Better tracking nationwide could save lives, a watchdog report says.
If the nation wants to reduce the number of children who die in child care, a watchdog organization has concluded that it must take a basic first step -- figure out how many such deaths actually occur.
Remarkably, no one knows that figure with any precision, or whether the number is rising nationally, or if policies designed to protect children are working, according to Child Care Aware of America, a respected national research group.
"Little is known about deaths [and] serious injuries to children," said Ollie Smith, interim executive director of the Washington, D.C.-based organization. "We don't even know where or how to establish a baseline for this."
Better reporting could help parents make informed decisions about child care and help regulators understand which children need greater protection, the group said in a report released Monday.
The failings outlined in the report mirror those detailed by a Star Tribune investigation of child-care deaths in Minnesota. A spike in deaths over the past five years went undetected by state regulators, health officials and the child-care industry, partly because the state's tracking of deaths and their causes has been inconsistent.
Since the newspaper's disclosure that more than 50 children died in day care over the past five years, state regulators have called for tighter monitoring of the incidents and tougher enforcement of child-care regulations.
In addition, a state mortality review panel is conducting a five-year review of child-care deaths to look for patterns that could suggest safety improvements.
"What's frustrating is when kids die for the same reasons" that the state has already identified as preventable, said Erin Sullivan Sutton, an assistant commissioner at the Minnesota Department of Human Services.
Sen. Al Franken, who serves on a Senate subcommittee reviewing child-care safety, said he is exploring legislation to increase the national monitoring of child-care facilities and the public reporting of deaths and injuries.
Last week the Minnesota Democrat submitted a bill calling for increased training of child-care providers so they can provide safer and higher quality care.
"Parents are having a hard time getting information about a child-care provider's safety record,'' Franken said. "Some states don't even report this information.''
In Minnesota, all child deaths are forwarded to a state mortality review panel if they result from maltreatment or occur in facilities, such as day cares, that are licensed by the state Department of Human Services. But the panel hasn't issued regular annual reports and didn't detect the recent uptick in child-care deaths.
Minnesota is one of 38 states where child-care deaths must be reported to licensing officials. Child Care Aware reviewed these states, though, and found wide variation in how they collected data and whether they ever analyzed it.
Calls for a national tracking system came as early as 2005, when sociologist Julia Wrigley used newspaper reports and police and court records to estimate the number of child-care deaths in the U.S. and to identify common causes.
Wrigley said child-care deaths have been "largely invisible" to the public because of the misconception that they all result from SIDS and can't be prevented.
"The establishment of such a [tracking] system would signal that deaths in child care will no longer go almost unnoticed," said Wrigley, who is now an associate provost at City University of New York.
Turnaround in Kansas
The Star Tribune review found that in Minnesota, the majority of child-care deaths involved sleeping infants, and most took place in small, home-based day cares, not larger child-care centers. Some were ruled unexplainable, or linked to SIDS, but others involved children who were placed to sleep on their stomachs, in violation of state guidelines, or with heavy blankets or other known suffocation hazards. Some providers had too many children in their care to adequately supervise them all.
In Kansas, a state now ranked among the best for licensed in-home child care, a transformation of the system started with improving its reporting. Just five years ago, no one in the state was systematically tracking deaths in day care facilities.
When the state created an electronic tracking system, the numbers were startling and revealed troubling patterns related to sleep practices, supervision and child-care practices, said Rachel Berroth, director of the state's Bureau of Family Health. That led to an education campaign and sweeping legislation in 2010 that improved the system.
"It's sort of evolved from what started as tracking deaths in child care and sharing our data," Berroth said. "There was so much interest that it became so much bigger."
Brad Schrade • 612-673-4777