I Am My Keeper; I Am My Brother's Keeper






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396 PEDIATRICS Vol. 87 No. 3 March 1991


Opinions expressed in these commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees.

I Am My Keeper;

I Am My



In response to a 1987 General Assembly bill, all

political jurisdictions in Maryland were required to

conduct a needs assessment for school-age child

care. The bill did not dictate how the assessment was to have been done; therefore, different junisdic-tions solicited somewhat different information. Baltimore City, the ninth largest city in the United States (population = 790 000), selected grades in 60

and 10 randomly selected elementary and middle

schools, respectively, to distribute approximately 10 000 surveys to parents for completion. The re-sults were startling.

Overall, when parents were not at home, 4.3%,

20.4%, and 41.2% of 5- through 8-, 9- through 11-,

and 12- through 14-yean-olds, respectively, were in

their own care, and another 25.4%, 37.2%, and

42.3% of 5- through 8-, 9- through 11-, and

12-through 14-year-olds, respectively, were home with only a sibling (age undetermined).’ In addition, 39% of parents who did not need child care at the time

of the survey estimated that they would need care

during the following school year because they were

going to work, to school, on to enroll in a job training

program. For all respondents, self-care on sibling

care was not the preferred type of care; the actual

care used was determined by availability,

afforda-bility, and accessibility.

Overall, 15 500 children (of 84 000) in elementary and secondary schools were estimated to be entirely

alone when parents were not at home. This figure

agreed well with an estimate (17 000) rendered by

Baltimore City Public School principals previously

Received for publication Dec 18, 1989; accepted Jun 25, 1990.

PEDIATRICS (ISSN 0031 4005). Copyright © 1991 by the American Academy of Pediatrics.

in 1986. In addition, another 28 000 children were

going home to siblings only.

This type of needs assessment prompts certain

questions: Was the sample originally chosen truly

representative of all parents and their children?

Were respondents similar to nonrespondents in

their children’s care arrangements? Would parents

have an incentive to underreport self-care and

sib-ling cane? By Maryland law, no child younger than

8 years of age may be left alone on be caned for by

a sibling younger than 13 years. Hence, parents

whose children were in self-care on sibling care might have refused to return the anonymous

ques-tionnaire on downplayed the amount of time that

their children were without adult supervision.

Either way, the figures yielded by the survey are, at best, real and at worst, on the (very) low side.

As we enter the new decade, the results of this

survey are thought-provoking. Are we really con-tent, as a society, to permit children to watch themselves? In the waning years of the 20th cen-tuny, when violence has become commonplace in our major US cities, do we really expect elementary

and middle school-aged children to fend for

them-selves by going home and shutting the doors? If so,

what kind of adults do we hope to produce?

There is already evidence from the logs of calls from “warm-lines” established for children in

self-cane that a majority are lonely or bored.2 This

occurs in children from all socioeconomic groups;

children who are young and those who live in

high-crime of their cities (the latter generally being

poorer children) might fear for their own safety or

worry about the security of their homes when they are alone. Certain children in self-care, especially those who are bored, are more susceptible to peer pressure and may engage in activities about which

their parents have no knowledge.3 A recent article

by Richardson et a14 reported that self-care is an

important risk factor for alcohol, tobacco, and

mar-ijuana use. Interestingly, Richardson et al found

that 43% of eighth graders were in self-care for

more than 4 hours/week when parents were absent,

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a figure that agrees with Baltimore City’s 41% for

12- through 14-year-olds. In view of the increased risk for substance abuse in self-care individuals, it

is startling that nearly 50% of a subgroup of chil-dnen possess this risk factor.

Complacency should not exist when the matter

of sibling care is raised, either. In the first place, if

both children in the arrangement are fairly young,

both may be considered to be in self-cane. Secondly, there is no natural law that dictates that two sib-lings together will not be susceptible to each other’s

peer pressure. Quite the opposite. Most parents can

identify with one parent’s comments about her sons: “They’re good boys, especially each by

him-self. But put them together and [sigh] things

hap-pen that don’t occur when they’re not with each

other. The younger one eggs the older one on; the

older one teases his younger brother.” Thirdly, the

prevalence of sibling abuse (physical, sexual,

emo-tional) is completely unknown. That such

treat-ment exists is known through sporadic reports to

poljce or protective services agencies and by the

testimonies of victims who have now reached

adult-hood. Inasmuch as such a large percentage of our

children are in sibling cane, the relative lack of information about the prevalence of self-care or its

risks is unconscionable.

What can be done? Unfortunately, easy answers

are not forthcoming. The first issue we (especially

pediatricians and other advocates for children) can

address is that self-cane and sibling care are not appropriate for certain children. For years, assuag-ing parental guilt (by health professionals, educa-tons, legislators, etc) has taken precedence over the

developmental needs of children. Our society has

certainly not supported single parents, usually

women, whose employment has meant the

differ-ence between self-sufficiency and dependency on

welfare. Our society has also not recognized that

low wages has forced many parents, single and

married, to assume second jobs (thereby leaving

children unsupervised for an even greaten length of time). Our society has also not accepted the premise that all children are our future and, therefore, our

business in the present. Indeed, our society has been remiss in its support of all its families, espe-cially the most disenfrancised ones and the ones

who risk becoming disenfrancised if breaks do not

come their way. Unfortunately, society’s response

has been to look the other way or to assign guilt to

many already guilty, but loving, parents. Parental guilt and lack of support by society are troubling,

but they do not mean that we should correct one wrong in society by creating a, perhaps, greater wrong, ie, children in children’s care. It is indeed time to speak plainly.

Certain children are not equipped, physically or

emotionally, to care for themselves or siblings.

Al-though young children are undoubtedly ineligible for self-cane, at what age do they become eligible? 10 years? 12 years? Because children’s development varies markedly by age, a designated appropriate

age for self-care cannot be posited. And that is

exactly the point. Parents, with the assistance of

their children’s health providers, must make

mdi-vidual decisions for each child. Children with

emo-tional difficulties (eg, fearfulness, recurrent night-mares, aggressiveness, lack of close friends) are not

candidates for prolonged periods without adult

su-pervision. If a parent does not raise the issue of care arrangements during visits to the child’s health

care provider, the provider should. Regardless of

the provider’s personal feelings about working

mothers, he on she must be objective and act in the

child’s best interest. If the provider does not think

that a child should be alone, he or she must say so,

unambiguously, and then be prepared to assist that

child’s parent in identifying alternative care

ar-rangements. Providers should have access to

cur-rent information about child-care providers and

after-school programs in their communities and

share this information with parents. Because many

parents do not even know how to begin to look for child care, at the very least, the provider should be able to refer the parent to a local agency that could

be of assistance. Providers should follow up on any

parents whom they have referred to determine

whether the agency really has been helpful and

whether the child-care situation has been corrected.

A provider who finds out that a young child is in

self-care on sibling care must be prepared to

safe-guard the child(ren) by reporting the situation to

the proper authorities, when a parent is not inter-ested even in exploring alternative arrangements.

While some health professionals might believe that

a family’s child-care arrangements are its own busi-ness, it is the professional’s concern if the child is

deemed to be at risk for bodily or emotional harm.

By Maryland law, for example, children aged 8

years and younger home alone on cared for by an

underaged sibling (younger than 13 years) are

con-sidened “neglected.”

Several years ago, a warm-line for children

ne-ceived a call from a 5-year-old girl who was caning

for hen 2-year-old brother and 1-year-old sister. She was calling because the baby would not stop crying.

“How do you make a baby stop crying?” she asked.

Frightened, the counselor taking the call requested the child’s address and dispatched the police to the home. This kind of call is not rare. Unfortunately, some children hang up when counselors request identifying information because they are afraid of

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their parents’ anger if they divulge their identity or address. Young children home alone are a potential

disaster. Baltimore City had 814 house fines in 1988 that claimed 59 victims. Ofthese victims, 37% were

children 15 years and younger; in approximately

10% of investigated fines, children playing with matches were implicated as the cause (telephone communication, Public Awareness Office, Balti-more City Fire Department). It is unknown what percentage of these children were alone at the times of the fires, but it can be assumed that most of them were unsupervised to some degree, given that

they were playing with matches.

Society as a whole can change its attitude toward

working parents. The days when a majority of our

nation’s families were composed of two parents, one

of whom stayed at home, are gone. As evidence of

a change of attitude, more employers could develop

flexible working hours or a 30-hour work week for

individuals needing such hours. There is nothing

magical about “9 to 5.” Working from 8:30 AM to

3:00 PM, with either 30 on 60 minutes for lunch,

would mean, potentially, 25% less income for the

employee, but it might permit that employee to

decrease by 50% to 100% the amount of time that

his or her child must be alone. Perhaps the

em-ployee would save money if he or she has been

paying for after-school care. Interruptions after

3:00 PM because of calls between the child’s home

and the parent at work would cease. While not at

work, parents could keep their minds on their jobs

because there would not be unsupervised children

to worry about.

On local, state, and national levels, pediatric

organizations must be vocal advocates for

after-school programs for children, attesting to the

ben-efits of such programs both for the children and their families and for society as a whole. Individual

pediatricians should not only be able to refer

par-ents to appropriate agencies in their communities, but they should, as child health experts, be willing to work with schools, churches, recreation centers,

etc, to develop more local after-school programs.

An after-school program should not be a

baby-sitting service; it should be entertaining and

edu-cational (broadly defined). The program might

pro-vide a snack, time for outdoor play (weather

per-mitting) or indoor recreation, and time to work on

homework, all under supervision of an adult for up

to 3 hours each weekday. On a program might be

much more creative, providing time for children to

learn a new craft, art, on a musical instrument. Any program will need to consider the ages and interests

of its enrollees. Preadolescents might be boned by

a program geared to younger enrollees, but they

might be stimulated by one that provides fun and

some service to their community, such as volun-teening in hospitals, nursing homes, or parks. When

a community witnesses how its investment in such

an after-school program pays off (eg, service to its citizens, fewer youngsters on the streets), it will be inclined to invest in more programs.

If it is a given that there are not day-care slots for our nation’s preschoolers, it is even more

stnik-ing when considering school-age child-cane slots.

Even though Baltimore has added many additional

school-age child-care slots in the last year, it still has only 1835 places for the thousands of children

who need them. Baltimore is probably not atypical

in its mismatch of the number of available

after-school program slots and the number of children who need them. As the first step in developing strategies to assist children who have no adult supervision, more cities and counties must conduct needs assessments to determine the prevalence of

the unsupervised child in their communities and

whether this prevalence is uniform or varies greatly by neighborhood. By such analyses, after-school programs will be placed in areas that need them the most.

If we really want our children to believe that they are our nation’s future, we must act as though they are. We must not only take cane of them during their helpless infancies, but also during their more

independent childhoods and adolescences, when

they need more emotional than physical support.

All of us-parents, health professionals, teachers,

child advocates, legislators, -must “be there” for

our nation’s children. In the process of becoming a

“kinder, gentler nation,” it is the very least we can do.

PATRICIA D. FOSARELLI, MD Department of Pediatrics

The Johns Hopkins Children’s Center

Baltimore, MD


1. Baltimore City School-Age Child-Care Needs Assessment

Re-port. Baltimore, MD: The Mayor’s Office for Children and

Youth; 1989

2. Williams H, Fosarelli P. Telephone care-in services for

children in self-care. AJDC. 1987;141:965-968

3. Steinberg L. Latchkey children and susceptibility to peer

pressure. Dev Psychol. 1986;22:433-439

4. Richardson JL, Dwyer K, McGuigan K, et al. Substance use

among eighth-grade students who take care of themselves after school. Pediatrics. 1989;84:556-566

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I Am My Keeper; I Am My Brother's Keeper


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