Child-care deaths in Minnesota dropped dramatically last year — a trend that is being attributed to news coverage of unsafe sleep practices and other hazards in licensed day-care homes, along with intensified state oversight and tougher laws.
Three children died in child care in 2013, down from nine in 2012 and 11 in 2011, according to a review released Wednesday by the Minnesota Department of Human Services.
"It is heartbreaking when a child dies," said Human Services Commissioner Lucinda Jesson. "Although these results show continuing progress, we want to do everything we can to make sure children are safe."
A 2012 Star Tribune series found that child-care deaths had doubled over the previous decade, an increase largely attributable to infants placed in unsafe sleeping positions — such as face down or on fluffy blankets. Other hazards included overcrowding at licensed homes, which left some providers unable to supervise children adequately.
Since then, the state has increased training requirements and imposed tighter rules to enforce safe sleep practices. But many of these reforms are just getting underway; the state only recently hired two trainers who will make sure county inspectors are providing consistent oversight of safety requirements in home day cares.
The immediate drop in deaths, as a result, probably has more to do with startled child-care providers reacting to news coverage of the deaths and to memos issued by state regulators warning of tougher enforcement of existing standards, said Jackie Harrington, a Rochester child-care provider and a board member for the Minnesota Licensed Family Child Care Association.
"There was a lot of heightened awareness that trickled down to how [providers] enhanced their current safety practices," said Harrington, who cares for seven children, including one infant. "That was an immediate effect."
Dakota County began offering more training in safe sleep practices after law enforcement authorities investigated two infant deaths in 2011 and 2012.
Home day-care providers in those cases — Beverly Greenagel of Eagan and Rebecca Graupmann of Farmington — pleaded guilty to felony manslaughter charges and await sentencing in the next two months.
"We want to prevent these tragedies from happening," said James Backstrom, Dakota County attorney. "If we're talking about criminal prosecution, it's too late."
Almost all the deaths in child care over the past decade have occurred in licensed family homes, not group child-care centers. All three deaths last year occurred in homes, including one in Hastings in which the provider placed an infant to sleep on his stomach on a blanket and carpeted floor, according to state records.
"Seventy-five percent of the infant deaths [over the past decade] were associated with an unsafe sleep arrangement," said Jerry Kerber, inspector general for the Human Services department. "If we do nothing else but take that variation out of the equation — and we only have those truly unexplained deaths of infants left — it's dramatically different."
Under the state's new rules, parents must obtain a doctor's note if they want child-care providers to place infants in any sleep position other than the recommended one, on their backs. Research has linked that sleep position to a reduction in unexpected infant deaths.
The state now requires licensed family providers to complete 16 hours of training each year, including a review of safe sleep practices.
Minnesota also saw a decline in the number of child-care facilities shut down for sexual abuse of children, from 12 in 2012 to six last year. Kerber credited better supervision by providers of other adults and children in their homes.
While last year's progress occurred before the new training requirements took full effect, Kerber said annual reminders on supervision and safe sleep rules will prevent providers from becoming lax.
In every death case, he said, providers knew the rules they were supposed to follow.
"But he or she didn't recognize the importance of it until it was too late. That's the main focus of the training — to make sure people understand how important it is to follow these safe sleep requirements."
Harrington said the new regulations help, because they allow providers to be firm when parents present special requests that violate safe sleep rules. The updated regulations allow swaddling in certain circumstances, but prohibit loose blankets or other potential choking hazards in cribs.
On the other hand, Harrington said she fears the tougher oversight and news of criminal prosecutions are hurting the profession by discouraging new providers.
She conducts training at orientation sessions, and said attendance is down. Fewer providers are willing to take infants, she added, because they come with the most requirements and risks.
Nonetheless, she added, "The decrease in deaths is the ultimate goal, and that is happening, obviously."