Text by Josh Kovner, Hartford Courant; video by Mike Magnoli, FOX CT
Infants dying from unsafe sleep conditions was the leading cause of death of children in families known to the child-protection system over the last three years, officials said Wednesday.
In response, the Department of Children and Families plans to announce Thursday that it will markedly increase its focus on unsafe sleep environments and embark on a broad public-awareness campaign.
Caseworkers will inspect the sleeping conditions of children during every visit to a foster or family home, document the results and not leave the home until problems are corrected. That could mean enlisting the cooperation of the family pediatrician, or any in-home service provider, and alerting a DCF supervisor if the parent doesn’t agree to make changes.
If the problem is the lack of a safe crib, DCF will provide one.
Last year, the agency quietly distributed cribs to 260 families at a cost of $70,000. Now DCF isn’t being quiet about the need for the public to understand what leads to sleep-related deaths of infants under a year old.
Fifteen infants have died in sleep-related deaths since Jan. 1, 2011, among families in which DCF has an open case or a previous case. DCF reviewed all deaths of children under 18 in those families that were attributable to a cause other than a medical problem.
In comparison, there were 10 homicides of children and teenagers in this group during the three-year period, and six children drowned, five died in car accidents and five were suicides. There were 51 non-medical deaths in all.
The finding was a sobering confirmation of a concern long on the radar of child advocates and death investigators here. DCF Commissioner Joette Katz said the recent review of deaths grouped by causes showed a need for a broader public awareness campaign on par with car seats, smoke detectors and refraining from alcohol during pregnancy.
“We’re not just talking about educating DCF families,” said Katz. “Everybody puts babies to sleep.”
The fatal conditions included babies sleeping with adults on beds or couches, and infants suffocating on bedding, clothing, toys or other items in a crib. Infants have died while nursing, after mother and baby fell asleep. In one case, a baby fell asleep in a car seat. The mother, not wanting to disturb the baby, put the infant, still in the seat, into the nursery and closed the door. The baby stopped breathing without the family knowing it.
“In every case, there are two victims,” said Katz. “The child, and the parent who is devastated and overcome with guilt and remorse. They are often well-intentioned and loving, but they have caused the death of their baby.”
Even more sobering than the number of deaths is a fundamental fact: These deaths are preventable.
Like the “Back to Sleep” campaign of the 1990s that spawned a generation of parents who safely put their babies to sleep on their backs, “education and providing safe cribs when needed can make a huge difference” in lowering the death toll, Katz said.
She said she expects more families will receive cribs from DCF this year.
Sarah Eagan, the state child advocate, said infant mortality is higher among families with risk factors such as poverty, mental health issues and substance-abuse problems. She said DCF was in a position to provide “an important institutional response by talking with, and educating, high-risk families about safe sleep.”
The Office of the Child Advocate and its Child Fatality Review Board examines sudden deaths of children, including those in state care. Eagan said her office will work with DCF on the information campaign. DCF has developed a flier with safe-sleep tips and the mantra: “Every Night; Every Nap; Every Caregiver.”
The flier has a picture of baby, in one-piece pajamas, asleep on its back in a crib devoid of any bumpers, blankets or toys.
“My first instinct as a mother is to say, ‘Oh my God, this is terrible, the baby will be cold,'” said Katz. “But no, this is safe. Baby on back, firm mattress — it looks stark, but this is an awareness issue. This is how children die.”
Eagan and Katz said there has been a growing recognition in Connecticut about the lethal danger of unsafe sleep and the need for public-health alerts. Pediatricians, health care workers and other child-welfare experts should be involved in spreading the word, they said.
A national study of 3,136 sleep-related infant deaths from 2005 to 2008 found that 70 percent of the babies “were on surfaces not intended for an infant,” such as an adult bed, and most of the infants had been sharing that sleep surface with an adult or another child. Theresa Covington of the National Center on Child Death Review co-authored the comprehensive 2012 study.
In Connecticut, the top cause of sleep-related infant death is babies sleeping with adults, said Assistant Child Advocate Faith Vos Winkel, lead death investigator with the Office of the Child Advocate.
DCF’s Elizabeth Duryea said the department needs to learn from these deaths, adjust its practices, alert the public to the trend and help prevent them.
DCF’s findings reflect the urgency of the problem nationwide, but there isn’t a good way to compare infant death rates from state to state, said Linda Spears, vice president of the Child Welfare League of America.
In some states, sleep-related deaths within the child-welfare system are reviewed, as in the Connecticut case; in others it’s the infant deaths in the broader population, Spears said.
What is clear, she said, is more states are taking a closer look at sleep-related deaths of infants. The result is that deaths that several years ago would have been classified as sudden infant death syndrome, or SIDS, are now being ascribed a cause – leading to greater understanding of the problem, and more effective methods of prevention and response.
“People are increasingly concerned about unsafe sleep,” Spears said. “Many deaths were counted as SIDS, or simply not well counted at all. That is improving dramatically.”
Spears said Connecticut’s response “should help them reduce deaths, as long as it’s part of a response on all levels – which it sounds like it is,” said Spears. “Visiting nurses, hospitals, public health – the broad response makes the difference.”
She said that some communities have established banks of cribs to provide to needy families, but she said DCF’s practice of supplying the cribs is sound. It allows the caseworker to leave the house knowing for sure that the unsafe sleeping condition was addressed, Spears said.
She said that some families don’t know that sleeping with an adult, or wrapping a child in blankets, or overdressing them, is dangerous. They may equate it with nurturing, or they may have seen their grandparents do it with no bad consequences.
And some families know it’s dangerous not to have a sturdy, safe crib or bassinet, but they don’t have the money for it, Spears said.
Eagan acknowledged that the message seems counterintuitive. “We think they’re going to be cold and uncomfortable, so we want to tuck them in with that Afghan blanket — yet what we know about infants, is that those things aren’t safe. We can’t say it enough.”
Katz said the emphasis is on infants younger than 1 year.
“With the older kids, 1 to 2, go ahead, dress up the crib. It’s that first year when you have to worry.”