Analysis of US child care safety regulations

Unintentional injuries in child care centers in the United States: a systematic review

The study systematically reviewed all types of unintentional injury and injury prevention research studies occurring within child care centers in the United States. A total of 2 reviewers searched 11 electronic databases to identify 53 articles meeting inclusion criteria. No studies used trauma registries or randomized control trials. Data were not pooled for further analysis because studies lacked standardized definitions for injury, rates, severity, exposure, and demographics. The following child care center injury rates were reported: (0.25-5.31 injuries per 100,000 child-hours); (11.3-18 injuries per 100 children per year); (6-49 injuries per 1000 child-years); (2.5-8.29 injuries per child-year); (2.6-3.3 injuries per child); (3.3-6.3 injuries per 100 observations); (635-835 medically attended injuries per year per 100,000 children and 271-364 child care center playground injuries per year per 100,000 children); and (3.8 injuries per child per 2000 exposure hours). Child care center injury rates were comparable to injury rates published for schools, playground, and summer camp. Most injuries were minor, while most severe injuries (fractures and concussions) were falls from playground structures. Future studies need to use standardized injury definitions and injury severity scales, focus efforts on preventing severe playground injuries in child care centers, and report child care parameters for inclusion in national injury databases.

Annual risk of death resulting from short falls among young children: less than 1 in 1 million

OBJECTIVE

The objective of the work was to develop an estimate of the risk of death resulting from short falls of <1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday.

METHODS

A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed.

RESULTS

The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers.

CONCLUSIONS

The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.

Injuries in child care centers: gender-environment interactions

OBJECTIVES

To examine child characteristics (age, gender) and child care center environments (socioemotional quality, physical safety) that jointly predict injuries for preschool children.

METHODS

A two year prospective study of 360 preschool children, ages 2-6 years, was conducted in four urban child care centers. Composite scores for center quality and physical safety were derived from on-site observations, and injury rates were based on teacher reports. Poisson regression analyses examined age, gender, center quality, center safety, and the interactions of gender with quality and safety as predictors of injury incidence over one child year.

RESULTS

Age was significantly associated with injury rates, with younger children sustaining higher rates. An interaction between gender and center quality also significantly predicted injury incidence: girls in low quality centers experienced more injuries, while girls in high quality centers sustained fewer injuries than their male peers. Finally, an interaction between gender and center safety showed that girls in high safety centers sustained more injuries than boys, while girls in low safety centers sustained fewer injuries.

CONCLUSIONS

Injuries occur even in relatively safe environments, suggesting that in child care settings, the socioemotional context may contribute, along with physical safety, to the incidence of injury events. Further, gender specific differences in susceptibility to environmental influences may also affect children's vulnerability and risks of injuries. The prevention of injuries among preschool children may thus require attention to and modifications of both the physical and socioemotional environments of child care.

A statewide survey of hazards in child care centers

OBJECTIVES

The purpose of this study was to determine adherence to selected recommended safety standards in North Carolina child care centers.

METHODS

A self administered questionnaire eliciting information about safety practices in child care was mailed to a randomly selected sample of 409 North Carolina child care centers.

RESULTS

One hundred and ninety five usable questionnaires were returned from child care centers in 75 counties. Results indicated that all of the standards included in the state's child regulations were being adhered to by at least 80% of the centers. However, adherence to recommended standards not included in the state's regulations was quite variable, with one standard implemented by less than 5% of the centers. The lowest rates of adherence were found for standards specifying that resilient surface material be used under playground equipment (4%) and that certain foods that may present a choking hazard to small children not be served (27%).

CONCLUSIONS

Many hazards not addressed in North Carolina child care regulations are present in child care centers. Some safety standards are not adhered to due to lack of knowledge or limited resources. Inclusion of national standards in state child care regulations appears to reduce, but not eliminate, the likelihood of hazards being reported. Further research should include on-site inspections and attention to safety in family child care.

The compliance of licensed US child care centers with national health and safety performance standards

The American Public Health Association and the American Academy of Pediatrics recently published health and safety guidelines for child care centers. A survey was conducted to determine the extent to which practices in US child care centers are reflective of these guidelines. Compliance with 16 guidelines ranged from 19.5% to 98.6%, varied considerably by state, and was not consistently associated with selected center characteristics. Prevention efforts should focus on practices for which compliance is low and on those that have the greatest disease- and injury-reducing potential.