WEEKLY TRIP TO THE LIBRARY

Your Child's Health: The Parents' One-Stop Reference Guide to: Symptoms, Emergencies, Common Illnesses, Behavior Problems, and Healthy Development
By Barton D. Schmitt

Book Review by Maria Lopez, Nanny, Miami, Florida

Although this book is written for parents it is also a great reference for nannies and au pairs. Every in-home childcare provider should have this as a reference guide to pediatric illnesses.

There's a lot of information, with 300 major topics covered. The book discusses everything from supplies required for a new baby to adolescent rebellion. The book's greatest value is as a guide to coping with illness or injury.

The book describes symptoms and provides clear directions for first aid as well as advice on such topics as when to call 911, when to go to the Emergency Room, and when to call the doctor immediately.

Every nanny ought to own this book. If you need a gift for a nanny or au pair give it as a gift. But every public library should have a copy as well.



Tell us about your favorite books for nannies by emailing your book review to Stephanie@BestNannyNewsletter.com. Stop by next Saturday for another book review.

BECOMING A NANNY

We have discussed it before that many professionals become nannies. I am gland to say that all of the experienced nannies I know in town and around New York and New Jersey make more than the woman interviewed below in this article for The New York Times. And now that she is gaining expereince she will also learn how to negotiate a higher salary, benenfits, and pay taxes in the near future.

http://www.nytimes.com/2009/02/27/nyregion/27bigcity.html
Big City

Becoming a Nanny: Less Money, More Joy
By SUSAN DOMINUS

Three months ago, had she been interviewed about her job, Ms. L. would happily have used her real name, instead of just an initial, but that was back when she went to work every morning in a suit, heels and hose, sat at a computer and filed reports on deadline the way professional types do.

That was back when she got to her office in Midtown by 8:30 every morning, eager to keep her benefits and her job managing others’ benefits as a human resources coordinator at a major luxury retailer.

These days, Ms. L., once a financial analyst at Chase Manhattan Bank (a second vice president), a 55-year-old with an accounting degree, gets paid off the books, at least for now, which is why she spoke on the condition of anonymity. She has taken a steep pay cut, and she has one of those really young, inexperienced bosses.

At least the two get along. "She’s so content, always smiling at you," said Ms. L. as she sat in the lobby of an apartment building on West End Avenue, bouncing on her knee a 5-month-old with a pink hair clip. Instead of adhering to the schedule of a mercurial administrator under the gun from all sides, Ms. L. now follows the schedule familiar to so many New York City nannies: stroll, music class, playground schmooze, lunch, nap.

From glossy professional to nanny — it’s not like Ms. L. is a former chief executive waltzing around Manhattan with a sandwich board advertising her services, but it was definitely a career zag that she had never anticipated. Her own daughter, who is 25 and thinking about applying to law school, was horrified.

"She said, ‘Mom, you don’t want to be a nanny,’ " Ms. L. recounted, dangling a pastel-striped toy in front of her ward’s hands. " ‘You’re so smart, you’re so capable.’ She thought I should be in the corporate world."

The same day that Ms. L. heard from her employer that she had been laid off, a neighborhood friend shared that she and her husband had just parted ways with their nanny. Could Ms. L. possibly fill in for a week? She agreed — but only for a week.

The friend, who spoke on the condition that she be referred to only as Ms. G., insisted on paying her. "She told me she was going to keep looking for other jobs," said Ms. G., who is 44 and runs her own business.

Ms. L. said she sent out about 10 résumés, and even got one job offer, but it was in Westchester, and without a car, it wasn’t practical. The weeks wore on, her prospects looked less and less inviting, and she started to realize that she sort of liked this new gig.

"My own son just got married, but it’ll be years before he has children," she said. "Now I don’t mind so much."

Ms. G. said she was thrilled to have a close friend looking after her daughter (and fluffy white dog). "My husband and I walk out the door in the morning, look back at the door, and smile," she said.

SOMEONE once said that the first thing to say to a person who has lost a job is "Congratulations."

It’s a perspective that really works only in boom times, when the newly unemployed may well have been misplaced in their positions, rather than passive victims in a sweeping historical downturn.

Even in this economy, however, there may be plenty of New Yorkers who either have enough savings or are lucky enough to have a partner with a lucrative career — as Ms. L., whose husband is a day trader, does — and have, through the shake-up, gotten yet another luxury: a forced opportunity to re-examine their lives.

"I’m much happier," said Ms. L. "All my friends tell me I seem so relaxed. And I just love this baby."

She said she does miss the snappy feeling of getting dressed for work every morning, and her new, long hours — 8:30 a.m. to 6:30 p.m. — are filled with some of the aspects of nannydom that are sheer drudgery: changing diapers and washing bottles and singing nonsense songs over and over. Her pay does not reflect her vast professional experience — or her own experience as a mother, for that matter: She earns about $12 an hour, which, by New York standards, is actually on the low end of the nanny scale.

It was a pay sacrifice Ms. L. was willing to make. "I don’t do housekeeping," she said.
She has her limits.

E-mail: susan.dominus@nytimes.com
copyright 2009 Tje New York Times Company

DENTAL HYGIENE

Nanny and Au Pair Health Care Series
By Anne Merchant, Author of The Nanny Textbook

By the time children have reached their second birthday they are ready for their first visit to the dentist. It is important that the first dental visit be relaxing and uneventful. Be certain not to relay any negative feelings about visiting the dentist with youngsters. Any anxiety could cause children to fear going to the dentist which could affect their dental health for years to come, since people who fear dental visits avoid going for regular visits.

As soon as the first teeth appear, caring for teeth should become part of the daily routine for children.

How to Clean Baby Teeth

From birth until after teeth have erupted, use a piece of gauze or damp wash cloth to help remove plaque at bath time, at which time caregivers may introduce soft bristle toothbrushes.

Preventing Dental Disease

Never put babies to bed with a bottle. Not only is it dangerous since it may cause choking, but liquids like milk, formula, and juices can cause nursing bottle syndrome. Nursing bottle syndrome is a dental disease that rots the teeth, causing teeth to crumble. This may first appear as white spots on the teeth, which may later turn into yellow or brown spots. Early detection can prevent further decay and discomfort.

Nannies can help with the responsibility of caring for children's teeth until they are about the age of seven. Preschoolers and young school-age children are not yet ready to care for their teeth properly without help from adult caregivers.

The Proper Toothbrush

Buy child-sized brushes with soft bristles that do not scratch gums. Never use a brush with hard bristles.

The Proper Way to Brush

The proper way to brush teeth is to hold the toothbrush at a 45 ° angle facing bristles where the gum line ends and tooth begins. This helps loosen and remove harmful bacteria before it is lodged under the gums. Gently brush all teeth surfaces thoroughly and both sides and top.

Setting a Good Example

Children learn better when caregivers illustrate the proper tooth brushing procedures for them. Nannies may want to brush their teeth at the same time as the children. Children love to imitate grown-ups and nannies can help with this important hygiene task at the same time.

Before Visiting the Dentist

1. Prepare children by explaining that the visit to the dentist in a very simple conversation. For example, start by saying, “Oh by the way...”

2. "The dentist is the tooth doctor and we have to go for a checkup."

3. "You will sit in a Mommy, (Daddy), size chair that can move up and down so the dentist can look in your mouth."

4. Nannies should role-play the dentist visit by pretending to be the dentist to help prepare children for the initial visit.

Prevention is Half the Battle

Do not give children soft drinks, candy, (especially sticky candy like licorice or taffy). Get in the habit of providing snacks like fresh fruit and vegetables to children. Nannies should check their teeth and clean them at least daily as soon as the first tooth appears. Ask the doctor about fluoride drops if their town water does not contain fluoride.

Have you had any positive or negative experiences taking children to the dentist?

Procedures for Taking Children’s Temperatures

Nanny and Au Pair Health Care Series
By Anne Merchant, Author of The Nanny Textbook

The following instructions are helpful if using a mercury thermometer.

How Long to Leave Thermometer In

When taking a temperature by mouth or the rectum, leave the thermometer in place at least three-minutes. The auxiliary route must leave the thermometer in place for three- to five-minutes to get an accurate reading.

Procedure for Rectal Temperature
For Infants and Toddlers

1. Shake the thermometer down below 96º F and lubricate end with Vaseline or oil.
2. Place the child on their back on a safe comfortable surface.
3. Lift buttocks off the surface by grasping their ankles as if changing a diaper.
4. While child’s buttocks are lifted, insert clean, lubricated, thermometer into rectum, approximately one-half to one-inch. Never force the thermometer! If there is resistance, stop, and use another route to take the temperature.
5. Divert the child’s attention by talking to them during the procedure.
6. Remove, wipe off, and read the thermometer.
7. Write down the reading, notify pediatrician if temperature is 101º F or above.
8. Wash the thermometer in alcohol or with soap and water, dry it, and put in the proper storage place.

Never take a rectal temperature on a child with diarrhea -- use the auxiliary route.

Procedure for Rectal Temperature
For Children Who Can Follow Directions

1. Shake the thermometer down below 96º F and lubricate the end with Vaseline or oil.
2. Turn the child on his or her side. Be certain to provide privacy!
3. Insert the thermometer into the rectum. Do not leave the child alone and continue to hold the end of the thermometer. Do not force a thermometer. Report the inability to insert thermometer to the pediatrician and take the temperature reading using one of the other two routes.
4. Remove the thermometer after three-minutes, wipe off with a tissue, and read. Record the reading and report any significant data.
5. Wash the thermometer in alcohol and tepid water and put in proper place.

Procedure for Oral Temperature

1. Shake the thermometer with three or more brisk jerks of the hand. Be certain never to interchange one thermometer between the mouth and the rectum.
2. Once the mercury is below 96º F place the thermometer under the child’s tongue.
3. Leave in place for at least three-minutes.
4. Wash the thermometer with alcohol and tepid water, dry it, and put it in proper storage place.
5. Wash your hands.
6. Record the reading in the proper place.
7. If the child has a fever, make a notation that the temperature should be re-taken in three hours.
8. Notify the pediatrician if the reading is 101º F or greater.
9. If the child has had something hot or cold to drink, or has been running around or overly excited, wait 15-minutes before taking their temperature.

Procedure for Auxiliary Temperature

1. Shake the thermometer down below 96 ºF.
2. Place under the armpit.
3. Leave in place for three- to five-minutes. Be certain that children hold their arm against their body so the instrument will not fall out.
4. Remove and read.
5. Record and report significant data.


What to Do If Children Have a Temperature

When children have a temperature encourage fluids and give them Tylenol or ibuprofen if the physician orders it. Never give children aspirin unless the doctor specifically orders aspirin. Keep children as quiet as possible. Retake their temperature every two to four hours until the temperature subsides. Convulsions can occur when children have had an elevated temperature.

HOW TO READ A THERMOMETER

Nanny and Au Pair Health Care Series
By Anne Merchant, Author, The Nanny Textbook

It is rare these days to see a mercury thermometer used in the home. However, there are still some in use and nannies should be familiar with the correct procedure. It is essential that caregivers be completely at ease with this procedure. The local Board of Health or Visiting Nurse Association can teach caregivers the proper procedure and they are probably the best resources when childcare providers are not enrolled in a formal training program. Many homes now have modem thermometers, which are no n-evasive and digital. The following is provided for those using a mercury thermometer an d/or a simple digital thermometer.

Be certain to call the local Board of Health for instructions on how to dispose of a mercury thermometer.

When to Take Temperature

Nannies should take children's temperatures anytime they suspect a fever, when children feel warm, are fussy for no other apparent reason, or show other unusual symptoms. A reading of or above 101º Fahrenheit is considered elevated. Call the physician and continue to assess children by taking their temperature again in two hours or sooner if they appear to feel worse. Caregivers should continue to take children's temperatures every two- to four-hours as long as the temperature remains elevated.

Ways to Take Temperatures with a Mercury Thermometer

Body temperature is measured with a thermometer. Although the majority of households with small children have digital thermometers which are simple to use some households still use mercury thermometers. There are three ways to take a temperature: orally, (by mouth), auxiliary, (under the arm pit), and rectally, (by the rectum). The most accurate of these methods is rectally. Caregivers should use the rectal route for infants and children under the age of three or anytime children are uncooperative. The oral route can be used for routine readings on children who are cooperative.

Normal Body Temperature

The normal body temperature is 98.6º Fahrenheit, although some people may have slightly higher or lower temperatures. As caregivers gain experience in taking temperatures they will notice that rectal readings will be one degree higher then oral readings. This is why the rectal route is more accurate. When recording a temperature always state which method was used. For example, 98.6º P0 means 98.60 by mouth. If the reading is by rectum, it should be written as 99.60 R, (the R indicating rectal). An auxiliary reading would be written as 98.6º AX. Never take a temperature by mouth and add on another degree, simply state which method of taking temperature was used.

Reporting to the Physician or Parent

Any time children's temperatures reach or exceed 101º Fahrenheit it should be reported immediately to the pediatrician. High temperatures may indicate the beginning of a serious infection requiring medical attention. Many households now have digital thermometers which came with specific instructions.

Tomorrow: Procedures for taking children’s temperatures.

UNDERSTANDING PEDIATRIC ILLNESSES

Nanny and Au Pair Health Care Series
By Anne Merchant, Author of The Nanny Textbook

Anytime nannies have questions or concerns about the health of the children left in their care, caregivers should discuss it with medical professionals or pediatricians.

If the concerns are related to teething pain or a minor rash, the children’s parents or a relative may be able to help evaluate the situation. But, since each person has a unique chemical composition, side effects and each individual's reaction to medication cannot be anticipated, so nannies typically should not follow the advice of a friend, neighbor, or relative regarding the treatment of children. Nannies are responsible to seek the best advice from trained medical professionals and not merely from a convenient source.

Concerns such as difficulty breathing or an elevated temperature require the input of the pediatrician immediately. If caregivers are not certain whether children are seriously hurt, they should always have the children be seen by a physician or at least call the pediatrician to discuss the situation.

It is always best for nannies to follow-up on any concerns or questions they have with the appropriate professionals. Nannies should never attempt to diagnose or treat an illness or injury on their own.

The following information is intended for the purpose of increasing caregiver level of knowledge. It should never be used instead of seeking the advice of the pediatrician. The terminology incubation, range, and isolation are under the following illness headings. The definitions of those terms are below.

INCUBATION PERIOD refers to the time when the illness is contagious. Unfortunately symptoms usually do not present themselves until after the incubation period. Be cautious exposing siblings of ill children to the other children in the family since siblings may be in the incubation period of the same illness.

RANGE is the average length of the illness.

ISOLATION is the time period that the illness is contagious while symptoms are present. Isolate sick children from other children.

CHICKENPOX
Incubation period: 14- to 20-days.
Range: 12- to 21-days.
Isolation: until skin is clear.
Cough, headache, and chills are common symptoms of chickenpox which appear approximately 14- to 18-days after exposure to chickenpox. The chickenpox rash usually develops one- to two-days after other symptoms have started. One of the most common complications of chickenpox is skin infection because the rash is itchy. Babies typically have an easier time because they still have some immunity from their mother. Adults often require hospitalization. Children with chickenpox are contagious even before the rash appears. It is very difficult to stop the spread of chickenpox once it has started. Daycare centers, schools, and other highly populated areas are most prone to the spread of chickenpox. A vaccine is available. As children recover from chickenpox, watch for lethargy which may be the first sign of Reyes syndrome.

CROUP
Range: two- to five-days.
Croup is most common in children six-months to four-years-old. It is a virus that affects the throat and airway, causing a cough that sounds like a bark and difficult, noisy breathing. Use a humidifier to keep the air moist. Call the pediatrician immediately for advice. Croup usually develops after children have had a cold. The cough can be worse at night and may seem better during the day. If children's rooms are adjoined to bathrooms caregivers can open the door and turn on the hot water in the shower to generate steam, if humidifier is not available.

COLD AND SORE THROAT
Congestion, fatigue, fever, and pain when swallowing are common symptoms of cold and sore throat. Children may have runny noses and eyes too. Encourage fluids and rest periods with quiet play. Use paper tissues to reduce spread of illness. Do not allow children to drink out of same glasses or use the same utensils when children are sick. Wash hands frequently. Report back to doctor if children do not improve or symptoms become worse in two- to three-days, (such as difficulty breathing).

INFLUENZA (FLU)
Incubation period: one- to three-days.
Isolation: in acute stage.
Immunization is recommended because new strains of the flu present themselves regularly. Take children's temperature four times a day. Give sick children Tylenol or ibuprofen if their temperature is over 102º Fahrenheit after consulting with a physician. Record the child’s fluid intake and output. Give fluids generously. Children with influenza should be kept quiet and comfortable. Watch for a cough since influenza may lead to pneumonia.

PINK EYE (INFECTIOUS KERATOCONJUNCTIVITIS)
Incubation period: five- to seven-days.
Good hygiene and hand washing are required after touching the eye. Watch that children do not touch or rub their eyes. Also watch children carefully after application of antibiotic ointment because vision is blurred for about five minutes after application. Keep children off their feet and under supervision to prevent falls.

REYES SYNDROME
Reyes syndrome affects primarily six- to 12-year-old children. It is rare to see Reyes syndrome in anyone older than 18-years-old. In fact, this illness has become quite rare in United States. It is most often seen after children have recovered from a viral infection. There have been numerous instances where aspirin was given to children during an illness and subsequently those children developed Reyes syndrome. That is why it is recommended that people under 20-years-old never take aspirin. Reyes syndrome is not contagious, its cause is unknown, and if caught early enough children can make a complete recovery.


SCARLET FEVER
Incubation period: two- to five-days.
Isolation: respiratory precautions.
An isolation precaution for about two-days after treatment has started. Caregivers should wash linens for the same length of time. Give prescribed medications and control fever with acetaminophen or ibuprofen. Watch for peeling about five-days after onset. Scarlet fever was very common prior to the development of antibiotics. Symptoms, course, and treatment are nearly identical to that of Strep throat.

ARE THE KIDS REALLY SICK OR JUST OVERTIRED OR STRESSED-OUT?

AU PAIR & NANNY HEALTH CARE SERIES

All nannies and au pairs hate it when their charges are feeling bad: cranky, complaining, crying, or whining. It’s annoying when children don’t listen, complain they are sick when they aren’t, or refuse to obey even the simplest routine requests. But, often when children are cranky or complain of having a tummy ache or feeling sick, they are actually overtired or stressed-out.

When a child complains they often want something but don't know how to get it. They aren't mature enough to know how to ask for something or express what is truly bothering them. Caregivers must determine what really ails the child.

HUNGRY: First caregivers must try to determine if the child is tired, hungry, or just wants adult attention. Provide children with healthy snacks and meals at regular times throughout the day. When children are home from school try to feed them on a similar schedule as their school days.

OVERTIRED: More often then not, when kids complain they are sick they are just overtired. Allow them time to nap and down time to read books. An early bedtime is essential for all kids. A pre-school child may need to sleep 10 to 12 hours each day, whereas a school aged child sleeps about 10 hours each day.

OVER-SCHEDULED: Although adults are always well-intentioned children’s schedules often parallel their parent’s busy lives. children need time to relax and play independently. Children become stressed-out with long and demanding school days, sports, and after school activities.

EXPECT TOO MUCH: Another source of stress for children is expecting too much from them. In an attempt to teach kids responsibility, caregivers often expect too much. There's nothing wrong in expecting children to do their best. But when doing their best isn't enough, children often suffer and complain of feeling ill.

INCONSISTENT ROUTINE: Consistency is especially important to children. Most children do not handle change well. Children need to know what to expect and when to expect it. A secure routine can help relieve stress.

SIDE-EFFECTS: Another source of children feeling sick are side effects from medications. For example, some antibiotics may cause diarrhea, decongestants may cause excitability, and antihistamines may cause drowsiness. Caregivers should read medication labels to weigh the risks and benefits before giving children medications.

Whenever children complain they are feeling sick it is important that nannies and au pairs take their complaints seriously. Since children are not mature enough to articulate what is really bothering them, adults must determine what really ails the children in their care. If the child doesn't have a virus, the flu, or a cold, they may be suffering from stress or be overtired. Whatever the cause, it is the caregiver’s responsibility to help solve the problem to help the children under their care.

Do your charges suffer from being stressed-out or being overtired?

Weekly Trip to the Library

The Nanny Textbook 2003 By Anne Merchant
Book Review By Maria Lopez, Nanny, Miami, Florida

What I like best about The Nanny Textbook by Anne Merchant is that she has a nursing background and she teaches the nursing process to nannies. I have not come across another book written for nannies with the nursing approach. The book shares great information about common childhood illnesses which Best Nanny Newsletter will share with readers in short excerpts on this blog during the health care series for the next week. So, there is no better time to discuss The Nanny Textbook.

The first chapter is entitled “Keys to Making the Relationship Work.” The advice Anne Merchant shares with nannies about the parent and nanny relationship is clever and rings true.

I particularly like her ideas about housework for nannies. Many nannies resent having cleaning and housekeeping responsibilities. Anne Merchant recommends placing housekeeping responsibilities under a separate work agreement with an amount of salary apportioned for the housework duties. That way, if the nanny finds that housekeeping along with childcare responsibilities becomes too much to handle, the parents and nanny can drop those duties and that portion of salary.

Chapter three discusses the “Professional Nanny Process” which Anne Merchant developed from the “Nursing Process.” The process is to: ASSESS what is needed, PLAN how to carry out your responsibilities, IMPLEMENT the plan by writing it down, and EVALUATE the effectiveness on a regular basis.

She states that a nanny’s priorities are first and foremost the personal care of each child. Then a nanny should provide age-appropriate activities for children. Finally, when there is enough time a nanny should focus on home hygiene and home management duties.

The book primarily emphasizes the need for safety in the home and health concerns when caring for children. But it also discusses communicating effectively with parents, ethics for childcare providers, the growth and development of children, and helping children develop high self-esteem.

I like the worksheets included in the book that are helpful to both nannies and parents. Some charts and forms include: a daily log form, safety statistics, growth and development form, dosage medication chart, and a consent authorization form.

What I like least about the book is the poor grammar which requires the reader to slow down to re-read some sentences to understand their meaning. But, the author published The Child Care Textbook 2007 which should have better grammar.

WHAT TO IGNORE

Nanny & Au Pair Health Care Series

There is a barrage of information aimed at consumers offering health care advice. Which sources should a nanny follow and which should a nanny ignore?

A prudent consumer is skeptical about claims made in advertising. But it is not always easy to discern advertising from pure reporting. Increasingly, ad agencies and public relations firms disguise advertising as 'news' in segments that are shown on local news broadcasts. These are best to ignore.

Everyone has advice. Friends, family, neighbors all have their remedies for most maladies. But they do not know the child as well as you do. Plus, they are not qualified to make a diagnosis or medical advice. So, they are likely to offer an unproven remedy for an unknown illness. Our thought: accept the advice graciously, but ignore it.

The internet is a prolific source of information relating to illnesses, drugs, and drug interactions. Unless you are certain that you can interpret the data and understand the terminology, you should probably ignore it.

As a nanny, it is your responsibility to respond to health problems of your charge in a calm informed manner. When the child has health complaints, the nanny cannot ignore it. Work with the pediatrician and parents to determine the correct treatment course.

Have you ever disagreed with treatment advice of the parents?

BEWARE OF HOMEOPATHIC REMEDIES FOR CHILDREN

Nanny and Au Pair Health Care Series

Unless recommended by a physician no over-the-counter (OTC) cold preparations are suitable for a child under four-years-old.

The side-effects cited in this article are representative only and not nearly a complete list of all possible problems medications can pose for children.

Parents may give certain herbs to children to prevent or lessen the symptoms of a cold. Herbs are used because of the inaccurate belief that they are all natural and cannot hurt, and might help, children.

Echinacea: The most popular herb is Echinacea. According to the German government, only one of the four species of Echinacea is useful as a cold preventative. That form is not even available in the United States. Some children, especially those who are allergic to ragweed, may be allergic to Echinacea. The alcohol-based tincture form of Echinacea can be irritating to mucus membranes.

Vitamin C: Some people use large doses of Vitamin C to prevent or to treat a cold. Large doses of Vitamin C can cause stomach upset, diarrhea, and heartburn.

Honey: Honey is popularly used to relieve sore throat, or to mix with lemon to relieve colds. Honey should not be given to any child under one-year-old because of the risk of infant botulism.


Iron: Iron-containing vitamins are a threat to children and all vitamins should be kept out of the reach of children. Doctors may prescribe iron for anemia, but only give a child iron with a pediatrician's advice.

Aspirin: Headaches, sore throats, and other pain should be treated with ibuprofen or acetaminophen, but never aspirin. Aspirin should not be give to anyone under 19-years-old. Aspirin is to be avoided because it is a salicylate (see below) that can react with a virus that can cause the dangerous Reyes Syndrome. Use ibuprofen or acetaminophen in forms designed for pediatric use, rather than smaller doses of adult formulations.

Salicylate: The adult formulation of Pepto Bismol, Kaopectate, and willow bark are also salicylate-containing compounds and must be avoided by infants, children, and teenagers.

Antibiotics: Do not insist on antibiotics for a virus. Antibiotics do not cure or treat a virus, only bacterial infections.

How to Treat Common Childhood Ailments:

Vomiting, nausea, and diarrhea: Vomiting, nausea, and diarrhea are all potentially dangerous conditions that may lead to dehydration. Pediatric electrolyte replacement drinks are appropriate. Diluting adult electrolyte replacement drinks will give the patient a drink that is too acidic for a child.

Teething: There are many effective strategies to relieve the discomfort of teething but adult Anbesol and liquor may burn the gums and should be avoided. Cold gel pacifiers are a better choice.

Intestinal gas and heartburn: Intestinal gas and heartburn are treatable with a large variety of safe products. Use those made for the age of the child. Too much antacid can cause constipation, diarrhea, or stomach cramps. Over dosage of acid blockers can inhibit digestion. Track the diet of children with stomach or digestive discomfort for a few days to check if there is a sensitivity to some food.

Among the most effective methods to prevent the spread of illness is careful and frequent hand washing. Plain soap and water are all that is necessary.

Do you use homeopathic remedies when treating sick children?

SIDE EFFECTS OF MEDICATIONS

Beware of Common Side Effects

It is vital for caregivers to be aware of some common ailments and popular products used as treatments and the problems those medications may cause.

Runny noses, stuffed noses, and post nasal drips are among the conditions that prompt a doctor to prescribe an antihistamine or a decongestant, or a combination of the two. Dry coughs and incessant coughs typically require expectorants and/or cough suppressants.

Some Common Side Effects Include:

Antihistamines generally cause fatigue, loss of appetite, and dryness of the mouth and throat. Overuse can cause respiratory failure and weight loss.

Decongestants can cause nervousness, sleeplessness, and heart palpitations.

Expectorants can cause nausea and vomiting.

Suppressants can cause chest pain and lethargy.

Paradoxical side effects may occur at anytime. That means that for a small minority of patients, what normally causes lethargy, may cause excitation in a particular patient.

Quick List of Common Medication Side Effects:

Antihistamines fatigue and loss of appetite.

Decongestants nervousness and sleeplessness.

Expectorants nausea and vomiting.

Cough Suppressants chest pain and lethargy.

Antacids constipation, diarrhea, and cramps.

Paradoxical Side Effects opposite side effects then expected may occur at anytime.

Have your charges ever experienced side effects from medications you administered?

READING CHILDREN’S MEDICINE LABELS

How Nannies and Au Pairs Should Administer Medicines to Children

Parents, family, nannies, and au pairs devote themselves to the welfare of children. Yet, even with love and devotion, 80 percent of deaths of children under five-years of age are avoidable.

More than half of those deaths are caused by mistakes in the administration of medications given to benefit the child. An even greater number of children are injured or suffer serious side effects from inadvertent errors of common health aids found in most homes.

Before administrating any prescription medication to a child, the caregiver must assess the child's needs: know what to give, why the child needs it, how to contact the professional that is prescribing it, when to give it, how to store it, where to refill it, and at what cost the medication can purchased.

Caregivers should be aware of probable side effects and how to manage them if they occur. Know whether to give the medication until it is finished or only until symptoms abate.

Keep the phone number of the prescribing physician and pharmacy visible in the event of questions regarding reactions or directions.

Since each person has a unique chemical composition, side effects and each individual's reaction to a medication cannot be anticipated. Therefore, unexpected reactions must be reported to a licensed medical provider.

Over-the-counter, (OTC), preparations pose a special challenge for child care providers. They require no prescription are widely available, and are relatively inexpensive. Yet, they can be hazardous if used inappropriately. Adults must carefully read and understand the labeling found on every package.

The following categories are found on every medicine package label:

Active Ingredients: The first panel on the label lists the active ingredients and their purpose(s). This section provides the chemical name of the active chemical and how it is intended to work for the patient.

Uses/Indications: The next panel named uses or indications explains which symptoms the active ingredient is supposed to treat.

Warnings: The warnings section of the label alerts the caregiver to conditions, or people, that should not use the particular medication without the specific advice of a physician.

Directions: The directions explain the dosage and administration of the medication. Adults should always use a manufacturer provided measuring device and not a kitchen teaspoon, tablespoon, or dropper. Household goods vary widely in size and cannot be depended upon for proper dosage. Never dispense medicine in low or poor light, and certainly not in the dark. Always read the label and be sure you are using the intended medicine.

Other Information: The other information listed often notes proper storage and gives pertinent information about how and when the product should be taken.

Inactive Ingredients: The inactive ingredients listed on the medication label are the chemicals in the compound that are presumed to have no effect on the body. Dyes, preservatives, fillers, and food colors are among the compounds listed on this part of the label. A child may be allergic or sensitive to any of these ingredients, even though they are called "inactive." That also explains why one person may have a reaction to a generic drug but not the brand name of the same product.

When treating sick children remember that kids are not small adults. Do not dilute or reduce the dosage of adult products and dispense them to children.

Always check ingredients to be certain that there is no duplication or conflict between ingredients of different products.

Pediatric oral medications are often sweetened to make the palatable. However, they are not candies and like all medications, should be kept out of the reach of children.

Always record the type of medicine you give to a child, the time the child took the medicine, and the amount you administered to a child in your care so there is no chance of over medicating a child.

WEEKLY TRIP TO THE LIBRARY

Children's Book Related to Health Care

Going to the Doctor (First Experiences)

Going to the Doctor

By Anne Civardi
Ages: 3 to 8
Publisher: EDC Publishing, January 2006
ISBN-13: 9780794510046
This series of books introduces young children to situations they may find themselves in for the first time. Each book shows how a different family deals with new situations to teach children what to expect the first time they are faced with a similar situation.

Going to the Dentist
Going to the Dentist
By Anne Civardi
Ages: infant to preschool
Publisher: EDC Publishing, January 2006
ISBN-13: 9780794510077
To continue the "Usborne First Experiences" the colorful illustrations are interesting and informative for children to look for, talk about, and learn about. And the simple vocabulary will enable slightly older children to read the books for themselves.

 

 

Froggy Goes to the Doctor

Froggy Goes to The Doctor
By Jonathan London
Ages: infant to preschool
Publisher: Penguin Young Readers Group, October 2004
ISBN-13: 9780142401934
Froggy is going to the doctor for a checkup, and he's feeling a little nervous. "What if the doctor wants to give me a shot?" he thinks. He worries as he dresses and then he can't sit still in the waiting room. Finally, it's time to go in and change for his exam, but . . . OOOPS! He's forgotten his underwear! And that's just the beginning of Froggy's hilarious doctor visit that ends reassuringly with a gold star and a lollipop.

Just Going to the Dentist (Look-Look)
Just Going to the DentistBy Mercer Mayer
Ages: 1 to 6
Publisher: Random House Children’s Books, March 2001
Mercer Mayer's very popular Little Critter is on his way to the dentist. It's a thorough check-up, complete with dental x-rays. When Dr. Ghum insists on filling a cavity, Little Critter goes through it bravely. The visit is painless to the reader because of Little Critter's funny, honest way of look at things -- including the world of dentistry.

NANNY & AU PAIR VALENTINE’S DAY ACTIVITIES

Valentine's Day

Tomorrow is Valentine’s Day. Many nannies and au pairs will celebrate with the children today since many do not work on Saturdays.


Children typically bring Valentine’s cards to school to give to their classmates and teachers.


It is nice for nannies and au pairs to help their charges make Valentine’s Cards for their parents as well. Common supplies used to make Valentine’s Cards include: red, pink and white construction paper, paper doilies, markers, and glitter pens.

Valentine’s Breakfast to Make with Charges:
Make heart shaped pancakes. After cooking the pancakes simply use heart shaped cookie cutters to create a heart shaped breakfast. Serve with strawberries (or another red berry) and whipped cream.

Valentine’s Lunch to Make for Charges:
It is easy to make heart shaped sandwiches. We roll bread slices with a rolling pin and cut off the crusts. Spread peanut butter and red jelly (such as strawberry or raspberry) on the bread, then put the pieces of bread together making a sandwich. Use a heart shaped cookie cutter to make heart shaped lunch.

Valentine’s Dinner for Kids:
Heart shaped pepperonis on pizza

Here are some other ideas we love:

Friendship Box
http://crafts.kaboose.com/friendship-box.html

Cookie Bouquet
http://www.kids-cooking-activities.com/Valentine-recipes.html

What do you do with your charges for Valentine's Day? Do you share gifts?

NANNY & AU PAIR HEALTH CARE SERIES

The Difference Between KNOW and NO

Have you left the doctor's office uncertain of exactly what the diagnosis is, what tests were done, and what current and future treatment is recommended?

Whether for yourself or for your charges that is unacceptable. Know what was done, why it was done, and what to expect when you leave the facility. If uncertain, just ask the doctor or nurse.

Know what, if any, procedures, treatments, or medications to use. If you know you tend to forget these details, note the information at the time it is communicated to you.

If prescribed medication, know the name, the purpose, the proper storage, and correct dosage.

Know the other prescriptions, over-the-counter (OTC) medications, herbs, and dietary supplements the child uses.

Know to tell the pharmacist so the child may be protected from potential undesirable interactions.

Know whether the dosage is for a teaspoon or tablespoon, know how many hours between "four times a day" doses, know if you should wake up a patient for medication.

Know what foods to avoid or if the medication must be taken with food. Know to ask the health care provider if unsure or confused.

Say "NO" to marketing techniques that may endanger the child. Stores with pharmacies are said to sell ten times more health and beauty aids to customers than those without Rx departments. To boost traffic, some stores are dispensing antibiotics for free. Resist the temptation.

Say "NO" to the overuse of antibiotics. Most childhood colds are viruses unaffected by antibiotics.

Say "NO" to Rx or OTC preparations advertised on television or in magazines. Most are only slight improvements over older medications with a much higher price tag.

Say "NO" to homeopathic preparations, herbs, and any preparation not approved by your primary health care provider.

Say "NO" to increasing dosages or sharing medications.

Knowing when to say "NO" is another way to protect your charges.

WORKING WITH HEALTH CARE PROFESSIONALS

The ONE Thing

Ideally, each interaction with a health care professional, whether physician or pharmacist, will be with the same person you have seen previously. That person will be knowledgeable about the patient’s past medical history and have personal concern for the patient. Plus, the patient and caregiver would have a degree of comfort and ease that would promote candor between the provider, the patient, and the caregiver.

Such ideal situations seldom occur anymore. But, the nanny or au pair can act to minimize problems that might occur with changing providers.

The au pair or nanny should try use the same doctor for the child, or the same group of doctors, so both the office’s medical records and the physician can be used to highlight the individual patient’s medical history and lead to proper diagnosis and treatment.

When changing doctors, the previous office must send medical records to the new doctor. It is a wise precaution for the nanny to record all office visits and for the parents and for her own knowledge.

The same concept applies to a pharmacy. Try to use one pharmacy so that the pharmacist has prescription records and allergy information in the computer system and can check for potential drug interactions. Even so, the nanny should keep a list of drug allergies and a list of all medications, herbs and vitamins taken by the child.

Using one doctor or one pharmacy may not be factors a nanny can control. But the nanny can be the one that the parent and the child can rely on to assure that best information is available to the health care providers about the patient.

Have you ever had any issues with health care working with children?

Flu Shot Does Not Cause the Flu

What Nannies & Au Pairs Should Know About the Flu

Controversy swirls about the safety of vaccines, especially about the flu shot. Remedies abound, handed down in families like treasured heirlooms about how to treat the flu.

The flu sickens millions and kills thousands yearly. The flu may threaten all those who come into contact with a stricken individual; even those who may not yet have symptoms.

Prevention is the best tactic to lessen the threat of the flu. Getting a flu shot reduces the chance of contracting the flu by up to 90%, depending on how closely the shot matches the virulent year of the current flu season.

Some fear to take the shot, or have their family vaccinated, because they believe the flu shot causes the ailment. The flu shot is a dead form of the virus that triggers an immune system response but cannot cause the illness.

The risk to the young, elderly, or febrile of catching the flu exceeds the risk from the vaccine. Some people with extreme egg allergy cannot take the flu shot but may be able to use various pills and mists to treat or prevent the flu.

There are no antibiotics, vitamins, minerals, herbs, or homeopathic preparations proven to prevent or treat the flu for adults, children, and infants.

The flu is a serious illness and self-diagnosis complicates the treatment. The aches and pains, the high fever, the profound fatigue, and sudden onset are best treated by a health care professional. The young and the elderly are particularly prone to long –term debilitation from the disease and require prompt medical care

The protection of the flu shot does not carry over from one year to the next since the virus mutates from one year to the next. That fact emphasizes the need for all family members and childcare givers to get a flu shot at the start of each flu season.

The season of peak flu activity usually runs from November through April. If a child is six months old or older during this time period, the child and all caregivers and family members should receive the vaccination or use prescribed sprays or pills. Use of the flu shot does not change the need for proper hygiene, especially careful hand washing.

The flu has the potential to be dangerous, even life threatening. The flu vaccine has a long history of safety and effectiveness. This flu season, protect yourself, the family you work for, your family, and your community -- get the flu shot.

Have you or members of the family you work for caught the flu this year?

AU PAIR AND NANNY PROPER MEDICAL PRACTICES

START OF TEN DAY SERIES ABOUT HEALTH OF CHILDREN

Since it is cold and flu season it is a good time to review proper practices and helpful tips when dealing with health care providers, parents, and sick children.

As with all things that a nanny or au pair does, preparation is essential. You should know where the hospital, the doctor, and the pharmacy are located, how to get to them and their phone numbers, as well as the numbers for the police and emergency transportation. Be aware that contacting 911 from a mobile phone may or may not connect you to local police. Be aware of how 911 works in your locality.

The parent should provide the nanny or au pair with written permission allowing the caregiver to seek treatment, to authorize treatment, and to discuss treatment with health care providers. The parent should also provide insurance information or other payment options to allow the child to get proper care without delay. The nanny should also insist on an emergency phone number or signal so the parent can be quickly notified in event of an emergency.

The nanny or au pair should be able to assist the doctor, nurse, emergency medical technician, or other health care provider with vital information regarding the child. The au pair or nanny helps when she is aware of allergies, medications, or other substances used to treat the child, and pre-existing medical conditions. Be sure to include vitamins, herbs, or anything else that might impact diagnosis or treatment. Most importantly, as the advocate and person responsible for the child, you should be able to describe symptoms, the intensity of the ailment, and the temperament of the child.

A well-stocked medicine cabinet is essential for first aid and minor health issues. First, check the expiration dates and make sure all products are fresh. If not, dispose and replace the medications.

Basic Medicine Cabinet Should Include:

1. mild soap
2. hydrogen peroxide
3. bandages and gauze
4. triple antibiotic ointment
5. alcohol, witch hazel
6. liquid acetaminophen
7. liquid antihistamine
8. liquid antacid
9. saline solution
10. thermometer
11. ice bag
12. petroleum jelly
13. anything else your charges need for recurring problems.

Discard any children’s cough syrup unless specifically and recently prescribed. The FDA has determined that they are ineffective and potentially harmful. This list is not all-inclusive but should give you a head start on being ready for many minor problems.

Going to the doctor or dentist? Prepare the patient. If the child is going to get a shot, tell her so and that it will hurt for a while like a pinch or mosquito bite but that it is good and it is necessary.
A tooth being extracted? Ask the dentist if you might need to give the child a pain killer before going to the office.

Be prepared with pen and pad to note questions that you have and to record the answers so you can communicate clearly and accurately with the parent or health care providers.

Finally, be prepared to take control, show your calm confident demeanor so you can reassure an upset child-or parent.

Have the parents you work for signed an authorization to treat form giving you consent to make decisions in case of emergency involving the children?

The Nanny Tax Nightmare

Newsweek Article:
The Nanny Tax Nightmare

The perils of trying to comply with our Byzantine payroll laws—and how Washington can make the system easier for parents who want to do the right thing.

By Maja Beckstrom
Newsweek Web Exclusive

It's a good thing I haven't been tapped for public office. As I discovered last year, it's frighteningly easy to run afoul of the nanny tax, even when you're trying to follow the rules.

I dedicated dozens of hours to paperwork and even so, missed a payment for my nanny's unemployment insurance taxes. The $250 fine hurt. But the worst came later when my husband and I had to part ways with our nanny, in part because we were spending so much trying to comply with I.R.S. rules that we couldn't give her the raise she wanted. And so, on behalf of the hundreds of thousands of families like us, I'm hereby asking Washington to make it a little easier for us to do the right thing.

My husband and I had avoided the nanny-tax hassle for years, relying on grandma, flexible job schedules, an au pair who was exempt, and a parade of high-school and college babysitters who we didn't pay enough to hit the tax threshold. Last year we hired a young woman to watch our three children 20 hours a week, and we suddenly found ourselves owing payroll taxes. It was as if we'd morphed into a corporation. We weren't prepared for how expensive it would be, nor for the hair-pulling, late-night sessions in front of an Excel spreadsheet. As a friend said, "I have to do as much work to pay my nanny as 3M does to pay its employees."

I started polling friends about nanny taxes this week after President Obama's pick for chief performance officer, Nancy Killefer became yet another casualty of a nanny tax scandal. If you want to separate your real friends from your Facebook "friends," by the way, ask whether they pay the nanny tax. If they don't trust you, it's an awkward conversation. About half my friends with nannies pay the taxes, including one lawyer dad who said he wouldn't be able to sleep at night if he didn't. "If I'm not paying this, then the woman who takes care of my children is not going to get the Social Security she deserves," he said. "For a lot of nannies, it's not like down the road they're going to be making so much money that it will replace these low earning years."

Then there was my friend who pays a babysitter to watch her child while she attends school. When I told her late one night that she owed the nanny tax, she paused, and then said with utter fatigue, "I'm just going to forget we had this conversation." I happen to know she would have been forced to cut into her grocery budget to pay even a couple more dollars an hour. And those few bucks can add a surprisingly amount to the cost of childcare.

For us, paying the tax meant an extra $200 a month. For some families, the extra hit can be the difference between making money by going to work, or barely breaking even. Call me naive. We hadn't factored in taxes when we agreed with our nanny on an hourly rate. Suddenly her $14 per hour wage turned into a $16.50 per hour expense after we added federal and state unemployment insurance tax and 15 percent in FICA taxes (6.2 percent for the employee portion of Social Security, another 6.2 percent for the employer portion; 1.45 percent for the employer portion of Medicare and another 1.45 percent for the employee portion). We could have taken the employee portion out of her wage, but we knew she would have seen it as a pay cut.

As it turned out, we ended up mutually parting ways before she'd been with us a year. She wanted a raise. And after paying FICA, we simply couldn't pay her more. Meanwhile, we were competing against families who can pay more because they pay in cash. Even if you can afford to match the competition and still pay the nanny tax, the paperwork alone might be enough to send you over the brink. One friend tried to calculate her nanny taxes herself. She got it wrong and was fined. And she is doctor who understands statistics. "Trying to pay this on our own created so much stress," she said. "It seemed ridiculous that it should be that difficult." She ended up forking over $500 a year to have a payroll company handle it.

You can't even trust your accountant to get it right. After we got inaccurate advice from our tax-prep firm we too tackled the tax ourselves. I applied for a federal and a Minnesota tax ID number, printed out weekly payroll receipts and calculated the Social Security and Medicare taxes to withhold. I stayed up past midnight trying to fill out a quarterly wage detail on the Minnesota State Unemployment Web site before the deadline passed and we were fined … again.
I'm not suggesting that we eliminate this requirement, but we should not have a system where anyone who's ever hired a summer babysitter and not paid the tax is made unfit for public office. Parents owe payroll taxes if they paid a nanny more than $1,600 in 2008. Let's raise that threshold. And simplify the paperwork. In the meantime, here's my advice: If you aspire to public office, hire a company to handle your nanny tax. Or, enroll your child in the nearest child-care center. It's cheaper, you won't have to bother about taxes. And, you'll meet more of your constituency.

Maja Beckstrom Lives In St. Paul, Minn., Where She Writes About Family And Parenting For The St. Paul Pioneer Press. She Originally Blogged About The Nanny Tax For The Newspaper's Parenting Web Site, Minnmoms.Com. She Plans To Devote This Weekend To Figuring Out Her Former Nanny's W-2 Form.

URL: http://www.newsweek.com/id/183487

Any thoughts on the topic? Click "comments" below.

The What to Expect Baby-Sitter’s Handbook

Weekly Trip to the Library
The What to Expect Baby-Sitter’s Handbook
By Heidi Murkoff

The hurdle for nannies with this book is the title. Professional nannies hate to be called baby-sitters. But, if you can swallow your professional nanny pride and read a book with the term “baby-sitter” in the title, you might find it a concise and useful resource.

The size and shape of the book is appealing. It’s small with spiral bound spine makes it easy to access pages of interest. Some of the topics discussed in the book include: feeding children, playing, bathing, sleeping, discipline, and health and safety of children. Plus, it includes 73 of the most common questions sitters ask.

There is easy access to an emergency information form on the inside of the front cover.

Chapter 12 is my favorite part of the book which includes forms for parents to fill in information about their child's specific needs, routines, how to calm the child, and house rules to share with their childcare provider.

This is an easy to read, quick reference, for in-home childcare providers.


Come back next Saturday to read another book review of interest to nannies and au pairs. Feel free to share your favorite books with us by emailing your book reviews to Stephanie@BestNannyNewsletter.com.

NANNY & CHARGE DISCIPLINE CHART

Getting Children to Help Create Their Own Punishments

To finish our series about discipline we recommend creating a discipline chart with children.

Have the children help you make their discipline chart. For example, ask the children what they think would be a fair punishment for a sibling that yells at the other, if they talk back to an adult, or tease others.

Once the children have chosen their appropriate punishments, write the rules on a piece of poster board that you can post in a visible place, (like the refrigerator).

There will be no need to yell at the kids if they misbehave. No negotiating necessary. They only need to see the chart. The children cannot claim that the punishment is unfair when they help determine appropriate consequences for misbehavior.

The chart might include the following:

Yelling = no computer rest of the day.
Hitting = go to your room.
Talking Back = no phone usage for the rest of the day.
Calling Names = no television for the rest of the day.
Making Bed: star on reward chart.
Setting Table: Pick a book from library.

What forms of discipline do you use working with children?

USING TIME-OUTS FOR NANNIES AND AU PAIRS

Time-Out Should Not Be Used as Punishment

We have been discussing discipline. We have discussed time-outs. We have encouraged using timers to help positively discipline children. Most nannies, au pairs, and parents seem to use time-outs as punishment for children. When children do not behave caregivers often make the children sit in a “naughty chair” for a designated amount of time (a minute or so).

But, Jodi Pawel, a licensed Social Worker, Certified Family Life Educator, founder of The Family Network http://www.daytonfamilynetwork.com/, President of Parents Toolshop Consulting http://www.parentstoolshop.com/ and author of 100+ parent education resources, including her award-winning book, The Parent’s Toolshop, ttp://www.parentstoolshop.com/HTML/book.htm explains that time-outs should be used to help children gain control of their emotions rather than as punishment. She does not encourage caregivers to use timers.

The Parent’s Toolshop
By Jodi Pawel
http://www.parentstoolshop.com/HTML/book.htm

Many [caregivers] use the same type of discipline for every problem situation. One tool, however, is rarely effective for all situations. Plus, overusing one particular tool also reduces its usefulness. Time-out is just one tool -- and it really isn't a "discipline" tool; it's an effective anger-management tool. Since the purpose of a time-out is to help someone regain control, it is most appropriate to use when someone has lost self-control or there is extremely disruptive behavior.

Most adults have the mistaken idea that the whole point of sending children to time-out is to make the child suffer for their misbehavior. "You go to your room (or chair) and think about what you did." The tone of voice usually implies, "and you suffer." Imposing suffering only brings on more resentment and power struggles. Effective discipline, however, teaches children lessons from their poor behavior choices, rather than punishing them.

If you want time-outs to be constructive, try following these guidelines:

Develop a plan in advance. Teach children during a happy time about the value of a cooling-off period. Say, "When you feel like you're going to lose control, you can go (specify the place) and do something to make yourself feel better. Then, when you feel better, come out and we can work on a solution."

Teach children how to regain self-control. Suggest things the child can do to calm down while in time-out. Older children can help decide where to go and what they can do to help themselves calm down.

Allow the child to play. Many [caregivers] are upset when they find their child playing during time-out, but it's actually a good sign that the child has regained self-control. If they are ready to play, children might also be ready to do some problem solving.

Select a location for the time-out. Some children calm down faster when they are alone and in a quiet place. Other children have too much energy to be forced to sit still. Some children become more out-of-control and hurtful when they are forced to spend time-outs alone. These children can cool off in the same room as other people, as long as they aren't disruptive.

Some [adults] hesitate to use a child's room for fear the child will view the bedroom as a prison. If the time-out is initiated kindly and the goal is to give the child and you some quiet space, children won't see it as punishment. If you feel the child will be destructive, plan ahead and remove or put objects you don't want destroyed out of reach.

If you force a child to stay in a chair or room, it shifts the focus from what they did and their responsibility for calming down to who is in power. This turns the time-out into a punishment, which removes its effectiveness.

Present time-outs as a choice. A child can choose to settle down or take some time-out. Suggest the time-out in a kind and firm manner, followed by the encouraging instructions to come back when the child is ready.

Avoid timers. Use the child's ability to regain self-control or willingness to act appropriately to decide how long a time-out should last. Timers often turn time-outs into power struggles. If children have calmed down and are ready to return but parents won't let them "come out," it often escalates the situation. If children return before they have calmed down, firmly but kindly return them to the timeout and reemphasize the purpose is to cool off. Describe the behavior you want to see that shows they are calm.

When a time-out is over: If the child lost control due to anger, let it go and don't call attention to the behavior you want to stop. If the problem is serious or recurring, wait until both of you have calmed down and then use problem solving to generate ideas for handling the situation differently in the future.

Think about your long-term goal. If you want children to learn that it is their responsibility to control their behavior, use timeouts as cooling off periods which teach children how to achieve this self-control.

Do you use time-outs effectively working with children?

CREATIVE WAYS TO ENCOURAGE CHILDREN TO BEHAVE

Fun Ways to Reward Children

We started discussing positive discipline last week. Here are some creative ways to encourage children to behave properly.

http://familydoctor.org/online/famdocen/home/children/parents/behavior/201.html

Beat the Clock:
Good method for a dawdling child.
Ask the child to do a task. Set a timer. If the task is done before the timer rings, your child gets a reward. To decide the amount of time to give the child, figure out your child's "best time" to do that task and add five minutes.

The Good Behavior Game:
Good for teaching a new behavior.
Write a short list of good behaviors on a chart and mark the chart with a star each time you see the good behavior. After your child has earned a small number of stars (depending on the child's age), give him or her a reward.

Good Marks/Bad Marks:
Best method for difficult, highly active children.
In a short time (about an hour) put a mark on a chart or on your child's hand each time you see him or her performing a good behavior. For example, if you see your child playing quietly, solving a problem without fighting, picking up toys or reading a book, you would mark the chart. After a certain number of marks, give your child a reward. You can also make negative marks each time a bad behavior occurs. If you do this, only give your child a reward if there are more positive marks than negative marks.

Developing Quiet Time:
Often useful when you're making supper.
Ask your child to play quietly alone or with a sibling for a short time (maybe 30 minutes). Check on your child frequently (every two to five minutes, depending on the child's age) and give a reward or a token for each few minutes they were quiet or playing well. Gradually increase the intervals (go from checking your child's behavior every two to five minutes to checking every 30 minutes), but continue to give rewards for each time period your child was quiet or played well.

Will you try using these ideas to encourage good behavior with your charges? Do you have other ways to encourage good behavior in children?

Performance Czar Killefer Withdraws Candidacy

Nanny Tax in the News Again
By Laura Meckler, Wall Street Journal

http://online.wsj.com/article/SB123367405418643627.html?mod=googlenews_wsj

Nancy Killefer, nominated by President Barack Obama to be the federal government's first chief performance officer, is withdrawing from the post, the White House said Tuesday.

Ms. Killefer is the third Obama nominee to confront tax problems. Treasury Secretary Timothy Geithner was confirmed despite disclosure about his failure to pay certain taxes. Tom Daschle, Obama's pick for Health and Human Services, is under scrutiny for his delinquent payment of some $140,000 in taxes and interest.

Ms. Killefer, 55 years old, failed to pay employment taxes on household help for a year and a half the Associated Press reported. In 2005, the AP said, the District of Columbia filed a $946.69 tax lien on her home for failure to pay the unemployment compensation tax. The error was resolved five months later.

An administration official confirmed that she is withdrawing over a tax problem. The official said that the matter surfacing during the vetting that took place before her nomination was announced and the Obama team decided to move forward anyway.

"But the environment changed," the official said. "On the heels of Geithner and Daschle, she just didn't want to go through with it."

What are your feelings on the topic?

Witness to Nanny Abuse: Responding to a Bully

What Would You Do if You Saw a Mom, or Her Child, Berating the Family Nanny?

ABC Show Tonight

By K. MICHELLE SMAWLEY

http://abcnews.go.com/WhatWouldYouDo/story?id=6762596&page=1

Have you ever worked for an unfair boss, or witnessed someone talking to their employee in a way that made you uncomfortable, angry or scared?

You are not alone. A survey taken by Domestic Workers United found that almost half of working Americans have suffered or witnessed workplace bullying.

Watch the story on ABC's "What Would You Do?" on Tuesday, Feb. 3, at 10 p.m. ET.

ABC's "What Would You Do?" decided to find out how people would react when they saw a nanny mistreated by an abusive employer.

"What Would You Do?" set up hidden cameras at a popular neighborhood coffee shop, Ozzie's Coffee, in Park Slope, Brooklyn. In the midst of the latte rush hour, a nanny walked in with a little girl to meet up with the girl's mother.

There was nothing out of the ordinary here, except that the three actors had been hired by ABC as part of a social experiment about abuse of power. After a friendly greeting it became clear that mom wasn't happy with the help.

Our actor playing the tyrant mother noticed a stain on the little girls' shirt. The nanny tells her it was an accident. But the actor portraying the girl's mother wasn't buying it.

"I don't pay you to have her look like this, do I, do I? You know what, I don't want to hear any more excuses from you, you're useless, and a moron. I'm so mad right now I can freaking hit you," she said.

All of this was within earshot of a room full of unsuspecting regulars.

50 Cents an Hour

What makes this scenario particularly disturbing is that we spoke with nannies around the country who said that this type of treatment is not uncommon and in fact somewhat routine for nannies at the lower end of the pay scale.

Erline Browne has worked as a nanny for more than 15 years and served as a consultant during our shoot. She argued that there is wholesale disrespect for the profession.

"It's looked at, that you're doing this because you can't do anything else. If you could do real work, then you'd be out there doing real work. You're doing this because you're uneducated, you're useless," she told ABC.

Browne has interviewed hundreds of working nannies as a member of Domestic Workers United, a group in New York State that works to establish fair labor standards for domestic workers.

"There was one lady who I represented and she was pushed down some steps, she was also thrown out of a moving car into a pile of snow. There was another nanny that was working 70 hours, getting 50 cents an hour and sleeping on the floor on a thin mat," she said.

Joe Magee, an assistant professor at the Wagner School at New York University, researches power dynamics.

"People who have a lot of power, I think we tend to think aren't that nice, and I think that there is some truth to that," he said.

"Because most of what we find in our research on power suggests that you get a little bit more selfish, you get a little bit more focused on your own goals. You're less apt to think about other people's needs and values."

'I Could Just Slap You'

Inside Ozzie's Coffee we continued our experiment and "mom" began ordering the "nanny" around. "I need you to get me water, NOW."

"Just a bottle of water?" the nanny asked.

"Well I don't want it in my hand, do I?" the mother snapped back. During this exchange a man sitting right next to our actors was well into the New York Times and ignored our actors, so we decided to step it up notch.

Mom begins to berate the nanny about a long list of tasks, most of them not related to child care, another common complaint of working nannies. She adds insult to injury and tells the nanny that she will not pay her for the week. The man at the next table casts a few furtive glances over at our actors but mostly buries his head further and further into newspaper.

Finally mom lost her temper completely.

"I pay you to do what I ask you to do. Do you hear me? Do you hear me?!" she exclaimed, and then grabbed the nanny by the arm. At this point the man at the next table simply turned his head away. He had been listening to the abuse for 15 minutes and never once intervened, even after the mother became physical. The actors refused to give up even though the scenario was taking a toll on them. Mom began to scold the nanny because she forgot to bring a package to the coffee shop.

The dressing down took on an ominous tone. "I could just slap you across the face, because I'm so pissed off at you right now. You're useless and you're worthless," she yelled out. A woman from across the room had finally had enough, "Whoa whoa whoa, don't call her worthless," she yelled back.

"It's none of your business," our actor said, egging her on.

The bystander walks over to the mother, "Then don't do it in a public place. You treat your employee like this? You're repulsive," she says and walks away.

We caught up with the woman outside and she was still reeling from the experience.

"I felt like she was getting abused, definitely," she said. "And then I felt like it was inappropriate to do that in front of other people. She's lucky that I didn't throw the coffee all over her computer and her and her little daughter."

Confronting a Bully

For the two days we shot in Ozzie's Coffee, more than 250 people witnessed our scenario and we saw some incredible acts of generosity. One woman offered the actor playing our nanny her phone number so she could help her find another job. Another woman moved to action gave the nanny $40 to get home after she overheard the mother threatening not to pay her. But we were surprised at how few people actually got involved. Most would only respond after they were provoked or when the abusive employer left the scene.

Magee was not at all surprised that so few people directly intervened. "I think approaching the abuser is very difficult because one of the things going through people's minds is, what's the risk for me here if I confront this individual? And with an abuser, who is acting in a nasty way, we get concerned that we might be under threat if we confront that person."

A Young Tyrant

We decided to take our experiment one step further and decided to see what would happen if the one doling out the abuse was a child. Our actors walk into Ozzie's Coffee, one a nanny, the other a little girl under her care. The nanny told the little girl to get off the phone, "I need to talk to you, you need to hang up now," she says. "My stupid nanny wants to talk to me, my stupid nanny," the little girl tells her friend on the phone and reluctantly hangs up.

So far no one intervened, so our young tyrant gave it another shot and began berating the nanny.

"My mom pays you to be a good nanny. If you weren't so worthless &" the little girl continued to berate her caretaker.

Not long into this tirade a man walks up to the actors' table, "Why are you treating this woman like this, she's taking a lot of abuse from you," he said.

"Well sir, I don't think this is any of your business," our actress replied firmly.

"Do you own her?" he asked.

"Yeah, my parents pay her," the little girl replied nonchalantly.

"You're lucky you're not my daughter, because I'd take care of you," the bystander countered and then he walked out of the coffee shop.

Browne says that in her line of work it is becoming increasingly common for kids to act out, mimicking their parent's behavior. Her organization, Domestic Workers United, is lobbying the New York legislature to combat the abuse and advocate for benefits.

"Sick days with pay, health insurance, which is very important, personal days ... There are a lot of nannies, when they ask for time off to go and have a mammogram, they're fired," she said.

Magee offered advice to all employees who find themselves working in an abusive environment: "I think in any employment relationship the first thing you want to do is, have a conversation. If that doesn't work, next thing I would do is to document the incidents that happen because at least that gives you some legal recourse. And the third thing is to use your base of power, which is the labor market. You can always walk away from that job as long as you can find another one."

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