Recommendations include giving providers better training to protect sleeping infants.
Sylar Gragert, 3, looked at gravestone of his brother, Alexander, who was 7 weeks old when he died of SIDS in day care. No charges were filed, but Serena Gragert wonders whether the former "day-care lady" was too busy with other kids to monitor her son. Nobody had checked on him for 90 minutes before he was found not breathing.
Responding to a sharp increase in child-care deaths, a special state panel recommended Friday that Minnesota adopt tougher standards for safety training and license enforcement of in-home child-care providers.
A 31-member board of experts in pathology, law enforcement, pediatrics and other specialties issued the recommendations after reviewing 10 years of child mortality records.
Three-fourths of the 86 deaths since 2002 involved sleeping infants, so the panel recommended that child-care providers get improved training on safe sleep guidelines, such as putting infants on their backs without thick blankets or other suffocation hazards.
"Some providers, they think when they put a soft cuddly object or comforter in a crib with an infant, that they're helping," said Lucinda Jesson, commissioner of the Minnesota Department of Human Services, which oversees child-care licensing. "Well, that's not helping. That's putting that baby at risk."
The panel also recommended that providers automatically lose their licenses if infants in their care are found in unapproved sleep positions, and that they be required to get written clearance from doctors before overriding safe-sleep guidelines when putting infants to sleep.
Many of the recommendations address issues raised by an ongoing Star Tribune investigation of deaths in child care. Newspaper stories, for example, noted that basic inspection data is often inaccessible to concerned parents. The state now recommends that county "correction orders" issued against providers be posted online and that all licensed providers carry liability insurance.
Three of the deaths in the state report took place in child-care centers; the rest occurred in licensed home-based care.
The state panel raised particular concern that one in 10 of the deaths involved providers who were operating over their licensed capacities.
"This limits the ability of child care providers to provide appropriate supervision to all children in their care, especially the youngest and most vulnerable," the report stated.
Beyond better enforcement of adult-child ratios, the panel recommended that the state reduce the ratios for providers when the children in their care include infants and toddlers.
A coalition that includes the American Academy of Pediatrics and the American Public Health Association recommended earlier this year that one provider in a home day care watch no more than two infants, and that any lone provider with two infants have no more than six children in total.
Minnesota's licensing standards for home-based care allow some lone providers to have up to 10 children in care while watching up to two infants, and other lone providers to have up to 12 children in care while watching a single infant. The state panel recommended that the state adopt the new national ratios.
Jesson sent a letter to legislative leaders, seeking their support in the upcoming session for tougher safety standards.
The delicate balance with increased licensing requirements is that they could become so cumbersome that good providers quit. The state has seen a decline over the past decade in licensed home child-care providers -- even as the number of preschool-age children has increased.
A reduction in the child-to-adult supervision ratio, for example, would slash earnings for in-home providers, who already make relatively low annual salaries, said Dan Wielinski, a board member for the Minnesota Licensed Family Child Care Association.
"The cost would either be passed on to the parents or we could see a decrease in the number of family licensed providers as this will make it impossible for them to stay in business," he said.
The association's policy committee is reviewing the recommendations. Wielinski said he supported the panel's calls for increased oversight and inspections, especially of providers with violation histories, and safe sleep waivers only when infants had documented medical reasons for them.
The association has advocated additional state funding for mentoring programs so that top child-care providers could train new providers.
The panel's recommendations include 40 hours of training for in-home providers prior to earning their licenses and 24 hours of training every year after that. Licensed providers currently complete eight hours of annual training.
Jesson said some recommendations in the report are "common sense" and wouldn't increase costs or put new pressure on the child-care industry. Posting more inspection results online would help inform parents so that they could become better consumers of child-care services.
The state issues suspensions and revocations of child-care licenses, but county inspectors actually monitor the home day cares. Jesson said the state needs to work with counties to improve consistency on how they inspect homes and when they issue sanctions.
Jeremy Olson • 612-673-7744