We usually think of surveillance as the aggregation of health data at a State or Federal level. Stroup and Thacker, in discussing surveillance for health problems affecting workers and children in child-care settings (1), understand that there is a role for case based as well as rate-based surveillance. Rate-based surveillance is most valuable for establishing the magnitude of a problem, assessing its geographic distribution, and tracking its trends. In the United States, Alexander Langmuir was probably the foremost disciple of rate-based surveillance for communicable diseases (2). In contrast David Rutstein was the proponent of focusing on Sentinel Health Events (SHE), cases of selected diseases and injuries that signal a failure of prevention (3). The goal of the SHE approach is to identify the causes of these failures of prevention, so that they can be remedied, often by local action. It is interesting to speculate that if the SHE approach were adopted by child-care providers they themselves may become the most effective advocate for prevention. Imagine the impact possible if a child-care provider asked the appropriate questions about why a child failed to be vaccinated or was injured, and this act led to augmented prevention.