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1. http://www.kdheks.gov Our Vision – Healthy Kansans Living in Safe and Sustainable Environments

2. Death in Kansas Child Care • 2007 Child Care Scenarios • Child Care Death Data • Patterns Regarding Care • What Can We Do Now Governor’s Child Health Advisory Committee July 25, 2008

3. Child Care Death Defined A child care death is defined as a death to an individual, ages 0-17, from any cause wherein the child was in the care of a regulated home or facility at the time of death or at the initiation of the events that resulted in death regardless of the place of death.

4. 2007 Child Care Scenarios • 12th day of care: 2 month old child placed in bouncer on adult bed with pacifier and mesh cover; found unresponsive. 188 minutes (3 hrs 8 minutes) between checks • Cause of Death: SIDS • 10th day of care: 1.5 month old child placed on side for nap in playpen in basement; provider went to doctor and teenage daughter was left to care for children; infant found unresponsive on stomach. 65 minutes between checks • Cause of Death: SIDS • 6 month old child placed on adult bed to nap; provider took medication and slept on couch; adult did not know child was on bed and took nap on bed; infant found wedged between mattress and footboard. 60 minutes between checks • Cause of Death: Asphyxia

5. Doll Re-Enactment of Wedging Wedging: The asphyxia of a person by their own weight compressed between two hard surfaces. During 2007, two infants were placed on adult beds and fell between the mattress and footboard, cutting off breathing

6. Child Care Deaths • KDHE contracts with local health departments to conduct inspections and provide regulatory services for approximately 8,000 child care facilities • Child Care Licensing Surveyors report child care deaths to KDHE and conduct investigations • Tracking system and new investigation procedures were implemented during 2007 • Data and circumstances surrounding deaths reveal patterns regarding the care of children • No other agency or organization collects information as specific in regard to child care deaths

7. Child Care Death Investigations Implemented new procedures in order to: • Guide investigations of serious injury and death in care • Gain additional information for sudden, possibly unexplained deaths of children under 18 months • Ensure uniformity in the collection and documentation of information obtained in such investigations across Kansas (new CCL form modeled after CDC SUIDI form) • Facilitate the development of standardized tracking of data in the Child Care Licensing and Registration Information System (CLARIS) • Recommend changes in regulation and enforcement that could reduce the risk of death

8. What We Track • Identifying information for facility and child • Circumstances surrounding death • Staff and children present (capacity) • Medical attention received • Other agencies involved in investigation • Official cause of death • If infant death (0 to 18 months), additional information is collected

9. 2007 Child Care Deaths The leading cause of death in child care is SIDS; however, case information reveals safe sleep practices are not always followed.

10. Triple Risk SIDS Theory Infant Physiologic Responses Infant Physiologic Responses • Arousal response deficit • Subtle brainstem dysfunction • Slow development SIDS External Stress Factors Development Development (vulnerable age) External Stress Factors • 2-4 months – most vulnerable • 4-6 months – decreasing vulnerability Sleep position, bedding, temperature, season, swaddling, smoking, drug use, minor respiratory symptoms, poverty, and limited prenatal care Source: SIDS Network of Kansas

11. Child Care Practices Related to Death Most common cause of death is SIDS, which by definition is NOT preventable, but we CAN reduce the risks. • Supervision: • Average time between checks is 48 minutes • All infants in back bedrooms with doors closed/partially closed or in a lower level of the home at the time of death • Inappropriate sleep location and/or surface: • 50% of infants (6 of 12) were napped on adult beds or other baby seats (ex: bouncer) instead of an approved crib or playpen • Inappropriate sleep position(stomach or side sleeping): • 75% ( 9 of 12) of infants were napped inappropriately, either by location, position, or both • 33% (4 of 12) of infants were not slept on their backs as recommended • Unaccustomed sleep position—does it play a role in child care deaths?

12. Sleep Location and Position

13. What Responsibility Do We All Have When it Comes to Child Care? “For by the time the child reaches six months of age, his primary caretaker becomes a crucial and irreplaceable person who must be there…” Source: Karen, R. (1994). Becoming Attached: First Relationships and How They Shape Our Capacity to Love.

14. Governor’s Child Health Advisory Committee Mandate: “Advise the Governor and the Kansas Department of Health and Environment (KDHE) on issues involving children, including…” Positioned to impact child care law and regulation, educate on safe child care practices, and reduce the risk of harm to Kansas children in out of home care.

15. Wrap Up: Death in Kansas Child Care The majority of victims are newly enrolled infants Leading cause of death is SIDS – sleep related Infants are not consistently placed on their backs Infants are not consistently placed in approved cribs or playpens Infants are not placed without bedding or soft items Infants are not supervised during sleep Providers lack training in reducing the risk of sudden infant death or unintentional suffocation • No providers who experienced a death had acquired training in reducing the risk of sudden infant death • Only 16% (2 of 12) had safe sleep brochures • The two providers with documentation napped as recommended

16. What Can KDHE Do Now? • Continue collecting data and analyze for emerging patterns • Provide data and case information to the Child Care System Improvement BEST Team to enable them to make informed decisions to guide regulation revision • Increase awareness of parents, providers, and public regarding recommended child care practices that protect children • Collaboration with agencies and organizations in Kansas • Media Campaign on Safe Child Care and Infant Care Practices: Safe Child Care Environment Task Force

17. Contact Information Rachel Berroth, MS ECE Regional Administrator Early Care & Youth Programs Child Care Licensing & Registration Program Kansas Department of Health and Environment Curtis State Office Building 1000 SW Jackson Street, Suite 200 Topeka, KS 66612 785.296.1270 rberroth@kdhe.state.ks.us http://www.kdheks.gov/kidsnet

18. http://www.kdheks.gov Our Vision – Healthy Kansans Living in Safe and Sustainable Environments