To the Editor.—

We believe that there is insufficient evidence to state that "children are at no greater risk of injury in day care settings than in the home environment," as concluded by Rivara et al.1 Because the number of injured children was small (N = 29), it is unlikely that this study could provide accurate age-specific rates or identify rare but serious injuries. Studies of day care environments2,3 suggest that children in day care are exposed unnecessarily to many hazards that have the potential to cause serious injury (eg, unsafe playground surfaces and equipment heights).

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