Two grave incidents in Minnesota day cares – the 2016 hanging of an infant who barely survived, and the alleged recent shaking of a baby who died – reflect a troubling but little-known trend: A child's first month in care often can be the most dangerous.
Although day-care deaths are rare in Minnesota – and have declined in the past decade – state records show a pattern of tragedies occurring during an infant's first weeks at a new provider.
Transitions into child care can be stressful, because providers haven't bonded with the children yet or learned their routines, said Cindy Croft, director of the St. Paul-based Center for Inclusive Child Care, which trains child-care providers. In addition, she said, a new day-care provider might use different feeding and napping routines that could upset the children.
"There can often be more challenges," Croft said. "There could be more crying from the child, because they're stressed too, so that adds stress to the caregiver."
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Gabriel Cooper had been in the care of Sylwia Pawlak-Reynolds for just three days before the child-care provider allegedly shook him on July 12, causing fatal brain injuries, his parents revealed this week.
And court documents in the second-degree attempted murder case of Nataliia Karia, who is scheduled for trial Feb. 20, indicate that she became emotionally overwhelmed and attempted to hang a child who had been in her licensed child-care home for less than three weeks.
They aren't isolated cases. Within the past five years, two home day-care providers were convicted in Dakota County of neglect of infants who suffocated after they were placed in unsafe sleeping positions. In both cases, the infants had been placed in care within a month of their deaths.
Research has identified an increased risk in the first days in care, although the work concerned deaths linked specifically to unsafe sleep positions.
Placing children on their stomachs, or with toys or fluffy blankets, increases their risks of suffocation. Whether children are more at risk of shaken-baby syndrome or abuse in the first days of child care has not been studied.
The American Academy of Pediatrics in 2016 recommended that child-care providers take special precautions regarding sleep positions with new infants in their care. A 2000 study also showed that as many as one-third of SIDS deaths in child care occur within the first week.
"Bottom line – there does seem to be an increased risk for SIDS in the first few weeks of day care," said Dr. Rachel Moon, lead author of both the pediatrics guidance and the study, and director of the child health research center at the University of Virginia. A leading culprit is the placement of an infant to sleep on his or her stomach, "particularly when the baby is not used to that position," she added.
Moon said she wants to study whether increased emotional distress in babies when they transition into child care also creates a heightened risk.
Minnesota law requires licensed child-care facilities to place infants to sleep on their backs in cribs – and to deviate from those requirements only when a parent presents a note from a doctor. But parents should insist up front that these standards be followed, said Alison Jacobson, chief executive of First Candle, a Connecticut-based advocacy group seeking to prevent sudden infant deaths.
Rather than asking providers about their practices, she said, parents should assert: " 'You need to place my baby on his or her back to sleep every time in a crib – with nothing else in that crib.' "
First Candle provides a checklist of questions for parents to ask to identify any safety concerns when selecting care providers.
In recent years, however, Minnesota parents have found choice harder to come by for licensed family child care. While the number of large child-care centers has increased, the number of licensed home day cares has declined 22 percent since the end of 2012.
That was the year of a Star Tribune series on a sharp rise in child-care deaths, which prompted state legislation to increase training hours for licensed child-care providers – especially in the areas of safe sleep positions and the prevention of shaken baby syndrome (also known as abusive head trauma).
Child-care deaths in Minnesota decreased from 52 deaths in the five-year period ending in 2012 to 17 in the next five-year period. However, critics blame the rising pressure and regulation for a drop in providers.
State officials have also created options to help providers through stressful times. Croft's organization received a state grant last year to expand a program that provides in-home consultations to licensed providers over the best care of infants, and strategies to maintain safety. Providers who complete the free training receive $500 stipends, but Croft said many simply appreciate the support in a field where they otherwise feel isolated caring for children all day.
"Sometimes," she said, "they just need a little shot in the arm."