Child care safety refers to children’s safety from injury or death from accidents or acts of violence, or from emotional or sexual abuse, while in child care settings. Child care is defined as paid care provided by nonrelatives.
Nearly 8 million children of employed mothers in the United States are in some form of child care provided by nonrelatives. Despite this large enrollment in child care, little has been known until recently about children’s level of safety in care, as no national government or private agency collects data on injuries or fatalities in child care. Whereas extensive research exists on issues such as airline safety and risks posed in the nuclear or chemical industries, much less is known about safety issues in human services.
The United States lacks a developed child care system, instead relying on a patchwork of arrangements differing in their level of formality and government oversight. Child care arrangements involve nannies or babysitters in children’s own homes, 7 percent; family day care providers in the caregivers’ homes, 27 percent; and children enrolled in child care centers, 66 percent. Care in the child’s home involves the least regulation, with parents hiring caregivers on their own and with no caregiver licensing or required training. Family day care homes may be regulated but may also be exempt because of small size or may operate underground. Child care centers are more formal organizations, the great majority licensed and inspected by the states and with professionally trained directors.
These markedly different organizational types of child care lead to different patterns of risk. This in turn suggests that researchers studying safety in human services can benefit from considering organizational factors that affect the routine circumstances in which care is offered.
Risks by Type of Care and Age of Child
Fatalities are the most serious caregiving failures in child care and the most likely to be reported. The first national study of child care safety of 1,362 fatalities from 1985 to 2003 showed that overall child care was quite safe compared with other environments in which children spend time. It also revealed, however, striking differences in the safety of different types of child care and among children of different ages.
Infants are by far the most vulnerable children in care. Their fatality rate from both accidents and violence is nearly 7 times higher than that of children ages 1 to 4. Equally striking are differences in infant fatality rates across types of care. The infant fatality rate for children in the care of nannies or family day care providers is more than 7 times higher than in centers.
The most dramatic differences across types of care occur in rates of infant deaths from violence. Remarkably, no reports of deaths of infants from violence in centers occurred between 1993 and 2003. Deaths from accidents are more evenly distributed across types of care, although centers also have a safety advantage in this area among the youngest children.
Overall, child care centers offer greater safety than care offered in private homes and, in particular, offer a high level of protection against fatalities from violence, with the protection extending even to infants. The safety of infants is striking: Within children’s own families, as well as in types of child care offered in private homes, these are the children at greatest risk of fatalities from abuse or violence.
Risk and the Organization of Child Care
The safety of child care centers does not arise from overall higher-quality care than that offered in family day care or by nannies or babysitters in the child’s home. Researchers find that, on average, center care for infants is of lower quality than that offered in the more intimate modes of care provided in private homes. Centers have organizational features, however, that offer multiple forms of safety protection to children even when the centers themselves do not offer particularly responsive or sensitive care.
Most important, staff members in centers do not work alone. They have others watching them and helping them cope with fussy infants or whining toddlers. This helps them maintain their emotional control. It also helps identify an unstable or volatile worker. Center teachers also have more training than most caregivers in private homes, and they are supervised by professionally trained directors. Finally, centers control access by outsiders more effectively to keep out people who might pose risks.
These protections help reduce risks of accidental deaths, such as suffocation and drowning, but they are especially important in preventing violent deaths. Not a single shaken baby fatality occurred in a child care center, whereas 203 happened in private home arrangements. Child care centers are almost completely protective against this impulsive and often lethal form of violence against infants. In types of care offered in private homes, however, it is the single most important mode of death from violence. The stress of an infant crying, in particular, can drive care-givers to impulsive violence. With little professional training, without supervisors or coworkers, and with low earnings for long hours of work, even experienced caregivers can lose control. They can cause serious injuries or death to infants from just 20 seconds of violent shaking. Other members of providers’ households can also shake or otherwise abuse infants when confronted with their crying.
Child care centers do not protect against all forms of violence against children or against inattentiveness that can lead to accidents. Children in center care are at greatest risk when they are taken out of the center and lose the organizational protections the institutions provide. Fatalities can occur when children are taken to pools and adults do not notice a struggling child in the water; they can also occur when young children are forgotten in center vans. Children can also suffer injuries in centers when angry or poorly trained teachers grab or push them, but these forms of assault almost never rise to the level of fatal violence.
Improving Child Care Safety
Child care safety could be improved by the provision of more resources and closer regulation of care. In particular, the safety advantages of centers could be recognized and more funding provided for the expansion of center care to the most vulnerable children, infants. In addition, caregivers working in private homes could receive more training and support to increase their empathy toward crying or difficult children. Resources could be expanded for licensing and regulation so that “bad apples” in child care who commit repeated acts of abuse could be more easily identified and excluded from the field. Finally, safety data could be collected so that parents could choose care arrangements wisely, and preventive measures could be developed on the basis of comprehensive information.
More broadly, research on child care safety shows that safety in human services depends crucially on organizational features of care. These may be distinct from the features that determine quality levels. Even the lowest-quality child care centers, for example, provide very high levels of safety protection for infants and almost complete protection against fatalities from violence for all children enrolled in them. By collecting and analyzing data on safety violations in human services, a better understanding can be gained of ways to reduce risk as to well as to increase quality.
- Wrigley, Julia and Joanna Dreby. 2005. “Fatalities and the Organization of U.S. Child Care 1985-2003.” American Sociological Review 70:729-57.
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