Health Care and Bedwetting

Soggy sheets and pajamas — and an embarrassed child — are a familiar scene in many homes. But don't despair. Bed-wetting isn't a sign of toilet training gone bad. It's often just a developmental stage. Bed-wetting is also known as nighttime incontinence or nocturnal enuresis. Generally, bed-wetting before age 6 or 7 isn't cause for concern. At this age, nighttime bladder control simply may not be established. If bed-wetting continues, treat the problem with patience and understanding. Bladder training, moisture alarms or medication may help reduce bed-wetting, according to the Mayo Clinic.

A number of things can cause bed-wetting, according to FamilyDoctor.org. Some of the more common causes of bed-wetting include the following:
•Genetic factors (it tends to run in families).
•Difficulties waking up from sleep.
•Stress.
•Slower than normal development of the central nervous system (which reduces the child's ability to stop the bladder from emptying at night).
.•Hormonal factors (not enough antidiuretic hormone is produced, which is the hormone that slows urine production at night).
•Urinary tract infections.
•Abnormalities in the urethral valves in boys or in the ureter in girls or boys.
•Abnormalities in the spinal cord.
•A small bladder.

Bed-wetting is not a mental or behavior problem. It doesn't happen because the child is too lazy to get out of bed to go to the bathroom. Children achieve bladder control at different ages, according to Family Doctor; and by the age of 6 years, most children no longer urinate in their sleep. Bed-wetting up to 6 years of age is not unusual, even though it may be frustrating to parents. If a child is younger than 6 years of age, treatment for bed-wetting usually is not necessary. Although most children who wet the bed are healthy, your doctor can help you determine whether your child’s bed-wetting is caused by a medical problem. First, your doctor will ask questions about your child's daytime and nighttime bathroom habits. Then your doctor will do a physical exam and probably a urine test (called a urinalysis) to check for infection or diabetes.

According to Family Doctor, your doctor may also ask about how things are going at home and at school for your child. Although you may be worried about your child's bed-wetting, studies have shown that children who wet the bed are not more likely to be emotionally upset than other children. Your doctor will also ask about your family life, because treatment may depend on changes at home. Your doctor may give your child medicine if your child is 7 years of age or older and if behavior therapy has not worked. But medicines aren't a cure for bed-wetting. One kind of medicine helps the bladder hold more urine, and the other kind helps the kidneys make less urine. These medicines may have side effects, such as dry mouth and flushing of the cheeks.

The most important reason to treat enuresis is to minimize the embarrassment and anxiety of the child and the frustration experienced by the parents, according to Medscape.com. Most children with enuresis feel very much alone with their problem. Family members with a history of enuresis should be encouraged to share their experiences and offer moral support to the child. The knowledge that another family member had and outgrew the problem can be therapeutic. A positive attitude and motivation to be dry are important components of treatment. Children with enuresis benefit from a caring and patient attitude by their parents; punishment has no role. A positive approach by the physician is also important to instill confidence and enhance compliance. Many children have given up on the concept of dryness, and an optimistic attitude should be encouraged. Behavioral modification with positive reinforcement may enhance treatment results. Consistent follow-up is important to gauge the therapeutic results. An explanation of the probable cause of the enuresis is important for every family. If a child has no daytime symptoms or has experienced significant dry spells in the past, the presence of a structural abnormality as a cause of the enuresis is unlikely. This should be explained to the parents to allay any fears about other causes and to reassure that invasive investigations are not necessary. Parents should be asked to provide specific examples of potential causes that have them worried, so that these often irrational fears can be discussed and relieved. Much more detail can be found at this site: http://emedicine.medscape.com/article/1014762-treatment.

Bed-wetting can lead to behavior problems because a child may feel guilt and embarrassment, according to Family Doctor. It's true that your child should take responsibility for bed-wetting (this could mean having your child help with the laundry). But your child shouldn't be made to feel guilty. It's important for your child to know that bed-wetting isn't his or her "fault." Punishing your child for wetting the bed will not solve the problem. It may help your child to know that no one knows the exact cause of bed-wetting. Explain that it tends to run in families (for example, if you wet the bed as a child, you should share that information with your child). Remind your child that it's okay to use the bathroom during the night. Place nightlights leading to the bathroom so your child can easily find his or her way. You may also cover your child's mattress with a plastic cover to make cleanup easier. If accidents occur, praise your child for trying and for helping clean up.

While bedwetting can be a symptom of an underlying disease, the large majority of children who wet the bed have no underlying disease, according to eMedicineHealth.com. In fact, a true organic cause is identified in only about 1% of children who wet the bed. However, this does not mean that the child who wets the bed can control it or is doing it on purpose. Children who wet the bed are not lazy, willful, or disobedient. There are two types of bedwetting: primary and secondary. Primary bedwetting refers to bedwetting that has been ongoing since early childhood without a break. A child with primary bedwetting has never been dry at night for any significant length of time. Secondary bedwetting is bedwetting that starts again after the child has been dry at night for a significant period of time (at least six months). Much more detailed material about bedwetting can be found at this site: http://www.emedicinehealth.com/bedwetting/article_em.htm.
 
According to ChildDevelopmentInfo.com, almost all children outgrow their bed-wetting habit. As children mature, their muscles become stronger and their bladder capacity increases. They tend to sleep less deeply and to become more sensitive to messages the bladder sends to the brain. There are two approaches to treatment: Medical or Behavioral. The medical treatment usually consists of the use of one of two drugs--Imipramine (Tofranil) or Desmopressin Acetate. Behavioral treatment is often more effective and certainly is safer than medical treatment. While behavioral treatment may take somewhat longer to show results, the improvement usually continues indefinitely. More info about treatment can be found at this website:  http://www.childdevelopmentinfo.com/disorders/bedwetting.shtml.
 
Although embarrassing for children, and frustrating for parents, bedwetting can be resolved over time with patience, encouragement, and treatment. Remember that the condition is most likely temporary and should be resolved in time. Talk with your family doctor, and discuss the situation with your child in a non-theatening manner. It's just as much a difficult circumstance for your kid as it is for you. Understanding, common sense, awareness, and love rule the day. Take a deep breath and don't lose control. Keep in mind that you were a child once, too.  

Until next time.

Health Care and Imaging

If you've ever had to get an MRI or go for X-rays, you are familiar with imaging. These tests are performed when medical providers are looking for specific situations concerning your health. Laboratory tests can be valuable aids in making a diagnosis, but, as screening tools for detecting hidden disease in asymptomatic individuals, their usefulness is limited, according to the Encyclopedia Britannica (EB). The value of a test as a diagnostic aid depends on its sensitivity and specificity. Sensitivity is the measure of the percentage of individuals with the disease who have a positive test result (i.e., people with the disease who are correctly identified by the procedure), and specificity is the measure of the percentage of people without the disease who have a negative test result (i.e., healthy individuals correctly identified as free of the disease).

If a test is 100 percent sensitive and the test result is negative, it can be said with certainty that the person does not have the disease, because there will be no false-negative results. If the test is not specific enough, however, it will yield a large number of false-positive results (positive test results for those who do not have the disease). The ideal test would be 100 percent sensitive and 100 percent specific; an example would be an early pregnancy test that was so accurate that it was positive in every woman who was pregnant and was never positive in a woman who was not pregnant. Unfortunately, no such test exists. The normal value for a test is based on 95 percent of the population tested being free of disease, meaning that 1 out of every 20 test results in healthy individuals will be outside the normal range and therefore positive for the disease, according to EB.

Hippocrates immersed his patients in mud; and where the mud dried first, it was an indicator of disease for him. The ancient Egyptians moved their hands across the surface of the body to scan and monitor changes in temperature distribution, according to Thermology.com. Modern physicians around the world now use infrared thermal imaging cameras with their computers to provide very high technology evaluations of patients. The health applications are numerous and important. With non-invasive infrared thermal imaging, it's very easy to evaluate the physiology of the human body. In a living subject, such as a human being or animal, the changes in blood flow to an area result in a measureable thermal response. These temperature differences appear as color gradations based upon increases or decreases in the thermal activity of the various anatomical areas. This has even applied to environmental studies, crop studies and other biological areas.

The formulation of an accurate diagnosis is often facilitated by the use of lighted optical scopes and diagnostic imaging technologies, according to EB. Procedures such as endoscopy, laparoscopy, and colposcopy make use of generally flexible optical instruments that can be inserted through openings, either natural or surgical in origin, in the body. Many scope instruments are fitted with small video cameras that enable the physician or surgeon to view the tissues being examined on a large monitor. A number of scopes also are designed to enable tissue biopsy, in which a small sample of tissue is collected for histological study, to be performed in conjunction with visual analysis.

One of the most commonly employed diagnostic technologies is x-ray imaging, according to EB. X-rays are highly effective for obtaining images of bone or other specific tissues. However, their inability to distinguish between different tissues of similar densities limits their applications. Several highly specialized imaging techniques, such as computerized axial tomography (CAT), magnetic resonance imaging (MRI), and positron emission tomography (PET), have largely supplanted traditional X-ray methods. However, when X-rays are used together with special contrast agents, they are capable of imaging select tissues, such as arteries and veins in angiography and the urinary tract in urography.

Digital Infrared thermal imaging or electronic telethermography, is one of the few available physiological tests for physicians, according to Thermology.com, and is in use throughout the world for the adjunctive or supportive evaluation of the following conditions, non-invasively:
--Breast / thyroid.
--Peripheral vascular.
--Cerebral vascular.
--Musculoskeletal.
--Inflammatory.
--Neoplastic conditions.

According to EB, other diagnostic procedures employ electrodes, transducers, or sound waves to produce graphs or traces that provide information about the function and structure of certain organs. For example, in electrocardiography special electrodes connected to a recording instrument are applied to the body; this enables a graphic tracing of the electric current in the heart. Electrocardiography provides detailed information on the condition and performance of the heart. A procedure known as echocardiography relies on the transduction of sound waves into electrical signals to record information about heart structure and function. This technique makes use of the ability of high-frequency sound waves to penetrate through tissues. The use of these sound waves also forms the basis of the diagnostic procedure of ultrasound, which is most commonly used to examine fetuses in utero in order to ascertain size, position, or abnormalities

There has always been a discussion about thermal imaging systems and the requirements for protocol as recommended by various professional groups in the field. When discussing protocol, it's important to note that this is a user defined safety net that's created to assist the health and scientific field, in this case, to eliminate technician error in the process of capturing a thermal image. It's very much subject to change as technology evolves and processes become redundant. The instrument used for medical applications is going to have very different requirements than that being used in the industrial or military sector. With the explosion of infrared thermal imagers on the market for all types of applications, the medical or health care area remains very specific with its requirements for obtaining high quality and consistent thermograms. Imaging environment controls, patient or subject preparation, capturing capabilities, technician training, and image processing features are all factors to be considered with usage of an infrared thermal imaging system, and vary greatly between medical and industrial infrared imagers. The knowledge level required for operating controls reliably at the time of imaging is also a factor. This is particularly relevant when taking images over time and making comparisons. In the health care field, this is important to make appropriate evaluations that guide the diagnostic process, and not leave much room for error, according to Thermology.com.

According to HealthcareTechGuide.com, the 21st century cardiology department is part clinical wonder, part IT marvel. Clinical leadership aside, at the heart of the business of cardiology today are physicians, administrators and IT professionals who have carefully examined clinical processes, optimized clinical and operational workflow, improved billing, created benchmarks and engineered cost savings. Physicians need anytime-anywhere access to images and reports to make instantaneous, well-informed patient care decisions. Changes in the healthcare provider segment of the healthcare industry are having an impact on storage and IT infrastructure. As providers shift from legacy paper-based processes to automated tasks enabled via healthcare applications, more patient information is born online. Applications including PACS, electronic medical record (EMR), document imaging, integrated patient records, and physician order entry are all causing increased storage demand. As these applications are used by personnel to treat patients, the reliability, recovery, and availability of data they manage become paramount.

When your doctor prescribes an MRI, UltraSound, X-rays, or other imaging procedures, the reason for it is to help you with his search to make you better. Health care is expensive, and much of the costs are driven by new developments in technology. The end result is that those machines continue to improve in quality and the ability to assist the medical community to diagnose and treat various diseases or medical issues. However, wouldn't you rather have the modern wonders of imaging, cost factor aside, to make sure you get the most complete and proper reporting available? Just think, in the early 20th century, a mere 100 years ago, the vast majority of medicine was still guesswork when it came to diagnosing ailments within the body. Short of cutting you open, and that in itself a life threatening situation, there was very little ability for physicians to find out what was going on inside you. Today, with the advent of digital technology and more accurate test results, the mortality rates for many diseases once considered incurable have been vastly reduced. And the accuracy of tests continues to improve with every new generation of equipment approved for the health care market. Although not perfect, medical imaging processes have improved over time to current day abilities that have dramatically transformed health care. Imaging tests can be expensive and intimidating to many individuals; however, the end results are very much worth all efforts to preserve your life and improve your health.

Until next time.

Health Care and Home Health Aides

Families searching for home health aides, companions, eldercare givers, personal care attendents and housekeeping staff know how important it is to select the right support staff for their loved ones, according to 4HomeHealth.com. When you have elderly relatives that require care, and nursing homes are not an option, home health aides can be a real help to offset the lack of available time you have to monitor the health and safety of those individuals. If you work for a living out of the home, and your time is extremely limited during the day, care giving for those who need supervision during your absence. American families today are challenged to find balance between their professional lives and their personal lives. Parents working outside the home need childcare.

 

American families need help in the home, whether a full time housekeeper, household manager, personal assistant, or a regular cleaning service. Care for elderly family members needs to be located. Can you trust your nanny applicant, the person applying to help your mother at home, your housekeeper? Children and the elderly are our most vunerable family members. Families that employ staff in their homes become employers in the eyes of the Internal Revenue Service and their state's Department of Labor. All these issues, and more, are worth investigation and require due diligence by a reputable company who can assist you in making these types of decisions.

 

A Home Health Aide (HHA) may also be known as a Home Caregiver, Certified Nursing Assistant (CNA), Patient Care Technician or Residential Assistant (RA), according to CityTownInfo.com. An HHA provides basic, personal care and health-related services to a variety of individuals (patients) who require more assistance than family and/or friends are able to provide. HHAs are part of a category of occupations that is commonly referred to as "direct care workers." The services/care that a Home Health Aide provides depends upon their specialty area. A registered nurse (RN), physical therapist (PT), other health professional, social worker, or home health agency generally gives assignments and duties to a home health aide. For each patient, an HHA is responsible for recording services performed, as well as the patient's condition and progress. They also record and report any changes in a patient's condition to the case manager or supervisor and also discuss observations with them.
The types of patients with whom a home health aide may work include:
•The elderly.
•Physically disabled.
•Terminally ill.
•Convalescent persons.
•Hospice patients.
•Individuals with long-term illness.
•Adults with mental disabilities (e.g., Alzheimer's disease).
•Children with mental illness.

Home health aides generally work in a patient's private home or residential care facility by assisting with, and performing, a variety of duties that include:
•Checking temperature, pulse, and respiration rates.
•Changing (surgical) dressings.
•Assisting with prescribed exercises.
•Helping to move patients in and out of bed, chairs, baths, wheelchairs, and autos.
•Administering prescribed medications.
•Providing psychological and emotional support.
•Reading aloud to, or conversing with, patients (for mental health maintenance).
•Purchasing and preparing meals (at times following a prescribed diet).
•Dressing the patient.
•Grooming the patient.
•Personal hygiene (e.g., bathing the patient).
•Changing bed linens.

Home health aides also perform a variety of housekeeping chores such as cleaning, laundry, and grocery shopping. Also, depending on their assignment, an HHA may be responsible for picking up prescriptions and/or transporting a patient to scheduled doctors' appointments, or any other venue the patient wishes to go. While some HHAs work part-time, the majority work a full-time, 40-hour work week. Many may also work nights, evenings, weekends, and holidays for patients who require round-the-clock care. If not self-employed, Home Health Aides are typically employed by state or county welfare agencies, or private home health agencies. More often than not, home health aides have heavy workloads that include physical demands such as walking and standing for long periods of time. Also, because an HHA may be required to move clients from one spot to another and assist in standing and walking, it is very important that they learn and practice correct procedures for lifting and moving patients. Other hazards that an HHA may encounter in this occupation include minor infections and major diseases (e.g., hepatitis). It is important to note, however, that infections can be avoided by adhering to proper procedures. There are also duties performed by an HHA that most individuals would consider unpleasant, such as changing soiled bed linens and emptying bedpans.

Most home health aides simultaneously work with a variety of patients where the duration of each assignment may last anywhere from a few hours, days, or weeks. During a given day, many will drive from one patient to another. There are also HHAs who work with the same patient at their residence for many months or years.
While physical and emotional demands are part of this occupation, most HHAs find it gratifying to enhance the lives and help those in need. Individuals in this profession must possess and exude the following characteristics, attributes, and abilities:
•Patience.
•Dependability.
•Precision and accuracy.
•Emotional stability.
•Sensitivity.
•Honesty.
•Discretion.
•Strong communications abilities.
•Good physical health (including strength to lift, carry, push, pull).
•Service oriented.
•Socially perceptive.
•Problem recognition/sensitivity/solving.
•Ability to work as part of a team.

The U.S. Department of Labor Bureau of Labor Statistics (USDL BLS) projects that overall employment for home health aides is expected "to grow 50 percent between 2008 and 2018, which is much faster than the average for all occupations." Growth will vary between these individual occupations. Furthermore, according to the USDL BLS, for Home Health Aides specifically, the following factors will contribute to the "much faster than average employment growth:"
•Increasing demand from the aging population for in-home services.
•Cost containment efforts focused on moving patients (as quickly as possible) out of nursing care facilities and hospitals that have higher inpatient costs.
•Preference by consumers for in-home care services.
•Medical technology advancements for in-home treatment.

While neither a high school diploma nor formal education is a requirement in this profession, it is advantageous for an individual to have at least achieved a high school diploma or equivalent. Some employers provide classroom training for new hires, but most individuals receive on-the-job training under the tutelage of RNs, Licensed Practical Nurses (LPNs), or other seasoned/experienced HHAs. The latter form of home health aide training may take anywhere from several days to a few months to complete. Other training available to home health aides includes workshops, lectures, and in-service training. Once an HHA completes training, it is not uncommon that they be required to go through a competency evaluation to ensure that they can properly perform required tasks, according to CityTownInfo.com.

It is important to note that HHAs, who work for employers who receive Medicare reimbursement, must adhere to specific Federal Government guidelines. As such, HHAs are required by Federal law to pass a competency test that covers a wide range of disciplines; training may be obtained beforehand. Furthermore, a Home Health Aide may seek voluntary certification from the National Association for Home Care and Hospice (NAHC). Licensing as a Certified Nursing Assistant (CNA) may be required by some states. When it comes to advancement, opportunities are limited. Moving on to health occupations generally requires formal education or training. Most HHAs move on to become RNs, Medical Assistants, or LPNs. If not self-employed, HHAs will find employment with state or county welfare agencies, private home health agencies, social assistance agencies, health care services, and nursing and residential care facilities. Typical Home Health Aide Programs May Include Courses in:
•Geriatric Skills
•HIV/AIDS Awareness Training
•Introduction to Body Systems
•Introduction to Nutrition
•Introduction to Physical Therapy
•Occupational Therapy Aide Training
•Patient Communication
•Patient Mobility
•Patient Personal Care
•Phlebotomy
•Recording Vital Signs
•Respiratory Equipment Training
•Respiratory Therapy Aide
•Understanding Vital Signs
•Uses of Basic Laboratory Equipment

Finding and hiring a HHA company or individuals is a task that can take time. Working with reputable sources helps to define who will take care of your loved ones. Make sure you do your homework, or work with someone who is knowledgeable in this field and can advise you about this decision. Although relatives, volunteers from your church or other organizations are helpful, in most cases you will need professional assistance--personnel trained in home health care. Your family deserves the best attention available within your resources to provide care if you need help or are unable to perform the responsibilities required to be a care giver.
 
Until next time.

Health Care and Child Care

As a new parent finding child care for the first time, or a family attempting to find a new provider, locating high-quality child care might be easier said than done, according to ChildCare Aware.org. There are many things to consider before selecting a child care provider. Whether you're just beginning your search for child care, as a new parent, or you're attempting to locate a new provider, locating high-quality child care can be tricky.

According to Childcare.About.com, There are certain pieces of basic information that must be provided for caregivers, whether using a sitter for the afternoon or enrolling your child at a weekday day care center. This goes double for a child with special needs. While it's not necessary to divulge every detail of your child's history, you should make sure the provider has enough information on hand for their day-to-day care -- and in case of emergency. Your phone number and a doctor's phone number are just the minimum. Once created, keep the list saved on your computer where it's easy to update and print more as needed.

The child care resource and referral agency (CCR&R) in the area where you now live can help you find available and affordable child care and early education in your location, according to ChildCare.gov. Contact Child Care Aware, a free, Federally funded service, at http://www.childcareaware.org/  or at 800-424-2246 to find a local CCR&R. The local CCR&R may also be able to help you find out if you qualify for free or subsidized child care. Links to State CCR&R agencies are available on the NCCIC Web site at http://nccic.acf.hhs.gov/statedata/dirs/display.cfm?title=ccrr . And a list of all state agencies can be located here:  http://nccic.acf.hhs.gov/statedata/dirs/display.cfm?title=ccdf.

Here are some tips, according to Child Care Aware, to locate quality child care facilities and care givers:

1. Start Early:  Start looking as far in advance as you can. No matter what type of care you are considering - a child care center or care in someone else's home - finding the right child care option can take some time.

2. Make a Call:  Begin your search by calling your local experts - your child care resource and referral (CCR&R) center. CCR&Rs can give you the facts about child care, and a list of child care options in your area that may meet your needs. In addition to what is in this brochure, make sure to ask your CCR&R these things:
•What are the licensing requirements in my area?
•How can I get information about complaints and licensing violations?
•Are there any child care financial assistance programs that my family qualifies for?

3. Visit and Ask Questions:  Make sure you visit the child care options you are considering. Find out about these key indicators of quality:

•Adult to Child Ratio: Ask how many children there are for each adult. The fewer the children for each adult, the better for your child. You want your child to get plenty of attention. The younger your child, the more important this is. Babies need an adult to child ratio of no more than 1:4 (one adult for four infants), while four-year-olds can do well with a ratio of 1:10 (one adult for ten children).•Group Size: Find out how many children are in the group. The smaller the group, the better. Imagine a group of 25 two-year olds with five adults, compared to a group of 10 with two adults. Both groups have the same adult to child ratio. Which would be calmer and safer? Which would be more like a family?

•Caregiver Qualifications: Ask about the caregivers' training and education. Caregivers with degrees and/or special training in working with children will be better able to help your child learn. Are the caregivers involved in activities to improve their skills? Do they attend classes and workshops?

•Turnover: Check how long caregivers have been at the center or providing care in their homes. It's best if children stay with the same caregiver at least a year. Caregivers who come and go make it hard on your child. Getting used to new caregivers takes time and energy that could be spent on learning new things.•Accreditation: Find out if the child care provider has been accredited by a national organization. Providers that are accredited have met voluntary standards for child care that are higher than most state licensing requirements.The National Association for the Education of Young Children (NAEYC) and The National Association for Family Child Care (NAFCC) are the two largest organizations that accredit child care programs.

4. Make a Choice: Think about what you saw at each visit, and make the best choice for your child and family.

5. Stay Involved: The work isn't over when you find good care for your child. You and your child's caregiver are partners now. Here are some ways to be involved:
•Have parent-caregiver meetings regularly, and ask questions.
•Offer to volunteer time when needed, like participating in clean up days, fixing broken toys.
•Be there for your child's birthday party.
•Visit your child at child care and read a book aloud.
•Join in special events, like field trips, Career Day, Black History Month, or other holidays. Even if you can't get time off from work during the day, you can still check in at drop-off and pick-up times. Ask the caregiver how things are going, and how your child is doing. Visiting and participating in events at your child's provider sends a strong message. It tells your child and your child's caregiver that you think what your child is doing and learning is important.

After returning to work from maternity leave, many new mothers will start to worry about their company's "mommy track", or the work-life balance your company gives working mothers. Balancing your home life with the rigors of a pressure-packed work environment, according to Childcare.About.com, is not for everyone and talking to other working moms in the company will provide a good idea of what the future will hold. If the company you currently work at seems too demanding and would take away from what you need to do at home, perhaps a more easy going employer and a relaxed working environment will give you what you need to provide for your family while having the time and energy to be a great mom at home.

If you are having difficulty finding good child care, according to Child Care Aware, here are a few guidelines that may help in your search:
--Stay in touch with your CCR&R referral specialist, ask them to keep thinking about what might work for you.

--Look in a different location; on your way to work, near work, or near a public transportation stop on your route to work, try a different route to work.
--Talk to friends, neighbors, people at your library, church or community center who may have faced the same problems. How did they solve them?
--Discuss your child care need with your employer and with co-workers. If many of you are having the same difficulties, your employer needs to know.
--Make a short term plan for child care, but keep working with your local CCR&R till you find the kind of care you're looking for.
--Get on the waiting list at every program that would work for you. Sometimes openings come up unexpectedly.

Good child care can be expensive, and often may be difficult to find. However, remember that they work for you. When the care of your child is left up to others, make sure that you are comfortable with your choice, and that whomever is watching your child can be trusted. If you pay for services, then expect the best. If you don't do your homework, your child can suffer from poor choices that you make. Good due diligence when selecting great care for your child provides safety and comfort for your child, and peace of mind for you.

Until next time.