Hundreds of licensed child day care providers in Michigan have been quietly ordered to eliminate the disciplinary tool of enforcing timeouts for unruly children under the age of 3. The rationale: Such measures are “unlikely [to] prevent repeat misbehavior” and can leave a toddler “upset, confused and angry.”

The new regulation was enacted by the Department of Licensing and Regulatory Affairs in December and implemented over the last few months.

The department has long had a rule against corporal punishment, confinement or inflicting mental or emotional stress as means to enforce discipline in a day care. The recent action adds a ban on timeouts and placing substances such as soap or hot sauces in a child’s mouth.

The regulation does say that other “reasonably appropriate discipline or restraint may be used to prevent a child from harming himself or herself or ... harming other persons or property.”

Some day care providers wonder what that means, and consider the new restriction a case of government overreach.

Sherry Loar, who has run a licensed day care for young children in Petoskey for more than 25 years, questioned the department’s logic. “If not timeouts, what? Do you let them walk around and bite other children until they’re three? What do they want us to do?”

State regulators provided a clarification of their ruling.

“Time-out is a form of behavioral modification that involves temporarily separating a person from an environment where an unacceptable behavior has occurred. The goal is to remove that person from an enriched, enjoyable environment, and therefore lead to extinction of the offending behavior,” the licensing agency stated in an email. “It is inappropriate to discipline children under 3 years of age for behavior that is beyond their control and understanding. They should be kindly and firmly removed from what they cannot do and be redirected to an activity they can do. If children under 3 years of age are upset and need time to calm down, an adult should go with the child to a quiet place and help him calm down. The adult can help the child calm down by doing a relaxing activity with him, such as hugging him, reading a book, listening to peaceful music, or sitting with him as he cuddles with a stuffed animal until he feels better.”

The timeout has been in use for decades as way to address extreme physical or emotional outbursts in children. In it, a caregiver attempts to calm an unruly child by briefly removing him or her from the activity being disrupted, such as group play.

The tactic was developed in large part as a response to a growing consensus among child development experts that physical punishments, such as spanking, were counterproductive.

In recent years, however, the tactic has come under more scrutiny, with some experts suggesting that it not be used for children under 3 or 4, because they are too immature to grasp the lesson being rendered. They also say it may also be inappropriate for children over 6, because it leads to shame and humiliation, especially if administered in a school setting.

The preferred approach to misbehavior, according to some, is to redirect the disruptive child to another activity, like reading.

One reader of a popular website on childrearing commented on redirecting. “Our day care used to laugh at redirecting. He hit someone? OK, now he has to go read a book. He threw the book? OK, so now he has to go play with cars. He took a friend’s car? OK, now he has to go play in the kitchen! He hit a friend with a spatula?”

Petoskey’s Loar clashed with Michigan’s day care bureaucracy a decade ago over an attempt to involuntarily unionize the home day care workforce. When asked about timeouts, she said that a blanket ban on them is one more way the administrative state is extending its control over private sector providers.

Loar, who gives care to about a dozen children, most of them infants and toddlers, said she and her staff have almost never had disciplinary issues, and she doesn’t recall having used timeouts.

That doesn’t mean, she said, that the tactic is never appropriate in specific contexts with specific children.

“The way that it’s written, it’s like until they reach age 3, it’s a free-for-all,” Loar said. Regulators and childcare providers, she added, should work together to help children. But “this is not about children. It’s about increasing government control.”

On March 24, the state of Michigan’s Department of Licensing and Regulatory Affairs threatened administrative action against physicians for prescribing certain anti-malaria drugs not specifically approved for the COVID-19 coronavirus, or for trying to stockpile the drugs.

But on March 28, the U.S. Food & Drug Administration approved the use of hydroxychloroquine or chloroquine in emergency situations to combat the coronavirus for certain hospitalized patients. The agency’s chief scientist wrote, “Based on the totality of scientific evidence available to FDA, it is reasonable to believe that chloroquine phosphate and hydroxychloroquine sulfate may be effective in treating COVID-19. ...” Those drugs have been widely used for decades to fight malaria.

The state of Michigan would not address whether it would still pursue punitive actions against physicians now that the FDA has commented.

Instead, the state licensing agency wrote an email on March 30 to Michigan Capitol Confidential that read: “Prescribers and dispensers have a responsibility to apply the best standards of care and use their clinical judgment when prescribing and dispensing these and any other drugs to treat patients with legitimate medical conditions.”

On March 30, LARA released a statement from Debra Gagliardi, the director of the Bureau of Professional Licensing, that acknowledged the FDA ruling's on the new drugs. But Gagliardi's statement didn't reference LARA's previous stance that threatened administrative action.

"LARA appreciates the essential role of our prescribers and dispensers and recognizes their ability to make proper clinical decisions including following responsible prescribing and dispensing practices," Gagliardi stated. "LARA thanks all of the dedicated licensed health professionals and others who continue to provide the best possible care for Michigan’s citizens during this state of emergency."

The FDA noted that because the drugs meet relevant safety and effectiveness criteria, it would let chloroquine phosphate and hydroxychloroquine sulfate be used to fight coronavirus in specified circumstances, even if they have not been formally approved for treating COVID-19.

The FDA stated that, based on limited trials and data, it was reasonable to think that the drugs could be effective treatments. The agency’s permission, given as an emergency authorization, allows physicians to prescribe the drugs to adults and adolescents hospitalized for the coronavirus.

Below is the March 24 statement of the Michigan Department of Licensing and Regulatory Affairs:

“Prescribing hydroxychloroquine or chloroquine without further proof of efficacy for treating COVID-19 or with the intent to stockpile the drug may create a shortage for patients with lupus, rheumatoid arthritis, or other ailments for which chloroquine and hydroxychloroquine are proven treatments. Reports of this conduct will be evaluated and may be further investigated for administrative action. Prescribing any kind of prescription must also be associated with medical documentation showing proof of the medical necessity and medical condition for which the patient is being treated. Again, these are drugs that have not been proven scientifically or medically to treat COVID-19.”