Reducing maltreatment risk

Children have received food to which they are allergic. The following may reduce the likelihood of children's exposure to such food:

• Create a protocol to ensure that children are not exposed to allergens and ensure that all staff people are trained on the protocol. Some providers have included the use of a different colored cup, plate, or placemat to aid in recognizing food allergens.
• Ensure that allergies are posted as required.
• Ensure that the facility is provided with current prescribed medications, such as Benadryl or an EpiPen®; if the child has been prescribed epinephrine for allergies. In addition, provide training to staff people on how to recognize symptoms and respond to a child having an allergic reaction, which may include information on how and when to use an EpiPen®.

Due to the severity and preventability of incidents regarding hot water, sunburns, and other. In addition, information is provided regarding burns from hot food and drink. The following information may reduce the likelihood of such incidents:

To prevent burns from hot water:

• Routinely check the temperature of water coming out of faucets in various locations at varying times of the day, including any time a water heater is installed or repaired.
• Install temperature control devices on the hot water heater or faucets.
• Train staff people to measure and control water temperature (not to exceed 120 degrees Fahrenheit).

To prevent burns from the sun:

• Develop and implement written procedures, in consultation with a health professional, to reduce the risk of injury from sun exposure.
• Increase staff people's awareness of medications that may increase photosensitivity.
• Train staff people on preventative measures such as avoiding mid-day sun exposure, applying sunscreen prior to sun exposure and at frequent intervals during sun exposure especially when engaging in water activities, covering exposed skin with hats or clothing, and checking the expiration dates on sunscreen products.

To prevent burns from food and drinks:

• Train staff people to ensure that all food and drink served to children is at a safe temperature.
• Increase staff people's awareness of the danger posed by their own food and drinks when in an area with children.

To prevent burns from bottle warmers:

• Secure bottle warmers to the back of a countertop
• Ensure that electrical cords are out of the reach of children
• Post signs warning that the bottle warmer may be hot and that staff people should not allow, or carry, children in the area of the bottle warmer.
• Move, clean, and maintain bottle warmers only when there are no children in the area.

Children have suffered elbow injuries at child care centers. The most common injury is referred to as "nursemaid's elbow," partial dislocation, or radial head subluxation. The most common cause of such an injury is staff persons lifting or pulling children by the wrist or hand. Examples of incidents involving children suffering "nursemaid's elbow" include the following:

• A staff person "yanked" a child by the hand when the child refused to walk with the staff person.
• A staff person pulled a child by the hand(s) when the child extended their hand(s) for assistance getting up from the floor or over a partition.
• A child dropped to the floor while a staff person held onto the child's hand.

In addition to increased awareness of this safety concern, the following might help prevent these injuries:

• Lift children by grasping them under their arms or around their bodies.
• Discontinue leading a struggling child by the hand.
• Never grab, drag, pull, yank, swing, lift, or restrict movement of children of any age by their arms or wrists; allow the child to hold onto the staff person's hand instead of the staff person holding onto the child's hand.

Minnesota Statutes, section 142B.54, subdivision 1, states that except for family child care settings and foster care for children in the license holder’s residence, providers must establish and maintain policies and procedures to ensure that an internal review is completed within 30 calendar days and that corrective action is taken if necessary to protect the health and safety of children in care when the facility has reason to know that an internal or external report of alleged or suspected maltreatment has been made.

The review must include an evaluation of whether related policies and procedures were followed before, during and after the incident; whether the policies and procedures were adequate; whether there is a need for additional staff training; whether the report is similar to past events with the children or the services involved; and whether there is a need for corrective action by the license holder to protect the health and safety of the children in care.

Children have been injured on playground equipment. The following may reduce the likelihood of playground injuries: 

• Ensure surfaces around playground equipment are covered with material such as wood chips, mulch, sand, pea gravel or safety-tested rubber-like material.
• Ensure that protective surfacing extends at least six feet in all directions from play equipment.
• Ensure play structures are spaced an adequate distance apart.
• Check for dangerous hardware or sharp edges on equipment.
• Check equipment and playgrounds regularly to ensure they are safe and in good condition. Dirt or grass surfaces below playground equipment do not adequately protect children if they fall.

Ensure that the playground equipment is age-appropriate for the children using the equipment. Children who are allowed to play on playground equipment designed for older children are at greater risk of injuries from falls. 

Further information from the U.S. Consumer Product Safety Commission regarding playground equipment is available in the Public Playground Safety Handbook (PDF). The U.S. Consumer Product Safety Commission also warns that children’s climbing equipment should not be used indoors on wood or cement floors (PDF) even if covered by carpet. Carpet does not provide adequate protection to prevent injuries.

Thorough development, training and implementation of a child care center risk reduction plan required by Minnesota Statutes, section 142B.54, subdivision 2, may help reduce the likelihood of incidents of known risk to children, including:

• Closing children's fingers in doors
• Leaving children in the community without supervision
• Children leaving the facility without supervision
• Dislocation of children's elbows
• Burns
• Injuries from equipment
• Food allergies
• Children falling from changing tables.

Rough handling of children in child care centers by staff people also has been reported. The following may reduce the likelihood of such incidents:

• Provide training to the staff persons on acceptable methods of behavior guidance as required by Minnesota Rules part 9503.0055.
• Discuss with parents or guardians methods of behavior guidance they have used successfully with their child.
• Develop a behavior plan when a child engages in persistent unacceptable behavior and provide training to staff persons on the implementation of the behavior plan as required by Minnesota Rules part 9503.0055, subpart 2.

Children's fingers can be pinched in doors at child care centers. Children are at risk of their finger(s) being caught in a closing door; resulting injuries have included severing of a fingertip and permanent loss of a fingernail. There have also been incidents where children's fingers were pinched in cabinet doors. The following may reduce the likelihood of this type of incident from occurring:

• Delineate a visual "safety zone" around the door, showing an area where children should not stand or sit.
• Increase awareness and supervision by staff persons around doors.
• Use door protectors (light weight plastic that adheres to the door and frame and discourages a child from placing his/her fingers in the hinge side of the doorframe). These are not guaranteed to prevent an injury, but may reduce the severity of the injury.
• Secure doors in an open position, if appropriate.
• Remove any unnecessary doors.

Sexual contact can occur between children at child care centers and at children's residential facilities. The following may reduce the likelihood of such incidents:

• Increase awareness and supervision by staff people in child care centers, including awareness of children who are playing in obstructed view areas such as climbers, play houses and tents as well as discussions about appropriate boundaries with children.
• Increase awareness and supervision by staff people in children's residential facilities, including increased awareness of where children are at all times, especially in areas that are difficult to supervise, such as bedrooms, hallways and bathrooms. Develop plans to address supervision for children with histories of engaging in inappropriate sexual behavior and discuss appropriate boundaries with all children receiving services.

The Licensing Division receives reports involving children leaving child care centers without staff persons' knowledge, children left without supervision on playgrounds or in classrooms, children left behind in community settings and children leaving the group during outings or field trips. In addition to the provision of required supervision (Minnesota Statutes, section 142B.01, subdivision 27 and Minnesota Rules, part 9503.0045, subpart 1, item A), the following suggestions are made to reduce the likelihood of such incidents:

• Increase awareness by staff persons of the elevated risk during transitions and at busy times of the day when entrance doors are frequently used by parents and other visitors.
• Maintain an accurate attendance list of children. Take attendance at regular intervals during the day by matching names on the list with the children present.
• Ensure that children are within sight and hearing at all times. Train all staff people on appropriate supervision requirements and document that staff persons demonstrate competence in implementation.