An in-home child care provider and an advocate for the child care center industry joined a Minnesota lawmaker Wednesday in supporting changes in infant safe sleep standards for children in care. Specifically, they told the House Health and Human Services Policy committee that they support a change requiring a doctor's note from a parent before a child care provider deviates from the required practice of putting infants to sleep on their backs and in cribs. Currently, providers only need written authorization from parents to do that, despite the wealth of research showing that sleep-related deaths are more common when infants are placed on their stomachs.
"This takes the responsibility off of the provider when the parent asks the provider to have their infant sleep in an alternate position," said Lynn Barten, a family child care provider in Alexandria, Minn. "It forces the conversation back to the parent and the doctor."
While she feels putting infants to sleep on their backs is safest, she said it can be hard to convince parents. "It's hard because you have that professional relationship. You don't want to say no."
A doctor's note is one of several changes being proposed this year either through legislation or through policy changes reflected in Gov. Mark Dayton's budget. The changes are in reaction to an alarming increase in deaths in child care over the past decade -- deaths that are concentrated in licensed family child care homes and typically involve violations of safe sleep practices.
Licensed family child care provides care for 1.5 times more children in Minnesota than larger child care centers. But they also have been the sites of 28 times more child-care related deaths over the past decade. Of 86 deaths in licensed care over the past decade, 83 occurred in home daycares. The annual number of deaths has been rising, said Jerry Kerber, inspector general for the Minnesota Department of Human Services.
"This is a serious health issue for family child care and for families that are relying on family child care," Kerber told lawmakers in his testimony on Wednesday.
In addition to the doctor's note, Kerber said his department is recommending 16 hours of annual training for home-based child care providers -- up from the current requirement of 8. Kerber said his department didn't just pick some larger number, but rather thought about how much time would be needed in training to adequately cover essential safety issues. The department is also recommending more frequent training about CPR and the prevention of shaken baby syndrome.
While the subjects covered in training might not change from year to year, the repeat training will help remind providers about safety procedures and discourage their "temptation" to put infants on their stomachs just because they might fall asleep faster, he said.
"I can only imagine how stressful the environment is what all of those children in care," he said.
The department has not taken on the thorny issue of reducing the maximum number of children in home-based care. The department's own child mortality review panel recommended a lower capacity, but department administers haven't pressed that issue, which child care providers strongly oppose.
The requirement for a doctor's note was proposed to the legislature several years earlier by Rep. Patti Fritz, DFL-Faribault, but didn't gain support. Fritz said she put her own children to sleep on their stomachs years ago, but "as we go along in life we learn in better ways and, I guess, the right ways."
Supporting her bill was Michelle Wilson, an Eagan child care center administrator representing the Minnesota Child Care Association (which represents centers but not homes). "Requiring a physician's signature would allow one more opportunity for parents to be educated (about) the risks of stomach sleeping," she said.
Lawmakers on the House committee suggested that the state needs to help providers by clarifying some confusing policies. For example, providers across the state receive different advice about whether any blankets (potential choking and suffocation hazards) can be in cribs with sleeping infants. They also don't know what to do by state policy when infants fall asleep in their arms.
Kerber acknowledged that Minnesota's county and state regulators have provided conflicting information to providers at times. He said proposed legislation and policy changes will provide much clearer and consistent direction this year.