Regulatory Compliance and Safety of Child Care Centers

Abstract

Source: Crowley AA, Jeon S, Rosenthal MS. Health and safety of child care centers: an analysis of licensing specialists’ reports of routine, unannounced inspections. Am J Public Health. 2013; 103(10): e52– e58; doi: 10.2105/AJPH.2013.301298Investigators from Yale University examined reports from unannounced licensing inspections of child care and group child care centers in Connecticut in order to determine factors associated with regulatory compliance. Inspection reports from visits to centers caring for children <6 years old between 2006 and 2008 were reviewed. Investigators examined the association between regulatory compliance and the following factors of interest: (a) accreditation by the National Association for the Education of Young Children (NAEYC), (b) center funding source, (c) compliance with a weekly child care health consultant visit, (d) compliance with 20 hours of child care provider continuing education, and (e) median household income of the area where the child care center was located.The study team grouped 72 regulations into 9 categories that pertained to all child care centers and 4 that pertained only to centers providing infant and toddler care. The 9 categories pertaining to all centers were outdoor safety, indoor safety, indoor health, child and staff documentation, emergency preparedness, child physical health, child supervision, program documentation, and educational programming. The infant and toddler categories were indoor safety, outdoor safety, health, and development. Overall compliance with each category of regulation was calculated. Regression analysis was used to identify the association of each of the 5 factors of interest with compliance in each of the regulatory categories.A total of 676 child care centers were inspected during the study period. A high degree of compliance (>96%) was found for child physical health (eg, nutritious meals), child supervision for preschool children, program documentation (eg, posting a license), and educational programming. Child care centers serving all ages were noncompliant most frequently (48%) with the regulation requiring a hazard-free playground. Infant and toddler centers were most frequently noncompliant with regulations in indoor safety and health categories. For example, 28% of infant and toddler centers had choking hazards such as plastic bags and balloons within the reach of children.Compliance with the regulation requiring evidence that each full-time provider has completed 20 hours of continuing education per year was the factor most strongly associated with compliance with other regulatory requirements. NAEYC accreditation and child care location in areas with higher household income were also significantly associated with increased compliance for some of the regulatory categories. There were no consistent associations between child care funding source and compliance.The authors conclude that continuing education for child care providers is an important intervention to improve the health and safety of children in child care centers and that analysis of licensing reports can assist efforts to improve the quality of child care.Dr Dougé has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.According to the 2012 Report from Child Care America, over 15 million children under the age of 6 years require child care.1 This represents more than half of such children in the United States in 2013. Since so many families rely on child care for their children, it is imperative that centers that care for their children are healthy and safe. Each state has developed its own set of regulations.The data from this study came from inspection reports of child care centers in Connecticut. Although the study determined the frequency of noncompliance with regulations and which characteristics were most associated with increased compliance, the results may not be applicable to other states that may have more or less stringent regulations or differing frequency of inspections of child care centers.The results of this study indicate that the there is room for improvement for child care centers to demonstrate that they are providing a healthy and safe environment for children. To improve, national health and safety performance standards such as Caring for Our Children could be adopted.2 The adoption of these guidelines could ensure uniformity of regulations across the nation. In the meantime, pediatric providers can counsel families to pay attention to compliance with continuing education requirements for child care staff, the safety of the indoor environment for infants and toddlers, and potential playground hazards when considering a child care center.Playground safety is an area of major import, both within and without day care centers. More than 200,000 playground injuries/year occur in children <14 years of age; almost half of these are severe (eg, fractures).3 Physicians can join parents in advocating for hazard-free playgrounds.