the lowest legal limit for staying in business. High-quality care requires more than complying with regulations. To find out about what is covered by the regulations in your area, contact your city, county or state department of social services. State licensing regulations also can be reviewed at the local licensing agency. Most are listed at the National Resource Center for Health and Safety in Child Care Web site at: http://www.nrc.uchsc.edu/.

Accreditation is another way help ensure a standard of care. Accreditation is different from licensing. High-quality centers should be accredited or in the process of obtaining accreditation. Accreditation means that an outside observer has determined that the facility generally meets the criteria for high-quality child care.

Several independent groups of early childhood care and education professionals offer accreditation for centers. These include the National Association for the Education of Young Children (NAEYC) and the National Child Care Association (NCCA). If a seemingly good center is not accredited by either of these organizations, ask why. Encourage the staff to consider seeking accreditation.

Parents should be welcome to make unannounced visits to the center to see their child, and they should be notified quickly if their child needs medical attention. Policies should be written and should explain how the center’s staff promotes positive, effective discipline and responds to sick children. There should be a daily schedule that is used and posted for review by parents. Toys and activities should be suited to the children’s ages and abilities. The facility should follow safety guidelines. Caregivers and center directors should be trained in early childhood education. Look for centers that have at least two caregivers per group and one group per room, a window or glass door for supervisors to view activities, and a plan for ongoing staff training.

Source: American Academy of Pediatrics (http://www.aap.org)

Some children show changes in behavior when they start child care. Toddlers may cry, pout, refuse to go to child care or act angry in other ways. Preschoolers may regress and behave like a younger child. They may be more wakeful at night. This behavior usually goes away after a few days or weeks in high-quality child care.

You can help your child adjust to a new child care arrangement. 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 family child care home that you have chosen with your child before beginning care. Show your child that you like and trust the caregiver.

Some children like to carry a reminder of home when they go to child care. A family photograph or small toy can be helpful. Talking to your child about child care and the caregiver is helpful. Being prepared makes any new experience easier for children. There also are storybooks about child care that you and your child can read together. (Check with your local library.)

After a child has been in child care, a sudden change in caregivers may be upsetting. This can happen even if the new caregiver is kind and competent. If you are concerned about your child’s feelings, you may want to arrange a meeting with the caregiver or ask your pediatrician for advice. Parents need to help the caregivers and the child deal with any changes in the child’s routine at home or child care.

High-quality child care helps children grow in every way and promotes their physical, social and mental development. It offers support to working parents. Your pediatrician wants your child to grow and develop with enjoyment in a setting that supports you as a parent.

Source: American Academy of Pediatrics (http://www.aap.org)

Effective Treatment Options

• Long-term, intermittent application of topical corticosteroids is appropriate, effective and safe. Hydration and covering it help enhance the effect of medication.
• Moisturizers are effective and safe. They are useful for both preventing the episodes and their treatment
• Topical Immunomodulators (such as pimecrolimus and tacrolimus) reduce the rash severity and symptoms in children and adults
• Oral antibiotics should be used to treat infected skin. They are not helpful for uninfected atopic dermatitis
• Topical antibiotics are effective for skin infections, but they lead to development of resistance.
• Oral antihistamines do not relieve itching associated with atopic dermatitis. They are indicated for patients with accompanying allergies (runny nose, watery itchy eyes, or hives)
• Ultraviolet phototherapy is effective option as well

FOR MORE INFORMATION

• Ghidorzi AJ Jr. Atopic Dermatitis. eMedicine. June 2001. Available at: www.emedicine.com/emerg/topic130.htm.
• Atopic Dermatitis Handout by National Institute of Arthritis, Musculoskeletal and Skin Diseases. (HTML, PDF)

MDMA (Ecstacy)

MDMA is an amphetamine that acts both as a CNS stimulant and as a mild hallucinogen. It is sold on the street and in clubs as Ecstasy and it is also known as” “E”, “X”, “XTC”, “Love”, or “Hug Drug”.

It is generally sold as a pill (click here for picture). The pill can have many other substances mixed with it (e.g. caffeine, dextromethorphan, ephedrine, and  pseudoephedrine, or potent hallucinogens such as LSD, paramethoxyamphetamine (PMA), methylenedioxyamphetamine (MDA), N-ethyl-3,4-methylenedioxyamphetamine (MDEA), and 4-bromo-2,5-dimethoxyamphetamine (2-CB). Many of these substances are “designer drugs” that are illicitly manufactured variants of pharmaceuticals and have intentional and unintentional effects (1).

Effects on your health:

• It can damage the neurons in your brain, impairing your senses, memory, judgment, and coordination.
• It increases your heart rate and blood pressure and can lead to heart or kidney failure.
• Because ecstasy is illegal and often produced in makeshift laboratories, it is impossible to know exactly what chemicals were used to produce it and where it came from. How strong or dangerous any illegal drug is varies each time. Higher doses of ecstasy can cause severe breathing problems, coma, or even death.

GHB (Gamma-Hydroxybutyrate)

Gamma-hydroxybutyrate (GHB) is an illegal drug that is used as a muscle builder, a “party drug” and a “date-rape” drug. GHB, which is an anabolic steroid, acts as a powerful central nervous system depressant. In the 1980s, GHB was sold in health food stores and used by many bodybuilders and athletes to lose fat and build muscle. GHB has been given nicknames such as Grievous Bodily Harm, G, Liquid Ecstasy, and Georgia Home Boy. GHB is available as a liquid, a powder form or a pill.

In 1990, the Food and Drug Administration banned the use of GHB except under the supervision of a physician.

Effect on your health:

• It can damage the neurons in your brain, impairing your senses, memory, judgment, and coordination. People who use GHB people may experience nausea, drowsiness, dizziness, Aggressive behavior, Impaired judgment, breathing problems, Hallucinations, Seizures, come and dealth. Also, different amounts have different effects on people. In other words, no amount is safe.

Rohypnol

Rohypnol, a trade name for flunitrazepam, belongs to a class of drugs known as benzodiazepines. When mixed with alcohol, Rohypnol can incapacitate victims and prevent them from resisting sexual assault. It can produce “anterograde amnesia,” which means individuals may not remember events they experienced while under the effects of the drug. Also, Rohypnol may be lethal when mixed with alcohol and/or other depressants. It is also known as R-2, roofies, rophies, roaches, the date rape drug.

Effect on your health:

• Rohypnol makes users very relaxed, confused, and “spaced-out.” It can take away all inhibitions, making people do things they ordinarily wouldn’t do. Enough rohypnol can make people pass out, and even slip into a coma if taken in combination with other drugs or in large doses.

Ketamine

Ketamine (ketamine hydrochloride) is a central nervous system depressant that produces a rapid-acting dissociative effect. Ketamine is an anesthetic that has been approved for both human and animal use in medical settings since 1970; about 90 percent of the ketamine legally sold is intended for veterinary use. It can be injected or snorted. Ketamine is also known as K, Special K, Ket, Vitamin K, Kit Kat.

Effect on your health:

• Certain doses of ketamine can cause dream-like states and hallucinations. In high doses, ketamine can cause delirium, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems.

Methamphetamine

Methamphetamine is a powerfully addictive stimulant that dramatically affects the central nervous system. Methamphetamine is commonly known as “speed,” “meth,” and “chalk.” In its smoked form, it is often referred to as “ice,” “crystal,” “crank,” and “glass.” It is a white, odorless, bitter-tasting crystalline powder that easily dissolves in water or alcohol.

Effect on your health:

• Methamphetamine releases high levels of the neurotransmitter dopamine, which stimulates brain cells, enhancing mood and body movement. It also appears to have a neurotoxic effect, damaging brain cells. Over time, methamphetamine abuse can result in symptoms like those of Parkinson’s disease, a severe movement disorder.
• The central nervous system (CNS) actions that result from taking even small amounts of methamphetamine include increased wakefulness, increased physical activity, decreased appetite, increased respiration, hyperthermia, and euphoria. Other CNS effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. Hyperthermia and convulsions can result in death.
• Methamphetamine causes increased heart rate and blood pressure and can cause irreversible damage to blood vessels in the brain, producing strokes. Other effects of methamphetamine include respiratory problems, irregular heartbeat, and extreme anorexia. Its use can result in cardiovascular collapse and death.

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