Lower Hudson Valley infant deaths 'didn't have to happen'

Public-safety officials did not properly interview witnesses and record their findings after Lower Hudson Valley infants died in unsafe sleeping conditions, an investigation by The Journal News found.

Some cases involved violations of local and state regulations that cover efforts to help parents limit sleeping hazards, such as cluttered cribs and bed-sharing, according to a review of hundreds of pages of fatality reports.

Social workers, law-enforcement and health officials also insufficiently addressed a range of risk factors related to the unnecessary loss of life over the past decade, the reports show.

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At least 37 babies died in unsafe sleeping conditions in Westchester, Rockland and Putnam counties during that time period, and records show many of them could be alive today had systemic flaws been addressed. It is difficult to determine exactly how many unsafe sleeping deaths occurred because public-safety officials failed to track important information about the tragedies.

"We were seeing deaths that didn't have to happen," said Dr. Jennifer Canter, a pediatrician at Maria Fareri Children's Hospital in Valhalla and part of a regional groups that review child fatalities.

A major problem in preventing those deaths has been closing gaps between the many agencies involved in each case, reports show.

"Statewide, we're ... working toward standardizing the approach, and this is an issue across the country," Canter said.

The Journal News obtained fatality reports and data for Westchester, Rockland and Putnam counties via the Freedom of Information Law. The state Office of Children and Family Services provided 39 reports, but withheld others based on privacy issues.

The OCFS, which oversees abuse and fatality investigations, declined an interview request to discuss the records.

Infant safe-sleeping posters and videos are popping up in New York City subways and hospitals as part of a public-health campaign launched in April, and similar efforts are underway in the Lower Hudson Valley.

Identifying trends and risk factors is the critical challenge, said Shelley Fleit, a regional director of the Sudden Infant and Child Death Resource Center.

"This is a very simple message, but it is so nuanced," Fleit said.

From 1990 to 2000, infant deaths related to unsafe sleeping nationally were nearly halved to about 3,500 per year, federal data show. An American Academy of Pediatrics policy change marked the actual turning point in 1992, when the group recommended babies be put to sleep on their backs, rather than face down.

Before that, infant deaths that should have been attributed to unsafe sleeping weren't properly identified, leaving public-safety officials oblivious to the unnecessary loss of life. Since then, tens of thousands of deaths have been prevented.

But that once-rapid success has essentially stalled over the past 15 years. During that time, the battle to save lives has struggled to address the remaining risk factors as gaps in investigations and record-keeping persist.

Findings

Details in several Lower Hudson Valley fatality reports suggest infant deaths could have been prevented had public-safety officials properly recorded risk factors and better educated parents and caregivers.

• One case in Westchester involved a 4-month-old boy who died in 2009 while sleeping on a bed with his 27-year-old mother and two brothers, 6 and 10.

Prior to the death, local agencies handled 10 child protection services' cases involving the household. One involved a 4-year-old boy burning his 6-year-old brother's face with a discarded cigarette.

The 10 citations included a range of abuse and neglect, including lack of supervision and inadequate food, clothing and shelter. School complaints about frequent absences and one of the boys showing up to class looking tired and malnourished prompted some of the inquiries.

The report describes educational and training efforts over the two years before the baby died. According to the report: "The family engaged in some of the services but the mother did not access mental health services or parenting classes right away..."

After the infant died, the mother gave birth to twins in 2011.

Social services officials noted the crowded conditions in the mother's home (her parents and a brother also lived there) and the newborn twins were taken from her and placed with her boyfriend's parents, the report shows.

• In 2011, a 7-month-old girl died while sleeping on an air mattress with her 18-year-old mother in Rockland.

The mother told investigators she couldn't use her crib because of bed bugs, the report shows. A teen-parenting program informed investigators that it had told the mother and grandparents, who lived with her, about the dangers of bed sharing.

The fatality report recommended social services conduct more thorough investigations into deaths linked to bed sharing.

• One report involved a Yonkers couple with 2-month-old twins. The mother told investigators she received insufficient warning about the risks of unsafe sleeping.

One of the twins died in 2008. The infant was "found prone in a pack and play pen with face covered with Boppy™ (pillow)," the report shows. The family had contact with social services and health-care workers prior to the death.

The mother said she was unaware of the risk of using the Boppy pillow as a sleeping aid. She told investigators that social services and health-care workers didn't warn her about the dangers before the death, although there is a manufacturer's warning about the risk affixed to the pillow, the report shows.

Investigators noted that a hospital official said breast-feeding mothers were warned about the Boppy pillow sleep risk, but this woman wasn't because she formula fed, the reports show.

Westchester's child fatality review team — one of the programs trying to improve efforts to prevent unsafe-sleeping deaths — issued reports to raise awareness in local social service departments and health care of the potential risks associated with the Boppy pillow after its investigation.

• Another report involved a 3-month-old boy who died in 2012 while sleeping in a bed with his mom, 19, dad, 28, and sister, 23 months, in Westchester.

The mother told investigators that she worked part-time at the Special Supplemental Nutrition Program for Women, Infants and Children. She said her supervisor at the government agency encouraged her to sleep with the infant while breastfeeding, the report shows.

The supervisor's advice contradicted a safe-sleeping educational program the mother went through at a local hospital, and the report recommended investigators follow up with the mother's employer to ensure it promoted safe-sleeping practices.

• Another case involved a 41-year-old mother who found her 2-month-old boy dead in his crib in 2009. She had placed him face down in the crib, with his head to the side on an adult-sized pillow.

The report noted the mother received verbal instruction regarding safe sleeping. That included warnings about the dangers of co-sleeping, placing the baby to sleep on the stomach and/or with a bottle in the mouth. Information also touched on the increased risk to the baby when stuffed toys are in the crib, but did not address the risks from soft bedding, such as pillows, the report shows.

• In 2014, a study by the U.S. Centers for Disease Control and Prevention and National Institute of Health found accidental suffocation deaths doubled nationally in the decade before 2010, from seven deaths per 100,000 infants to nearly 16.

Gaps in local and state reporting on deaths make it impossible to determine exact causes for the national spike, the study shows, but it arrived at one important conclusion: 55 percent of infants are placed to sleep with bedding that increases the risk of sudden infant death syndrome despite recommendations against the practice.

'I don't remember'

Details in the fatality reports also shed light on the many risk factors involved in unsafe sleeping deaths and hindering prevention efforts.

One case unfolded inside a White Plains home on a January morning in 2008, when a mother awoke early for work, reports show.

She did some chores and changed diapers on her 18-month-old daughter and infant son. Before leaving at 8:40 am, she placed the 2-month-old boy on the bed with his father, who she roused awake.

That was the last time she saw her son alive.

The father recalled using a blanket to prop up a bottle to feed the infant. The man fell asleep and awoke four hours later beside his lifeless son. Nearby, the 18-month-old girl played with toys on the carpet as the Disney Channel flashed on the television.

The father, who'd worked until 11 the night before, told detectives: "I understand that I fell asleep while my son was in the bed with me. I don't remember rolling on him. It could have happened, but I don't remember."

Prior to the death, social services and police had not had any contact with the family, which was torn apart by blame and guilt after the loss, reports show.

A majority of the fatality reports involved parents or other caregivers with a history of contact with social services and other public-safety officials.

Many of the deaths followed failures to properly address a range of unsafe-sleeping risk factors — including unkempt homes, bed sharing and caregivers with histories of child abuse, mental health problems and substance abuse.

Most cases also involved parents or other caregivers who received food stamps, Medicaid and other government assistance based on low-income eligibility.

Some investigations found parents were educated by social services and health care about the risks of unsafe sleeping. Others cited failures to gather sufficient information to determine if the hazards had been properly addressed.

Another critical problem in New York: The OCFS failed to issue its annual child fatality report for the past four years.

The state agency declined to discuss the issue. In response to questions about the impact of missing annual reports, the agency said it recently shifted to a new technology to record fatality data.

A spokeswoman said an update on the overdue reports was expected soon.

'Target problems'

Canter, the pediatrician, is also involved in several infant safe-sleeping programs, including one started in 2012 by Westchester County in response to its high rates of unsafe-sleeping deaths, about three per year between 2006-12.

Monroe County, which includes the city of Rochester, had one of the highest averages nationally at 10 deaths per year during that span.

Last year, Westchester had one infant death attributed to unsafe sleeping. Monroe had none. While experts say it is premature to draw conclusions, the drops follow an increase in outreach and educational programs.

Hurdles to reducing unsafe-sleeping deaths stem from a failure to sufficiently coordinate efforts. Each death involves a myriad of government agencies and public health officials.

Insufficient reporting and oversight of unsafe-sleeping deaths in New York is part of a national problem, said the CDC's Dr. Carrie Shapiro-Mendoza.

For example, the agency is urging state and local officials to more clearly define factors involved in sleep-related deaths, such as better separating SIDS cases from others to properly track data.

"We are also concerned about the lack of uniformity in determining cause of death for SIDS and other sleep-related deaths," she said.

Agencies investigating infant deaths, for example, use various policies and techniques. Differences in fatality reports, such as improperly applying such terms as undetermined and accident, make it difficult to evaluate the effectiveness of investigations and preventive programs.

Marla Behler, program coordinator at the Child Advocacy Center of Putnam County, said flaws in record-keeping, transparency and reporting harm efforts to shape public-safety policies.

"It's more for long-term tracking and prevention because you need accurate data in order to target problems," she said.

In 2014, the OCFS held a two-day summit of groups in 18 counties, including Westchester and Putnam, that review child fatalities. They discussed the challenges and benefits of conducting in-depth child fatality reviews, with a focus on comparing similar efforts nationally.

Meantime, unsafe-sleeping conditions remain the most common risk factor cited in infant deaths in the Lower Hudson Valley:

•In Westchester, unsafe sleeping was noted in 26 deaths since 2006, or a third of the 78 total child fatalities of all ages.

•In Rockland, unsafe-sleeping conditions were noted in nine of 23 deaths from 2009-15.

•At least two of 23 infant deaths in Putnam noted unsafe sleeping conditions since 2006, and four other deaths had related risk factors.

The three counties have different reporting policies, including when they started tracking sleeping risks. The data have been improving since state regulations started to address gaps in 2013.

Defining safe

Outreach based on the 2014 federal infant safe-sleep study has focused on teaching parents to keep pillows, toys and blankets out of cribs to reduce suffocation hazards. It also renewed debate over risks from parents sleeping with infants.

Some groups contend that bed sharing aids in babies' development and bonding with mothers, especially during breast feeding.

Fleit, of the Sudden Infant and Child Death Resource Center, said rethinking safe sleeping for infants has been a cultural and generational shift. She compared the national push to reduce unsafe-sleeping deaths to convincing people to wear seat belts.

Canter, the child-abuse expert, appears on a safe-sleeping video shown to new parents at local hospitals since 2012. She said properly handling the controversial topic of bed-sharing is an important part of the effort to shape outreach and educational materials.

"These are the children we're seeing die but, in reality, parenting is difficult," she said. "You can't be perfect all the time, and there are the realities of being exhausted and wanting to nurse."

She also noted that local, state and federal public health agencies recommend separate sleep spaces for infants. She said breastfeeding mothers concerned about bonding can place a crib next to their bed.

'Work on prevention'

Fleit and Canter are both part of regional teams that investigate deaths and report findings to the state.

Westchester started its child fatality review team in 2006, following the death of two Yonkers boys fatally scalded in their family's bathtub.

The state-funded teams cover 18 counties, including Westchester and Putnam. They include officials from law enforcement and social services who investigate child deaths.

"We see tragic and very sad and horrible things that happen, and the goal of the child fatality review team is to look at each unfortunate circumstance and look for an opportunity to work on prevention," Canter said.

For example, police, emergency medical technicians and other first responders are starting to receive training to better identify and record unsafe-sleeping data based on findings by the review team in Westchester.

Rockland doesn't have one of the child fatality review teams. It has a multi-discplinary team that draws from similar local agencies to investigate child death and abuse cases overall, but it doesn't receive the related state funding, about $53,000 annually for Putnam, for instance.

"Although I have been a part of and admire the methods being used in regions without CFRTs, the benefit of a (state-approved) CFRT gives an infrastructure to be able to do this in a way that is protocol-driven and evidence-based," Canter said.

Child fatalities in New York:

2010: 266

2011: 273

2012: 272

Total fatalities under age 1:

2010: 152

2011: 155

2012: 167

Child-death notifications that cited unsafe sleep conditions:

2010: 97

2011: 77

2012: 74

Source: State Office of Children and Family Services' most recent available data