The Community Child Fatality Prevention and Protection Team is charged by the State of North Carolina with reviewing the deaths of all Mecklenburg children under the age of 18 to identify and address systems issues that could prevent the future deaths of county children. One of our longtime leading concerns is unsafe sleeping arrangements. In the United States, North Carolina, and traditionally Mecklenburg County, the leading causes of infant death are conditions related to prematurity and low birth weight, congenital defects, and SIDS. In 2005, in Mecklenburg County the third leading cause of infant death was unintentional injury. Nine of these unintentional injury deaths resulted from suffocation due to unsafe sleeping arrangements. As we look for ways to lower our infant mortality rate, injury should be considered a priority area for attention since injury deaths are considered preventable. All of the nine infant suffocation deaths could have been avoided if the baby had been put to sleep appropriately. Unsafe sleeping is also a risk factor for SIDS deaths.

Safe sleeping includes putting an infant to sleep on its back in a crib (or appropriate substitute with firm surface) with no soft or fluffy bedding. Ironically, in most of these cases a crib was available but not used. In many of the cases the infant was put down on its stomach on soft bedding. Some of the deaths resulted from being put to sleep on a couch or adult bed where the child either became wedged between the cushions/mattress and the couch/bed or was suffocated by an overlying adult. Infant sleeping deaths occurred in the home with the parent, when visiting another home, and when the child was left in the care of a person other than the parent.

An ongoing, integrated and collaborative media/ awareness/education Safe Sleeping Campaign is needed in this community to target providers, parents, grandparents and other caretakers. The information needs to be repeated frequently and strongly from all providers of services to infants until parents, caretakers, and providers address safe sleeping as they do using a car seat. And as there is no legal enforcement as with car seats, the messages must be even more insistent. In the last decade, the Back to Sleep Campaign has drastically reduced the number of deaths from SIDS. In Mecklenburg County we should work equally hard to prevent deaths from suffocation due to inappropriate sleeping conditions.

Susan Long-Marin Chair, Child Fatality Review Community Child Fatality Prevention and Protection Team

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