Minnesota Legislature can make day care safer

A Pulitzer Prize-winning Star Tribune series of news stories over the past year spotlighted a public health crisis in Minnesota: an alarming increase over the past decade in the number of children dying at in-home day cares.

Now it's up to state lawmakers to approve long-overdue reforms to tighten lax regulations and enact critical safeguards to reduce the risk of sudden infant death syndrome and suffocation-related death.

The pragmatic, cost-conscious package of legislative reforms pushed by the state Department of Human Services (DHS) appropriately focuses on infant safe-sleep practices and better training for licensed family day-care providers.

Eighty-six Minnesota kids have died in day cares from 2002 to 2012; 83 of them were in family day cares, three of them in day-care centers. A report from a child-safety panel concluded that "most of the deaths in licensed child care involved an infant placed in an unsafe sleep environment or unsafe sleep position."

Recent legislative testimony by a top state official underscored the urgency for reform. There are 1.5 times as many Minnesota kids in family child-care homes as in day-care centers, according to DHS Inspector General Jerry Kerber. But there were 28 deaths in in-home settings for every death in a day-care center.

Centers are typically more expensive than family day cares, a key reason many families rely on the latter. Given that about 90,000 kids in the state are typically enrolled in this type of care, the department has moved aggressively to raise awareness of safe-sleep practices — putting infants to sleep only on their backs in cribs free of blankets, pillows and anything else that might obstruct breathing.

The agency also has strengthened enforcement and levied more fines for providers who didn't adhere to safe-sleep guidelines.

But a number of the proposed reforms recently cleared key committees in both chambers and are now included in broader health and human services budget legislation that could go to the floor this week.

The reforms generally survived the committee process intact, though some key components were weakened after pushback from some providers. Lawmakers in the coming debate should resist any further watering down of these important child protections.

The strongest new safeguard in the legislation is also the most controversial and, unfortunately, the most at risk of being jettisoned. Currently, the legislation calls for a physician's note of approval before a day-care provider can place an infant to sleep in any position but the baby's back. Right now, parents can authorize this.

Some will raise tired "nanny-state" objections to this requirement. But babies' safety in the crib should trump ideology. Requiring a doctor to sign off on risky sleep positions would protect more infants. It should also spur parents to take the same precaution at home.

Other common-sense changes: requiring safe-sleep training annually, instead of every five years; requiring more frequent CPR training that also focuses on kids, and doubling the number of overall annual training hours to 16 — a number that still falls far short of what the child-safety panel recommended.

The reforms under consideration are solid, if not groundbreaking, steps forward. "This is very important public policy here,'' Kerber said in an interview last week. "There are lives at stake.''

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