Parents who leave their child, especially their vulnerable infant, in the care of someone else can often feel fear or angst. One common concern for parents is that their child may suffer abuse when they (the parents) are not there to protect them. As pediatricians, how do we know which daycare centers or providers are the safest? How can we ensure that children are not harmed by those who are supposed to be caring for them?
Arguments for and against daycare centers are long and fraught with emotion. For example, some feel that in-home daycares are more child-friendly and nurturing, and in-home daycares can be a lot less expensive for families. However, in a recent article in our journal, Adamsbaum et al (10.1542/peds.2020-013771) have shown what many of us in child welfare have long suspected: children in daycare centers are less likely to be victims of severe abusive injury, i.e. abusive head trauma (AHT). In this study, researchers found only one case of AHT occurred in a daycare center out of over 300 cases of AHT. The rest of the AHT cases occurred in private homes. In addition, at least 93% of cases occurred when the child was in the care of a single person.
The risk to children in the care of a single caregiver cannot be overemphasized. This is an opportunity for pediatricians and other support professionals to intervene and provide education to families. Are parents leaving children in the care of an over-stressed, traumatized adult? Can parents look for other daycare options, or set up respite breaks for caregivers? Have the caregivers been educated about AHT and the risks of shaking a baby?
Unfortunately, not all children and families have access to high-quality, well-managed daycare centers. This lack of access is a factor in exacerbating existing disparities. Minority children are overrepresented as victims of child abuse, and the lack of access to safe environments can be a factor in this statistic. Many daycare centers have limited daytime hours and are not available on weekends. Nighttime and weekend workers are unable to take advantage of these centers. In addition, as I mentioned before, daycare centers are more expensive than many in-home child care options, which can be cost-prohibitive to lower-income workers. Making more affordable safe childcare options available for families can be one step in preventing children from abusive head trauma.