Most common preventable infant death?
The deaths of 83 Arizona infants were connected to unsafe sleeping and accounted for nearly a quarter of all preventable child fatalities in 2017, a new state report says.
The numbers underscore a need for more safe sleep education, says the 25th annual Child Fatality Review report released by the state health department on Thursday.
The report found the most commonly identified preventable factors for infant injury deaths in and around the home were unsafe sleep environments, including sharing a bed with siblings or adults and lack of supervision.
Parents are often unaware that infants are not able to physiologically handle their airways being covered by a blanket or a parent’s arm, and that they can die very quickly in such a situation, said Dr. Mary Ellen Rimsza, who chairs the Arizona Child Fatality Review Program.
“A big part of this problem is after it happens, everyone is silent about what happened. It’s just so sad and disturbing to the family, particularly if they recognize that maybe it could have been prevented, nobody talks about it,” Rimsza said.
“It’s not like a motor vehicle crash that makes the news . ... Or a drowning death that makes the news. We don’t know that your neighbors lost their baby to a suffocation.”
337 preventable child deaths in 2017
The report found a total of 337 Arizona children under the age of 18 died preventable deaths in 2017, which is 42 percent of all child deaths that occurred that year.
The number of preventable deaths was up slightly from 330 the previous year.
The intent of the child fatality review program is to identify ways of reducing or eliminating preventable fatalities for future generations. Over the last decade, the child mortality rate in Arizona has decreased in every age group, the report found.
In addition to deaths from unsafe sleeping, deaths from suicides and firearms were up in 2017, as were cases where substance abuse was a contributing factor in the child’s death.
Alcohol and drugs contribute to negligence
Child deaths connected with substance abuse often concerned a parent or another adult being negligent due to drugs or alcohol, the report says. In 50 of those deaths, the child was younger than a year old.
“With the younger children, it’s more a matter of the parents using drugs. And because the parents were using drugs, they weren’t supervising their children, or they were driving under the influence,” Rimsza said.
Child fatalities due to maltreatment accounted for 24 percent of all preventable deaths among children and most of the children who died were under five years of age. Substance abuse was a factor in most of those deaths.
“Basically when people are substance users they are not good parents. They are not taking care of the children. They are not watching them closely,” Rimsza said. “They are not getting them to medical care, preventing them from falling down the stairs or from getting into the pool.”
50 children took own lives in 2017
In the six years between 2012 and 2017 the child suicide rate in in Arizona increased significantly, from 1.7 per 100,000 kids in to 3 per 100,000. Fifty children in Arizona took their own lives in 2017, the report said.
“The problem with suicide deaths is in some way similar to the suffocation deaths,” Rimsza said. “We don’t get a lot of information about them, either.”
Factors that may have contributed to the suicide such as bullying, mental health problems and family discord often aren’t available to investigators reviewing the deaths, she said.
Most of the child suicides in 2017 were male, and most were between the ages of 15 and 17. Firearms were used in 44 percent of the deaths.
“We do recommend that if parents know there is a depressed child in the home, they get the guns away and try to get them into services,” she said.
Accidental deaths rise by 4 percent
Unintentional injury deaths increased by 4 percent over 2016 and were mainly caused by motor vehicle crashes and other transportation injuries.
The report makes several recommendations including more awareness programs about healthy behaviors prior to pregnancy, community suicide prevention and drowning risks. It also recommends education on the dangers of bed sharing and the ABC’s of Safe Sleep — alone, on their back and in a crib to prevent sleep suffocation.
Infants who share a bed with an adult or sibling, who go to sleep on their stomachs, or who sleep with excessive bedding, toys and clothing are all at risk of suffocation, said Vanessa Bustillos, statewide prevention coordinator for the Arizona Department of Child Safety.
“One of the challenges I find is a cultural thing, even from my own family, it was kind of normal to co-sleep or bed share,” Bustillos said. “Another challenge is the breastfeeding. It’s really easy to fall asleep while you are breastfeeding, so it’s unintentional co-sleeping.”
‘Baby boxes’ can help. What are they?
Other times, infants are in unsafe sleeping situations because their parents lack resources, she said.
For the past two years, DCS has been giving out “baby boxes” for families who cannot afford a crib. Baby boxes, which are laminated and include a mattress and fitted sheet, model a successful program in Finland, where infant deaths due to unsafe sleeping are extremely low, Bustillos said.
“The first baby box we gave out was a single mom of three and all three kids were under five. We were helping her with housing. She was in a hotel and sleeping with all three of them — she didn’t have anywhere for them to sleep,” Bustillos said.
“For us to give her a baby box as a temporary place for her baby to sleep was much safer than sharing a bed with the baby.”
Parents must complete an online course on injury prevention before they can get a baby box, and to date the state has given out more than 1,000, Bustillos said.
‘Safe sleep’ education is critical
DCS is also in the midst of creating a video where they have interview Arizona parents who have lost their children because of unsafe sleep situations.
“Part of the training I do is a parent testimonial but it’s from Ohio. It will be from Arizona when it’s done. It’s just so much more powerful to hear it from parents,” she said.
DCS is part of a safe sleep statewide task force with several other organizations and agencies, including the Arizona Department of Health Services and the March of Dimes’ Arizona chapter.
The task force, which formed in 2015, created a “crib card” that reminds parents of the ABCs of sleep. It also gives parents tips like “share your room, but not your bed,” “don’t overdress the baby,” and “keep soft objects or loose bedding out of the crib.”
Rimsza said new parents are overwhelmed and exhausted. But safe sleep education is critical.
“We used to think there was such a thing as crib deaths and then we changed the name to sudden unexplained infant deaths. And it wasn’t entirely clear until recently that these were largely suffocations,” she said. “And they were largely from being in unsafe sleep environments.”
Arizona sleep death statistics not improving
Sleep deaths continue to be a problem in Arizona and the numbers are not improving, she stressed.
“It is a problem in every state. Some states are doing better than we are, probably because they are getting the message out more to parents,” she said.
“It’s such a tragedy because they are healthy babies. They are normal babies. It’s just that they can’t breathe as easily as we can. They can’t move themselves around to get away from a pillow blocking their airway,” she said.
“Safe sleep just needs to be mentioned again and again and again.”