Child Care Options, Discipline, Eczema, Torticollis and Plagiocephaly From Our Members… Originally printed in July, 2006 Question: My husband and I are starting to look into our child care options. I was wondering what most families are doing. Is one parent staying home, nanny, daycare? ~Robin C. I went back to work part-time when my kids were 15-months old. Since then, they go to daycare three days per week. The kids really love the daycare. They do lots of activities that I couldn't easily do at home. They have art every day and go outside once or twice a day. There is also a large indoor play area for days with bad weather. I have seen their self-confidence really skyrocket and I think the daycare has helped them to keep up with their peers developmentally. The negatives are that they get sick A LOT. This past winter they had a cold pretty much every week. Unfortunately, they also got ear infections and RSV, which they got through relatively well. The illness factor is a biggy depending on how old your kids are and their health. Now that it is spring, they are doing much better. It is also extremely expensive. We pay about $2,200 per month total for all three to attend. I have heard of other triplet mothers who hired one or more students from a local community college to act as nannies. Often the mother or trusted relative, such as a grandmother, would co-nanny with the student/s for a few weeks to see how it goes. Ideally, it would get to the point that a relative and a student or two students could watch all three kids. An au pair is less expensive than a nanny, but I think triplets would be a large workload for one young adult. If you hire a full-time nanny, I believe you also have to pay their benefits and employer taxes. I decided that since my kids were over a year, I would rather have them in an environment with other children, but then, we also deal with the illnesses. I really liked being home with my kids for the first year. It was definitely the hardest job I have ever had, but was glad to be home. I also really liked going back to work part-time when they were 15-months! If your kids are still infants and you need child care, I would recommend care either in your house or at a small in-home daycare because of the illness factor. If your kids are older, I would recommend a larger daycare. Everyone has their own approach. ~Marsha M. I have had a very similar experience to Marsha. We had in-home nanny child care until our kids were about 22-months. We started them into a large daycare center and the pros and cons are exactly as she stated. The illness factor is huge. I'd say if your kids are less than a year old, you're better off with in-home care for that very reason. I think the cost is about the same. Our nanny was 22 and had some early childhood ed experience. She was wonderful with the kids and they formed a great attachment to her, but I can say that it was too much for her to care for all three of them for a full 10-hour day. We had to have supplemental help for her in order to make it work. Alternatively, you might be able to find a really experienced nanny that can handle all three at once. No matter what you choose, it's a hard decision. You will always have some sort of guilt or worry as you go off to work, but going to work is good too in many ways. ~Jenny L. Although I am a stay-at-home mom, we also have an au pair. My kids are two and we've had au pairs since they were just a few months old. For our family, it has worked out very well. The au pairs (two of them, each here for a year) have been very well trained and have been great with our kids. While they are not trained professionals, they are an affordable, reliable way to go (if you have the space for them to live in your home). I like it a lot because 1) you can determine the work schedule every week and it can change day to day. They can work up to 10 hours per day, 45 hours per week. 2) With her help, we go lots of places each week, from the mall to the playground. I always have an extra set of hands. 3) For the amount of hours/help you get, it is one of the most affordable ways to get help. 4) With proper training, I am able to leave the au pair home alone with my kids for several hours at a time. I do not usually leave her for more than three hours alone (unless the kids are sleeping). She is able to take them for walks in the triplet stroller, feed them, and entertain them. I could probably leave her for more than three hours, but I feel too guilty!!!! ~Melissa R. I agree with some of the other remarks made, but here are a few things to consider: 1. Getting sick in daycare: If your children have an older sibling in school, they have pretty much been exposed to a school environment already, via microbes brought home. If there's no older sibling, then yes, that first year is really tough. But it's going to happen sooner or later, anyway. 2. [Finding] a nanny for three children is very hard to do. I have interviewed sooo many nannies and have found maybe one or two even willing to watch three babies/toddlers all at once. It is really too much for one person. You might try an assistant nanny or family helper/babysitter to pair with your nanny. 3. Whichever way you slice it, daycare or nannies, its very expensive. Often church-sponsored daycare is cheaper, if you are comfortable going that route. You can see if your town/city has subsidized day care. More important than anything is the confidence you have that your care givers are warm and loving toward your child and competent. That criteria may make the choice for you. Au pairs are very inexpensive, but the problem again is that its one person who is new to the country, needs a little mentoring herself, and you, unfortunately, can't "try her out" before she comes over. You can talk on the phone and call references. I know a number of people who are very happy with their au pairs, but none of them have multiples. If you can stay home the first year, I agree, its a great thing to do for your babies, especially preemies. If not, you can try sources for babysitters such as churches, hospitals, local colleges/high schools, Craigslist (www.craigslist.com) and definitely always get references to call. The problem I have found with Craigslist is that young people are nomadic and can't commit long-term, but you can be clear about what you need in your posting. ~Michelle N. Question: My kiddos have hit those terrific twos and are testing the boundaries. When I try to discipline, they think it is funny, at least most of the time. What has worked for you? ~Denise N. Have you read 1-2-3 Magic? You really only have to read a few chapters to get the concept and then the rest is just examples. I have been using this for probably three months now - they don’t have the total concept, but the most important thing is follow through. In brief, 1) tell the child what they did wrong and what the punishment is, whether it's the bed room/time out chair; 2) just say two – don’t say anymore; and 3) just say three and follow through. I know its hard to follow through, but everyone has to be on the same page. ~Marie D. My kids think its funny when I try to discipline them too. If I put someone in a time out, once they get up, another sibling will do the same thing and then go sit in the time out spot and smile. They seem to think its a game. I try to do time outs rarely and reserve them for when they hurt each other repeatedly and don't listen when I tell them to stop. If they continue to be aggressive after the time out, I have on rare occasion sent one upstairs to a bedroom by themselves for a few minutes. They each have separate rooms and I have them stay in a sibling's room (not their own) so it doesn't interfere with sleeping. I have only done this a handful of times but it does work because they really don't like it. It is also good if someone is just all worked up and having trouble calming down. Mostly, though, I find that if after hitting each other I make them go give their sibling a hug, they will stop doing it. I also will tell them that we don't want to play with them if they hit. I also find that they listen better if I give them a reason. For example, I tell them that they can't go in the road because that is where the cars are. When we are in the yard and a car goes by I point it out. ~Marsha M. Question: Our daughter was just diagnosed with eczema. Our problem is that she seems okay during most of the day, as long as her skin is moist from the cream the dermatologist recommended. The huge problem has been at night - she wakes up almost every hour-to-two-hours rubbing her face and eyes and screaming and needs a bottle to fall back to sleep after the cream is applied. No one is getting any sleep. Any suggestions? ~Kathy D. Ask your doctor if it would hurt to give her a little Benedryl. It might help her sleep a little better and may aid the “itchies” too. ~Laurie K. My son had issues with eczema on his face. It started when he was less than a year old (it especially flared up when he was cutting a tooth - very bizarre!). My doctor didn't want to put him on the Elidel because there are higher risks for younger children. She prescribed Hydrocortisone Valerate Oitment USP, 0.2%. That worked great. It took the itch away and cleared it up when he had flare ups. ~Denise N. Our daughter had severe eczema and was prescribed Elidel which we used to clear her up and then only used it if needed. What really helped her as well was the fact that we used Dove hypoallergenic soap and washed the babies clothes in Tide Free and used nothing that had a scent to it. No fabric softeners, scented dryer sheets, skin lotions, etc.. This made a big difference for her. ~Judith M. In case this helps, I have a good friend who has suffered from eczema her whole life. She tried everything and as she is a nurse, suffering a lot because she washes her hands a zillion times a day. In her late 20s, she tried a wheat-free diet and voila, NO eczema. Fifteen years later, if she eats one piece of bread, it comes back. Its all wheat related for her. ~Jeanne S. Ask your doctor about what to use in the bath water. I think we used an oatmeal soothing bath soap by Yardley. Then, when [my son] got out of the water, I creamed him up with Cetaphil moisturizing cream. Look at the ingredients of any of the products; you don't want to put anything on them with alcohol or acid in it. What the dermatologist didn't tell me is that eczema is the first sign of an allergy, so look to see if there are any other signs. [My son] started getting bad reactions when I switched him from breast milk to formula. He had loose stool and seemed to be the one to spit up the most. It didn't get better as time went on and it took another 16 months to find out he was allergic to milk proteins. I know this is a lot at once; I hope it helps. ~Maureen W. My son also had it on his face when he was a baby, to the point where he scratched so much his cheeks got infected/impetigo. I also used .2% prescription hydrocortisone on his face and that worked well (after we controlled the infection). The handout I received from Children's Hospital said not even to use soap in the bath, just lukewarm water and not more than 10 minutes in the water. You can also switch to allergen/fragrance free detergent, all cotton clothes, etc. You can use Cetaphil or Aquaphor, or hydrolated petroleum, which I loved. The eyes are off limits to the hydrocortisone. The good news is that most babies grow out of their eczema by about 10-months of age, as I was told. I went nuts taking dairy, then wheat out of my diet, thinking it might be an allergy [via breast milk], only to have it go away (to a minimal level, anyway) around 10 months, just as my pediatrician predicted. ~Michelle N. Aquaphor has come out with it’s own bath wash, but its very hard to find around here. I use it on [my son] and we seem to have the eczema under control. I also use Norwegian hand cream on the spots and it works great. Do not use this thought if the spots are open. Always check with your pediatrician as some creams can cause more harm. My 3-year old has always had eczema and we have to watch what he eats or it will get worse. ~Mary W. Question: I need some advice on getting a new car. We don't know what kind to get that will fit all three and comfortably. Like many others, we are financially strapped and I also am not very good at handling a very large vehicle. Any advice would be appreciated. ~Jen V. Most of the families I know have one of the following (from my perceptions, anyway): Dodge Caravan, Toyota Sienna, Honda Odyssey, or Chevy Suburban. If you can't handle big vehicles, then the Suburban will be off your list! We have a Ford Explorer and although it has done the job for the past 3 1/2 years... it has not been ideal. Getting a child into that middle seat has always been a back-breaker. In a perfect world, I would have had a) a van with b) stow-and-go seating, c) the drop down DVD players, and c) the power doors. My parents have a Chevy Venture and we have always fit comfortably in that as well, but I don't see the Ventures around as much as I do the Sienna, the Odyssey or the Grand Caravan. To fit three across, I know the Explorer and Expeditions will work. ~Renée R. We bought a 2005 Honda Odyssey about three weeks after our kids arrived. I really did not want to drive a minivan, but it really was the best choice. You can fit three car seats (infant and forward-facing) across the middle seat which allows you to collapse the third seat and easily fit in your stroller. I am still kind of embarrassed to drive a minivan (I am an SUV fan), but it does handle very well and is very comfortable to drive. I also think it is easier to get the kids and stroller in and out of a minivan rather than an SUV where you have to lift everything that much higher. ~Joanne Z. I'm an SUV fan myself. I have a Dodge Durango and LOVE it! I can fit my girls' seats in the backseat perfectly. I also have the third seat (which I always have down) and I can fit my stroller AND groceries in. If you're not very good at handling a large truck like this (you learn to very quickly though), then I suggest a minivan. ~Joann C. I am one of the few who do not own a minivan or SUV. I have a Volvo station wagon that we bought well before we had kids. We found seats that fit across it (we have Britax right now) and I imagine you could as well with vehicles of similar or smaller size. We have three kids so if we had more, keeping the car would likely be unreasonable. As it is, we have had times where we needed to take a second car - for example, if we bring a sitter with us to an outing - but my kids are almost four now and we have managed. I also like the safety of the car I drive, but like any other choice, there are trade offs. And, as has been said many times on these discussion strings, you have to decide what is important and will work best for you. ~Joan S. I use the Dodge minivan regularly and love it. I also have one seat out. I use the Durango when the minivan is in the shop. It is nice, but I am only 5'3 and getting the middle baby in is really difficult. I would not want to have to do it every day. Also, in parking lots, the sliding door on a minivan is wonderful. The swing door on a car/SUV can be hard if some one parks really close to you. ~Annie F. We have a Dodge Grand Caravan with stow-and-go seating which fits all of us. Our other car is a Nissan Extera. It fits all three car seats across the bench and has plenty of room for the stroller. I don't like to drive it because it handles too much like a truck and is really high to get in and out of. The 2005s are bigger than the earlier models, which I don't think would fit the three car seats. Try and do creative financing: trade in with no money down, finance the taxes, take a 7-year loan on the car (I know, it's crazy to take a loan for that long, but you lower your monthly payment and you can pay it off early down the line), or take out some money from your home to buy the car since the interest on a mortgage is tax deductible. One more thing - the minivan is much better on gas than our SUV, although my last full tank cost around $60. ~Robin C. We purchased a Ford Windstar. It’s a tight squeeze, but [the kids] fit safely. ~Jodie V. Question: [My son] has been diagnosed with torticollis (deformity of the neck in which the head tilts toward one shoulder and simultaneously, the chin rotates toward the opposite shoulder) and plagiocephaly (refers to a persistent flattened spot on the back or one side of the head. Plagiocephaly is particularly common among infants with torticollis). For anyone who's had a child with either of the above: Did physical therapy do the trick? We've heard about using chiropractic care for the torticollis - any experience with that? Anyone push the issue with their doctor to get a plastics consult? Should we push for a helmet just to make sure? ~Robin C. One of our daughters had a significant flat spot on the back of her head and one eye was set a bit back from the other because her head wasn't round. She wore a helmet for about two months. When she went to Children's for a consult with the plastic surgery group, they measured her head and determined what percentage off she was from the "norm." I would definitely pursue it if you have concerns. It's an easy fix with the helmet and her head looks great now! Also, I should have said that the plastic surgeon told us that there is only a small window when a helmet can be effective - about 4-months of age to 10-months. With preemies, they can be a bit older, but after about that age, the bones in the skull are too hard to move. ~Marsha M. My son had a flat spot that the doctor said he would grow out of. He never did. He's lucky he has such thick hair. Its not that noticeable, even if I cut his hair really close. I'd push the issue for a helmet. ~Laurie K. One of my daughters had torticollis. It was pretty significant. She qualified for physical therapy services under Early Intervention. They showed me stretching exercises to do with her. Have you contacted EI for an evaluation? Its free, and they come right to your house. Also, I would pursue any avenue possible regarding the flat spot. I think you would definitely see an improvement with a helmet. They do say that they will outgrow the torticollis, but I can still see it in my daughter at 3-years old. Looking back, I wish I would've done more exercises with her. ~Joann C. My son has been followed by a pediatric neurologist since 4-months old. I asked him about a helmet for his torticollis and he said it was not necessary. My son is now 7 ½-years old and has a very flat side to his head. It is much more noticeable in the summer because of the short haircuts. I should of pushed harder to get one since my gut early on said to. Pursue the helmet! ~Karen S. As I started reading all of the responses, before your question, the first thing that came to mind was that you should take your child to a chiropractor who works with children. I worked with one for 12 years before I had kids and saw many children helped for all sorts of conditions. If nothing else, taking your baby for an evaluation would be worth the trip. My kids have been under chiropractic care since they were born. ~Kim R. My daughter had the issue with the torticollis and one of the boys had the plagiocephaly. Both were treated in-home thru EI services. EI called for a physical therapy consult. They came right to the house and a PT started working weekly (in addition to the regular EI appointments) with both to correct the problems. My son did not require a helmet as the flat spot fixed itself with the PT and other things we were doing to help (exercises, etc.). From my experiences (and everyone is different), I would highly recommend the EI route. It was the least amount of work on our end and both kids loved the special one-on-one time with the PTs. I also noticed that those who have kids with flat spots have "older" (meaning older than 5-yrs.) kids... hopefully, this means the treatments are better now. Renée R. All three of my sons wore helmets for plagiocephaly. [One son], who was the most severe, wore his helmet from age 6-months to 13-months. My other two wore their helmets from age 6-months to 10-months. I personally feel the helmets made a huge difference in all of their heads. If you feel your son needs the helmet, I would definitely pursue it. Also, I wanted to add that EI alone would not have helped my boys’ heads (I think it depends upon the severity of the head. The helmet is designed in a special way where certain layers are removed every couple of weeks as the bones adjust within the head (and while the baby is awake/asleep, they are off the flat spot.). The helmet is painless and the babies didn't mind them at all. Each baby had their own cartoon character on the back of the helmets so we could tell the helmets apart. ~Erin D. My son had a flattened spot on the right side of his head. Even with diligent repositioning, EI and tummy time, it didn't resolve and we ended up seeing a neurosurgeon at Children's. He recommended a helmet. We got it the end of February and saw the doctor last Friday. His head went from a 14 to a 5. The doctor said they usually expect it to drop in half so my son did better than they expected. You have to be committed to it. Some say the babies don't tolerate it, but he did fine with it. EI had recommended it last December, but I was in denial for about a month before I agreed it would be the best thing for him. I was right. ~Erin P.