RE: Sleep Related Deaths and CPS

["Walter Fahr" <wfahr@xxxxxxxxxxxxxxx>]

In Louisiana, we had identified that unsafe sleep environment and parental co-sleeping was a significant issue in infant deaths approximately eight years ago. After a research of the literature and consultation with an advisory panel,  we developed a statewide media  PSA campaign. The campaign focused on a safe sleeping environment , that has been repeated several times since. 

As I recall from the research of the literature in these type of cases, the strongest link to infant co-sleeping cases was the obesity of the parent co-sleeping with the infant. Substance use by the co-sleeping adult was not as strong a link as obesity. 

The issue of infant deaths due to co-sleeping or unsafe sleeping persists in a significant number of cases. Likewise, there is an inconsistency in decisionmaking at several levels of agencies involved in these cases. Coroners and forensic pathologists will give a variety of findings  in similar cases such as inconclusive, no finding of suffocation, SIDS or in a few cases a finding of suffocation. These findings will be different even when the same elements are present in cases.  Law enforcement also will have a variety of decisions and interventions based on local practice or the opinion of the  officer involved and will also lack consistency. However, if a parent is obviously under the influence, there is more likely to be a law enforcement investigation, but not necessarily an arrest. 

For CPS, who frequently have to weigh decisions by coroners and law enforcement in their decisionmaking, are obviously less prone to substantiate such cases with negative or inconclusive findings from both coroners/forensic examiners  and law enforcement. None of our agencies have clear guidelines on how and when to substantiate such cases. We have noticed that the use of a multidisciplinary team with external consultants such as physicans,  to review these cases prior to a decision, are more likely to contradict a negative finding from the coroners/forensic examiner. 

Although there is a greater likelihood to substantiate cases with illegal substance, adult co-sleeping resulting in infant deaths are not limited to illegal substances. Parents can be taking a variety of legally prescribed sleep medication, psychotropic medication and other prescriptions which can profoundly effect the ability of the adult to detect if they have overlaid on an infant. In these circumstance the parent should not be co-sleeping with an infant, but do these circumstance rise to the culpability of child death by negligence?  

Consistency in such cases will be very elusive, because there are so many variables present, including the opinions of the many professions involved.  I concur with most of what Carol Duncan is finding in Texas, especially with the autopsy/necropsy findings. I think that the focus solely on CPS decisionmaking will not adequately address the issue. The focus should be on the community of professionals that do or should be involved in the decisionmaking.

There was an interesting, related article in the January 26, 2009 edition of the Washington Post,
Rise in Infant Suffocation Renews Debate on Bed- Sharing  by Rob Stein.

Walter G. Fahr, MSW, LCSW
Program Manager-Child Protective Services
Office of Community Services
State of Louisiana
      (225)342-6832
fax (225)342-9087
wfahr@dss.state.la.us 

>>> "carol duncan" <cduncan@excap.org> 1/29/2009 1:37 PM >>>
Lindsay Gross wrote:   


 > In Michigan we are seeing some inconsistency in whether or not CPS is
substantiating when a child's death is the result of unsafe sleep
practices. Can other states respond and let me know if their state's CPS
is substantiating for sleep related deaths? If so, are they only
substantiating when there are substances involved or if they can prove
that the family had been educated on safe sleep? Has your state CPS set
out guidelines for how counties are supposed to act in these cases? <

 

 

I sit on the Dallas County Child Fatality Review Team and am also a
former CPS employee.  I consulted with a friend who currently works at
CPS regarding this question.  

 

In Texas, there is no particular policy on this.  The disposition often
depends on the outcome of the necropsy, which is often inconclusive in
determining whether the child died of suffocation as opposed to SIDS or
SUDI (Sudden Unexplained Death in Infancy).    If there is proof that
the parents were impaired by alcohol or drug abuse and it can be shown
that they did lay over the child, the State may substantiate that the
child died as a result of neglect.  However, I am told that these are
reportedly rare.   

 

 

Carol S. Duncan, LCSW, IMHM
Clinical Program Director
Child Abuse Prevention Center <blocked::http://www.excap.org/> 

214-370-9810