Published: February 19, 2008 11:20 pm            

'Unsafe sleep' leads to infants' deaths

SALISBURY, Mass. — Two calls for help came in to the Salisbury Police Station this winter that were painfully alike and caused every officer on duty to race to the scenes: The baby won't wake up, frantic parents screamed to dispatchers.

Results were tragically the same. Within two months of each other, two healthy babies went to bed but never woke up, leaving two families devastated.

Afterward, at Salisbury Police Department, officers called to check on their own kids, went home and hugged them a little longer than usual, and with tears in their eyes recounted the incidents to their wives.

"This kind of thing hits hard," said Salisbury police Chief David L'Esperance. "Police see a lot of bad things, but when kids are involved it's tough."

All unexpected deaths for children up to age 17 are investigated by law enforcement and child welfare workers, according to Essex County District Attorney Spokesman Steve O'Connell. There was no foul play found with the deaths of these babies, he said.

But, like other similar incidents that took the lives of other children in Essex County, there is a message to deliver to parents, O'Connell said: For helpless infants, sleeping can be dangerous.



Unsafe environments

Massachusetts' former chief medical examiner, Dr. Mark Flomenbaum, who was part of the state's Child Fatality Review Team, found unsafe sleeping environments of such a concern that he sent a letter to pediatricians early last year.

Flomenbaum wrote in his letter, "Although it appears that most parents and caregivers are placing their infants to sleep on their backs, we are continuing to see a number of babies whose deaths are associated with unsafe sleeping environments. In fact, since I took office in April 2005, we have seen at least 32 such deaths. Some of the unsafe sleeping environments include situations where infants were sleeping with their parents and/or siblings, left sleeping in car seat carriers, left to sleep on soft (adult) pillows, bedding, or couches or allowed to lay on the chest of a parent who fell asleep. I believe that most of these 32 deaths may have been preventable."

Detective Lt. Elaine Gill of the Massachusetts State Police and Pat Snyder-Matthews work at Essex County District Attorney Jonathan Blodgett's office and say infant deaths caused by mishaps during sleeping are far from rare.

Authorities in both Massachusetts and New Hampshire report that when children die unexpectedly, investigations are thorough. In Essex County, cases are also reviewed by the Child Fatality Team, Snyder-Matthews said. The majority of child deaths are found to be due to a variety of medical conditions, she said, but in about 10 percent of infant deaths, unsafe sleeping environments have played a role.

Of sleeping-related deaths, especially among infants who can't control their head and neck muscles and are too young to move on their own, "positional asphyxia" is often the listed cause of death. In laymen's terms, positional asphyxia occurs when the position of a baby's head, neck or body cuts off the windpipe, nose or mouth, making it impossible for the baby to breathe properly.

According to authorities in the field, the best defense against this potential baby-killer is prevention: keeping babies away from unsafe sleeping environments and providing them with safe ones.

Positional asphyxia knows no socioeconomic barriers, Gill and Snyder-Matthews said. It can cut across all spectrums of society. In the case files of Essex County there are cases of positional asphyxia that occurred when babies fell asleep on a parent's shoulder, when breast feeding, when sleeping on a soft comforter on an adult's bed, after falling asleep in a baby swing or baby carrier, or smothering while sleeping with their parents in their parents' beds.



Sharing beds

Dr. Thomas Andrew, chief medical examiner in New Hampshire, sees the same issues surface in the state he's served since 1997. A medical examiner in New York City from 1991 to '97, Andrew said he's seen certain types of deaths from unsafe sleeping environments rise since 2000. These include circumstances of parents sharing their beds with infants in an unsafe manner.

"Co-sleeping and bed-sharing has dramatically increased with this generation of parents," Andrew said. "There are some co-sleeping advocates who are very, very passionate about (the benefits of) co-sleeping, and they have the research which would indicate that when done correctly co-sleeping is safe. But those aren't the cases medical examiners see."

What Andrew recounts are situations of young parents who go to bed with their infants after having too much to drink or being very tired after being up very late. In those cases, he said, parents can sleep so soundly they're unaware when their babies' breathing becomes endangered or when their sleeping positions become hazardous.

In 2000, of the 10 baby deaths in New Hampshire, none was due to co-sleeping, Andrew said. But since then, the statistics have changed as the propensity for bed-sharing grows.

In 2001 in New Hampshire, six out of 12 baby deaths were due to co-sleeping; in 2002, five of 14; in 2003, five of eight; in 2004, eight of 13; in 2005, seven of 11; in 2006, 11 of 16 and in 2007, nine of 22.

For some parents, the concept of co-sleeping is a perfect and safe way to bond or meet every need of their children. In Japan, co-sleeping is the cultural norm, Andrew said, but in Japan sleeping takes place under different conditions than in the United States. In a Japanese home, sleeping may take place on the floor, on hard mats or futons, Andrew said, without the soft, ample bedclothes and pillows around which the American lifestyle revolves.

"That's a very different kind of co-sleeping than most Americans engage in," Andrew said.

University of Notre Dame anthropology professor and co-sleeping advocate Dr. James J. McKenna, Ph.D, writes that for millions of years mothers have slept with their infants and babies beside them. In his Mother-Baby Behavioral Sleep Lab, McKenna's research indicates co-sleeping is safe and provides numerous benefits for both mothers and their babies.

But in his article "Bedtime Story: Co-sleeping Research" McKenna discusses the possible co-sleeping hazards that arise in certain circumstances, such as when bedding is not appropriate, or when parents smoke or have used drugs or alcohol prior to sleeping.

Andrew said the controversy surrounding the pros and cons of co-sleeping or bed sharing has had an impact on advice given to state and federal agencies concerning co-sleeping. Most public health agencies - even the Centers for Disease Control and Prevention - decline to use the word "never" when discussing co-sleeping and unsafe sleep environments.

But for many like Gill, Snyder-Matthews, Flomenbaum and Andrew, the belief is still firm that co-sleeping can be dangerous and must be done with caution. In both New Hampshire and Massachusetts, medical examiners have recognized the deaths of infants who shared their parents' beds when parents unwittingly rolled over on their infants, suffocating them, or when fluffy bedclothes and pillows move and smother them.

McKenna has lectured about his co-sleeping advocacy even at events that put him in the midst of medical examiners, Andrew said, and that research can be compelling to many.

"But, I don't think he's convinced many forensic pathologists," Andrew said.

Of the other sleep-related deaths Andrew has seen, one occurred when a baby was put down to sleep on the floor covered by a plastic bag, which suffocated the infant. Another happened when a sleeping baby's head slipped between the top of a plastic, inflatable mattress and the headboard of a toddler bed. The tragedy led Andrew's office to contact the bed's manufacturer.



Angeljean Chiaramida writes for The Daily News of Newburyport, Mass. E-mail her at achiaramida@newburyportnews.com



Some safe sleep tips for parents

Taken from the Web site of the Centers for Disease Control and Prevention (www.cdc.gov):

Infants should ALWAYS be placed on their backs (face up) when they are resting, sleeping or left alone.

When infants are napping or sleeping, they should ONLY be placed in cribs approved by the Consumer Product Safety Commission.

Mattresses should ALWAYS fit snugly into the crib with no gaps where babies can become wedged.

Babies should ALWAYS be put down to sleep on firm surfaces or mattresses with no soft or fluffy items in the sleeping area, like toys, pillows, comforters or loose blankets.

Dress babies in sleepers or warm pajamas instead of covering them in blankets.

If blankets are used, ALWAYS make sure the blankets stay at below infants' waists.

ALWAYS dress infants to suit the temperature around them, dress them as you would want to be dressed.

Parents and caregivers who choose to share a bed with their infants should NEVER smoke or be under the influence of alcohol or drugs while sleeping with their infants.

Parents or caregivers who want to be close to their infants while sleeping can move the crib or bassinet close to their beds.

NO ONE other than parents or caregivers should ever sleep with infants.

NEVER place infants down to sleep on sofas, couches, pillows or waterbeds.

NEVER place infants down to sleep with pillows, stuffed toys, bumper pads, comforters, quilts or sheepskin.

NEVER smoke or allow others to smoke in the same room as an infant or child.

        

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