Child fentanyl deaths spur policy change

Officials: 8 infant, toddler fatal overdoses in CT since 2020

Eight Connecticut infants and toddlers have died from fentanyl intoxication since 2020 and more than two dozen others under the age of 5 have survived after being poisoned by the lethal drug since 2021, according to state officials.

The trend has prompted state agencies that deal with child welfare and adult social services to make policy changes to save young lives.

“The opioid epidemic in adults is having a profound impact on the safety, health and well-being of children,” said state Child Advocate Sarah Eagan, whose office receives data on every child death in Connecticut.

“All of our systems that are working with adults who need opioid abuse treatment have to be knowledgeable about the potential harm and impact on any child in the household.”

Case and social workers with the state Department of Children and Families are now required to assess the safety of children in a home where fentanyl may be used and seek input from a regional group of clinicians within one business day, according to “interim guidance” issued on Thursday. But it will take more time for DCF to finalize any policy changes based on the shifting dynamic of the opioid epidemic, officials said.

Fentanyl has escalated the opioid crisis in Connecticut to the point that residents are now more likely to die of an accidental drug overdose than a car accident, according to the state Department of Public Health. In 2021, 1,524 residents died of accidental drug overdoses — a 9 percent increase from the previous year — with 86 percent of the deaths involving fentanyl.

As more parents use fentanyl,

more children, particularly those under the age of 5, are at risk of being poisoned by the drug, Eagan said.

The question, Eagan said, is how are policymakers going to respond.

“Any agency coordinating services for care for adults with opioid-use disorder also has to have to help that individual reduce risk and provide child safety planning,” Eagan said.

Child deaths under the age of 2-and-a half due to fentanyl wasn’t documented before 2020, Eagan said in her annual report. That year one child under the age of 2 died by ingesting fentanyl. In 2021, there were six children under the age of 2 who died of fentanyl intoxication, including a baby who was less than a month old, said Brendan Burke, the state’s assistant child advocate. Their average age was 13 months old, Burke said.

In 2022, there has been one confirmed death of a child under the age of 2 from fentanyl intoxication — but that number may increase as toxicology results are processed, Eagan said.

Based on critical incident reports issued by DCF, more than two dozen children under the age of 5 with a median age of 2 were poisoned by fentanyl, but were revived by first-responders using Narcan, a drug that reverses an opioid overdose, Eagan said.

The deaths and non-fatal poisonings have occurred in suburban and urban communities throughout the state, Burke said. There were nine non-fatal fentanyl incidents involving children under 5 in Hartford County, seven in New Haven County, three in Fairfield County and one each in Windham, Middlesex, New London and Tolland counties since March 2021, data provided by Eagan’s office indicated.

Of the eight fatalities in young children, three occurred in Hartford County, three were in Fairfield County, and one each occurred in New Haven County and New London counties.

In at least one case, a Danbury grandmother was charged with manslaughter, drug possession and risk of injury to a child after her 1-year-old grandson died from a combination of fentanyl and a veterinarian tranquilizer he allegedly ingested while in her care in March 2021.

Cora Brandon has pleaded not guilty to the charges and has been held at York Correctional Institution on $500,000 bond since her arrest in May 2021. Her grandson was limp and unresponsive and had been “sleeping” for six hours before Brandon called his mother to report something was wrong, according to an arrest warrant.

Officials with the offices of the Child Advocate and the Chief Medical Examiner could not provide information on the towns where the fatal and nonfatal fentanyl poisonings occurred to protect the privacy of the families.

The information could identify the children since the fentanyl deaths were the only infants who died in some towns, Burke said. A fentanyl overdose can happen very quickly with a very small amount of the drug, DCF Commissioner Vannessa Dorantes said.

“Children are constantly putting their hands in their mouth,” Dorantes said.

Fentanyl is so lethal that even a small amount of residue left on a table or on someone’s hands can kill a small child quickly if first responders do not recognize the signs, DCF officials said.

“When a child is lethargic, it can some across that it’s something else,” Dorantes said.

Fentanyl depresses the respiratory system and heart rate, said Dr. Nicole Taylor, director of pediatrics for DCF. “It only takes minutes for an adult to start feeling the effects of fentanyl,” Taylor said. “For a little infant, it only takes a small amount for the child to overdose.”

First responders need to recognize the signs of opioid intoxication in children so Narcan can be administered, Eagan said. “Narcan is a life-saving tool,” she said. In addition to policy changes, Eagan also wants the committee that will decide how to distribute the state’s opioid lawsuit settlement to consider using the money to address the needs of parents and children affected by the epidemic.

The infant and toddler fentanyl deaths will be a topic of discussion at the state’s Child Fatality Review Board meeting this week, Eagan said. The group includes members from DCF, DPH, and the medical examiner’s office among others.

A group of DCF employees began meeting in late spring to determine what policies may need to change to keep kids safe, Dorantes said.

The collaboration resulted in the interim guidance issued to agency case and social workers last week.

“We couldn’t just act on the fly,” Dorantes said. “It’s looking forward on how we plan to respond.”

The short-term safety steps, including assessing a child’s vulnerability for fentanyl poisoning, will be included in the agency’s long-term safety plan, the commissioner said.

The guidance could include putting children in state custody if it is determined they

cannot remain safely in the home, said Zoe Stout, director of DCF’s legal team, which reviews decisions to remove children from their families.

But the point of the new guidance is not designed to bring more children into state custody, DCF Deputy Commissioner of Operations Michael Williams wrote in an email to staff. It’s to continue collaborative efforts to get parents and caregivers into treatment, he said.

“Any person using or handling fentanyl in the home is a safety concern,” Williams said.

Eagan