By Melissa Patrick
Kentucky Health News
FRANKFORT, Ky. – When it comes to keeping babies safe, three of the most important things are safe sleep practices, recognizing that bruising in non-mobile infants is not normal, and choosing an appropriate caregiver.
So said members of the state’s Child Fatality and Near Fatality External Review Panel, who told legislators at the Sept. 19 joint health committee meeting that three-fourths of cases they reviewed in 2017 were “potentially preventable.”
They lawmakers also heard the executive director of Prevent Child Abuse Kentucky say the state ranked No. 3 for “child maltreatment” in 2016. Jill Seyfred added that 23,827 Kentucky children were confirmed victims of child abuse or neglect in 2017, about 65 a day.
The ABCs – and D – of safe sleep
Dr. Jaime Pittenger, a review-panel member and the president of Prevent Child Abuse Kentucky, told the committee that 39 percent of the deaths the panel reviewed in 2017 involved sudden unexpected deaths in infancy, or SUDI, a broad term that covers both sudden infant death syndrome and other fatal sleeping accidents. That number is “on the rise this year,” she warned.
Pittenger, who heads the pediatric residency program at the University of Kentucky, stressed the importance of following the ABC’s of safe sleep to prevent injury or infant deaths – Alone, on their Back, and in a Clean, Clear Crib.
Safe Sleep Kentucky website graphic; for a larger version, click on it
And because so many of the fatalities or near-fatalities are connected to substance abuse, Kentucky has added a D to that list to point out the Danger of sharing a bed with a child, especially when under the influence of alcohol or other drugs.
Almost two-thirds of last year’s SUDI cases in Kentucky involved an impaired caregiver who slept with their baby and the baby died from suffocation or asphyxiation, the review panel found.
Pittenger pointed out that many Kentucky infants don’t have a safe place to sleep: “We can make it sound like everybody has a bassinet, a crib, but they don’t.”
Rep. Joni Jenkins, D-Louisville, suggested that the state look into providing children who don’t have a crib with a “baby box” with instructions on safe sleep, as some other states and countries do.
“Some years ago we decided that every child that left the hospital ought to have the appropriate car seat,” Jenkins said. “It seems to me that a logical [solution] is that every child that leaves the hospital after birth should have an appropriate place to sleep as well.”
“Those who don’t cruise, don’t bruise”: Pittenger offered this rhyme as a way to remember that bruising in infants not old enough to be mobile “is not normal.” She was quick to point out that bruising doesn’t always mean abuse, but “should raise a red flag to make you ask questions.”
Paula Sherlock, a retired Family Court judge, stressed the importance of reporting bruising in non-mobile infants: “We don’t want to think that our kids are abusing our grandkids, so we believe things that we shouldn’t believe.”
“Don’t leave your child with someone you wouldn’t leave a puppy with”: This was Sherlock’s advice for choosing a caregiver. She added, “People who have violent tempers, who have histories of domestic violence, should not be left in a care-giving role with children who can’t defend themselves or tell anybody what happened,” she said. “The vast majority of the kids we see are under the age of 4 and a huge portion of them are under the age of 2.”
|Happiest Baby blog photo|
Sherlock said 41 percent of Kentucky children determined to have abusive head trauma in 2017 were left with a caregiver to whom they were not related. “Typical of that is the boyfriend who is watching the baby while mom goes to work,” she said. “Mom has no affordable daycare, she has no good support system and so a completely inappropriate person is left with the child, who is not his child. We see a really startling number of these cases.”
Abusive head trauma is also called “shaken baby syndrome.” It can be caused by a direct blow to the head, dropping or throwing a child, or shaking a child resulting in an injury to the child’s brain.
Seyfred said the top risk for these children are substance abuse and family violence. “Substance abuse was documented as a risk factor in 65 percent of the reports, with family violence as a risk factor in 42 percent,” she said.
There are other dangers. Pittenger said people who have a history of crime or mental illness have also been connected to the majority of these abused and neglected children. The panel report found that 85 percent of the 2017 cases reviewed had a prior history with child protective services.
What’s Kentucky doing to protect its children?
Sherlock and others stressed the importance of the review panel, which she said works to identify gaps in the system and to find ways to fix them.
She also stressed the need to get quick, efficient, affordable and non-punitive help for Kentucky parents who are suffering from addiction.
“These parents need help,” she said. “These kids are very vulnerable and if they are being born to drug-addicted parents and then going home to be cared for by these parents, that is a recipe for disaster.” Sherlock said, “My experience in court: drug addicted parents did not by and large beat their children to death . . . but the neglect is so gross and so widespread that these children are not fed, they are not supervised.”
Rep. Kim Moser, R-Taylor Mill, and Sen. Reginald Thomas, D-Lexington, praised the HANDS program as a tool to help at-risk families learn how to better care for children. HANDS, for Health Access Nurturing Development Services, is a home-visitation program for new and expectant parents that works toward healthy pregnancies and births, healthy child growth and development, safe homes and self-sufficient families.
Thomas said he thought every parent would benefit from this program, but especially those at high risk. “The reality is that children don’t come with a how-to manual,” he said.
Moser also praised the START program, which integrates addiction services and other wrap-around services to families with at least one child under 6 years of age who is in the child-welfare system and has a parent with a substance-use disorder that puts that child at risk. START stands for Sobriety Treatment and Recovery Team. Moser said she would love to see both of these programs expanded.
Seyfred told the panel that Prevent Child Abuse Kentucky had recently partnered with WellCare and the Kentucky Hospital Association to create a video focusing on safe sleep, abusive head trauma, and choosing an appropriate caregiver to show new parents before they leave the hospital.
Pittenger spoke to the importance of this education: “One of the saddest stories I ever heard was a dad who just didn’t understand that shaking would hurt his child. He never knew, he never thought that what he was doing when he lost his temper would hurt the child. Some people just don’t know.”
Kentucky has also passed laws to require caregivers and professionals who serve children to receive training on pediatric abusive head trauma.
Sen. David Givens, R-Greensburg, charged everyone at the meeting to tell at least one person with a newborn or who is pregnant about what they had learned about the importance of safe-sleep practices and quality caregivers.
“We could save one child’s life just through that conversation,” he said. “So let’s do that. Let’s all leave here today charged in the course of the next two weeks to have that conversation with at least one person. We may make a difference.”
To report suspected child abuse in Kentucky, call 877-KYSAFE1 (597-2331) or online at https://prd.chfs.ky.gov/ReportAbuse/OutofHours.aspx. The national abuse hotline can be reached at 1-800-422-4453.