Minnesota day-care centers are the second-costliest in the nation, according to a recent report, and working families across the state rely heavily on licensed, in-home providers as a safe, affordable and more personalized alternative.

But a proposed day-care safety reform could increase costs and decrease the already slim number of openings at licensed, in-home providers. State officials weighing this well-intended reform -- reducing the number of children some providers can care for -- need to move cautiously or they'll price families out of licensed child-care homes and force them into unregulated arrangements.

"Child-care professionals typically don't have a lot of expendable income, so many providers couldn't afford to operate if [child-to-provider] ratios are reduced,'' said Jennifer Parrish, a Rochester child-care provider who said that losing one client would result in a 17 percent drop in her income. "Parents would have even fewer options, and providers would have to raise rates to the level that would make licensed care unaffordable for many families."

The recommendation to tighten adult-child ratios for providers who take in infants and toddlers is one of many proposals issued by a Minnesota child-safety panel after a Star Tribune series spotlighted a disturbing increase in deaths at in-home day-care sites. The panel's report, released about a week ago, is filled with thoughtful reforms, such as raising the minimum age for "helpers" to 16, making correction orders more accessible to the public and increasing training on prevention of sudden infant death syndrome (SIDS).

The state Department of Human Services (DHS) has highlighted these excellent recommendations in a letter to legislators that asks lawmakers to work with the department to review safety standards and consider statutory changes. The state agency is appropriately treating the increase in licensed family day care deaths -- from three in 2003 to 11 in 2011 -- as a public health priority. Eighty-three children have died since 2002. Action is needed.

The panel's recommendation on ratios is understandable, given that Minnesota's are more lenient than those called for by a national child-advocacy organization. But it's not clear how many states have moved to adopt these "best practices" standards or whether there's data to support that such standards will reduce deaths at in-home day cares.

Some might point to this sentence in the report as supporting evidence for the new ratios: "All of the deaths that occurred happened in homes licensed for 10 or more children." But almost all of Minnesota's licensed family child-care homes -- 96 percent-- are licensed for 10 or more kids. Data also is not yet available on how many kids were actually on the premises when the deaths occurred.

Before adjusting the ratios, it makes sense to try a focused approach first, one aimed at reducing the risk of SIDS and suffocation-related deaths in day care. According to the report, 75 percent of the deaths involved infants who died in their sleep or in a sleep environment. Previous national "safe sleep" awareness campaigns in the 1990s were linked to a decrease in these deaths. Yet Star Tribune reporters found too often that infants who had died in Minnesota day cares were at heightened risk because they were put to sleep on their stomachs or into cribs made hazardous by fluffy pillows or blankets.

The state report strongly addresses infant sleep risks, calling for annual training on this instead of every five years, for example, and for more frequent checks on sleeping infants. It also recommends revoking providers' licenses for safe-sleep regulation violations. These changes are overdue.

A public-awareness campaign like that waged by the city of Milwaukee Health Department would also be a worthwhile step. The department worked with a local nonprofit firm on a dramatic marketing campaign to highlight unsafe infant sleep practices. It's time for a high-profile, statewide Minnesota campaign that highlights the risks. Better awareness is also needed for state grants that help providers buy cribs and other equipment, as well as get training.

Targeted measures like these should be given a chance to work before the state moves to the more dramatic and potentially burdensome step of adjusting the ratios. The assurance this week from DHS officials that they will carefully research any changes and work with providers suggests that the state will strike the right balance on this important public-health issue.


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