It was one of many troubling incidents at unlicensed day care centers in recent years.
Action News Investigative Reporter Chad Pradelli sat down with a mother whose child died in one of those facilities in Bucks County, Pennsylvania.
In June 2017, Christina Sawicki got a gut-wrenching call from her babysitter in Bristol Township.
"She goes, 'It's Alivia,'" Sawicki recalled. "Alivia is not breathing. She's unresponsive. They're taking her to the hospital."
Sawicki's 19-month-old daughter had suffocated while sleeping in an improperly fastened car seat.
Alivia had been left alone in an upstairs bedroom while her babysitter, Jaimee Gorman, took care of eight other children -- most of whom were not her own. Gorman did not have a child care license despite watching as many as 13 kids at a time, which is far above the state limit of three unrelated children for an unlicensed day care.
An Action News investigation found that under-the-table child care providers, like Gorman, are not uncommon in the Philadelphia area. A data analysis of Paycheck Protection Program loans and advertisements on Brightwheel identified nearly 1,000 local day cares that did not appear in state licensing databases.
Reporters then spot-checked this list with online searches, phone calls and site visits, finding that about a quarter of sampled day cares were licensed under different names and addresses, recently closed or not required to be licensed. These results suggest there could be hundreds of illegally unlicensed day cares across Philadelphia and its collar counties.
However, the Pennsylvania Department of Human Services, which oversees child care providers, does not proactively look for those illegally operating without a license. Instead, the agency relies on complaints by parents or other individuals, investigating only when a concern arises.
Gorman was not on the state's radar until after Alivia died in her care.
In 2018, Gorman was charged by the Bucks County District Attorney with operating an illegal day care. She ultimately pleaded guilty to endangering the welfare of a child.
Deaths in child care settings are relatively rare: In the last five years, there have been 146 serious injuries and seven deaths of children at facilities known to Pennsylvania DHS. Five of the deaths were due to a 2019 fire at a family day care in Erie. Of the injuries, about 92% happened at day care centers, which account for roughly 97% of licensed child capacity.
The state reported one fatality and two serious injuries at illegal day cares during this period, but the lack of active oversight could mean more have gone undetected.
From 2018 through 2023, DHS issued 535 cease and desist orders to unlicensed child care providers across the state, with more than half of those in 2022 and 2023 alone. Pennsylvania DHS Secretary Val Arkoosh attributes the recent rise in these orders to agency inspectors' thorough work.
However, the 6abc data analysis suggests that state regulators are only scratching the surface of illegal day cares.
About three-quarters of the unlicensed providers identified by Action News appear to be home-based day cares like Gorman's.
State inspectors are limited in their ability to investigate these providers, because they can't enter a private home without a search warrant.
"We don't have eyes on every block of every street of every town in the Commonwealth," Secretary Arkoosh said.
Home-based day cares tend to be less expensive than child care centers.
In Bucks County, home-based day care for an infant typically costs around $10,700 a year, according to data from the U.S. Department of Labor. That's about 8.6% of the county's median household income. Center-based infant care costs nearly 1.5 times as much: $15,900 annually or 12.7% of the typical family income.
For providers, state licensing doesn't cost money -- but it does require significant time, ongoing training and safety protocols, like background checks and minimum staff-to-child ratios. Pennsylvania's roughly 12,000 licensed child care providers must undergo annual inspections to ensure they meet state standards.
To Alivia's mother, Gorman's neglect of licensing requirements was a dangerous decision, though she doesn't believe the babysitter ever intended to put her daughter in harm's way.
"So much goes through your head," Sawicki said. "What could I have done differently as a mother? How could I have protected my children?"
Secretary Arkoosh said parents should search for licensed child care providers using the state's online tool.
However, the agency's reactive approach to child care regulation cannot reverse the loss of families like Alivia's.
"You're always reminded, every second of every day, of the child you don't have," Sawicki said.