Preventing unintentional injuries in US early care and education: Are state regulations sufficient?

Highlights

• Most states required ECE provider training in emergency preparedness and first aid.

• Parent or state injury notification requirements varied by state and ECE setting.

• Notification requirements varied in both timing and manner.

• Few states required child care providers to take corrective action after incidents.

• States should align regulations to national injury prevention standards.

Abstract

Unintentional injuries are currently the leading cause of death among US children older than one. As many children spend significant time in non-parental child care, these injuries often occur outside of the home. This study examined US state early care and education (ECE) regulations related to injury prevention. We reviewed ECE regulations for child care centers and family child care homes through August 2018 for all 50 states and DC (“states”). We compared these regulations to six components from two national health and safety standards on injury prevention (“standards”). One state had regulations that met all six standards for both centers and homes; sixteen states had regulations that met at least five for both. Most states required child care providers to be trained in emergency preparedness (42 for centers; 38 for homes) or first aid including CPR (50 for centers; 46 for homes). Additionally, most states required providers in centers and homes to notify parents (47 and 41, respectively) and the state (40 and 41, respectively) when a child was injured; these requirements varied greatly in both the timing and manner of notification. Two-thirds of states required that providers keep copies of a completed injury form on the premises. However, few states (5 for centers, 3 for homes) required providers to take corrective action after an injury. Although most states had some injury prevention regulations, they varied greatly across states. More states should require corrective action after an injury to help prevent future injuries from occurring.

Introduction

Unintentional injuries, including falls, burns, and poisonings, are currently the leading cause of death among children older than age one in the United States (US) (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2018). During the most recent ten-year period for which national data was available, 2007–2016, a total of 25,724 children ages 0 to 4 years died from unintentional injuries – another 22.4 million experienced nonfatal injuries. Unintentional injuries to young children are also costly, generating annual lifetime costs of $25 billion in a single year, using 2010 data and prices. The good news is that injuries, like many public health problems, are largely “understandable, predictable, and preventable” (Judy, 2011).

Given that nearly 12.5 million children younger than 5 years are in some form of non-parental childcare (Laughlin, 2013), many of these unintentional injuries are likely to occur outside of the home. A 2013 systematic review examining child care center injury rates found that there were between 11.3 and 18 injuries per 100 children per year and 2.6 to 3.3 injuries per child (Hashikawa et al., 2013). Other studies have found similar injury rates between child care centers and non-parental home-based child care (Kotch et al., 1997).

To prevent these injuries, states have enacted early care and education (ECE) licensing and administrative regulations directing child care provider injury training and reporting requirements. This study examined those state regulations to document requirements related to provider training and response to injuries among children, parental and state notifications, and steps providers must take to prevent repeat incidents. We then compared these regulations to national health and safety standards on injury prevention (Caring for Our Children: National Health and Safety Performance Standards, 2011) to determine the extent to which existing regulations align with the standards. We further documented when regulations required providers to notify parents and the state and whether these notifications needed to be in writing.