City sources told the New York Daily News the child had been in a crib at a Queens day care center when a group of unsupervised younger children began tossing toys and stuffed animals into the crib.
The Queens district attorney's office is considering charging Devlin Daycare for the Aug. 11 death, however the city health department said its day care inspectors visited Devlin one hour before Perilli was found unconscious.
"My department had done everything it could or should have done," Health Commissioner Thomas Frieden said Friday.
Frieden has ordered an overhaul of the day care inspection system and fired of the head of the department's day care bureau, Donald Nolte.
The inspectors allegedly only checked if the owner, Heather Devlin, had a license, but the day center should have had one adult for every two infants under the age of 2. It was later determined there was as many as eight children under the age of 2, and only one adult.