396 PEDIATRICS Vol. 87 No. 3 March 1991
COMMENTARIES
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
Brother’s
Keeper
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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COMMENTARIES 397
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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398 COMMENTARIES
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
REFERENCES
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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1991;87;396
Pediatrics
PATRICIA D. FOSARELLI
I Am My Keeper; I Am My Brother's Keeper
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1991;87;396
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PATRICIA D. FOSARELLI
I Am My Keeper; I Am My Brother's Keeper
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