Child suicides spiked in 2018

Overall number of deaths jumped to 843

In 2018, 64 Arizona children killed themselves — the most recorded in the quarter century that health professionals have tracked the death of every child under age 18.

Overall, the number of child deaths jumped to 843, the highest number in the last six years, according to the annual Arizona Child Fatality Review. Premature birth accounted for more than a quarter of the deaths, with many of the mothers not having seen a doctor during their pregnancy.

The 64 suicides were among the 40% of deaths that the study deemed preventable. If people had been more aware, more cautious or had better access to medical and behavioral-health resources, Arizona might not have lost 74 children in motor-vehicle crashes or 43 to firearms shootings, the report stated.

Suicides spike

Particularly alarming was the spike in child suicides, up 28% from the previous year.

It’s hard to pinpoint the reasons for such a jump, said Dr. Mary Ellen Rimsza, the chairwoman of the survey by health professionals that examines the death of every child under age 18.

“Investigations of suicide deaths are very limited,” she said. But data from medical-examiner reports showed that 38% of the suicides, representing 24 deaths, was due to firearms.

Because of that, the survey’s authors recommend families remove firearms from their homes “if their child or any other family member is experiencing mental health problems such as depression, substance use, or suicidal ideation.”

Rimsza said it’s also important for

adults to act if they see behavior changes in teenagers. Seventy percent of the suicides were by teens ages 15 to 17. Children ages 10-14 accounted for the remaining 30%. “Teenagers are moody, so it may be easy to put it off,” Rismza said. But it’s best to err on the side of caution and get the child to a counselor or behavioralhealth professional.

School counselors would be a good resource, but Rimsza noted Arizona’s schools are understaffed, even though the Legislature provided some extra funding last year.

“We need more funding because these problems are often identified in the school setting,” she said.

No prenatal care = premature birth

As is the case every year, the majority of childhood deaths are due to natural causes, such as medical complications, as compared with accidents or intentional causes, such as homicides (which numbered 31).

The leading cause of deaths due to natural causes was premature birth, which accounted for 26% of such deaths. Most of those cases involved what medical professionals call “extreme prematurity,” meaning the child was born before 28 weeks. A child born at 39 weeks is considered full term.

The review found an 83% spike in women who had premature babies and who did not get any prenatal care. In 2018, 44 of the women whose babies were born prematurely and died reported they did not see a doctor during their pregnancy, compared to 24 the previous year.

Rimsza said there’s not enough medical history on the Arizona mothers who had premature births to put the blame solely on lack of prenatal care. But national studies indicate it’s a key factor.

Because of that, the study recommends affordable and accessible prenatal care, especially for populations that may not trust the health-care system.

Home-visitation programs such as the nurse-family partnership target low-income women in their first trimester to provide guidance on a health pregnancy. The partnership operates in Maricopa and Pima counties, but no programs serve rural Arizona.

Baby sleep deaths drop

If there was a bright spot in the report, it was a reduction in sudden infant deaths that can’t be attributed to any underlying medical condition. In 2018, 60 infants died due to a sudden, unexplained causes, down from 84 last year — a 29% drop.

Rimsza credits education efforts for the decline. In recent years, child-welfare and health officials have promoted “safe sleep” practices, such as avoiding sleeping in the parents’ bed, laying the baby on his back in his crib and keeping cushy pillows and stuffed animals out of the baby’s bed.

Those practices minimize the risk of the baby being suffocated, which is the primary cause of sudden infant death. The review determined 38 of the 60 babies died due to suffocation. Although the remaining 22 deaths couldn’t be determined, health professionals said the cause most likely was suffocation.

Most hospitals have a policy of instructing new moms on safe-sleep practices, Rimsza said.

The report details the various causes of death and makes recommendations on what can be done to prevent them.

For example, given the number of opioid-related deaths, parents should keep naloxone on hand to counteract overdoses. The study found 105 child deaths involved substance abuse, with opiates involved in 30 of them.

Alcohol was the most-prevalent substance, involved in 35 deaths, followed by marijuana in 32 cases and methamphetamine in 28, the report found.

By law, the report is submitted to the governor and lawmakers and can serve as a guide to policy changes.