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Sudden Infant Death Syndrome continues to confound medical authorities

Causes of child deaths in Montgomery County from 1997 to 2008

Babies are dying while sleeping with parents

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By Joanne Huist Smith, Staff Writer Updated 11:55 PM Saturday, July 10, 2010

Nick and Ashley Maloney want to understand why their 14-week-old infant died in February while napping at a baby sitter’s home.

Mom took care of herself during the pregnancy and saw a doctor for prenatal care. A seemingly healthy Luke received routine pediatric care after his birth in November.

The Beavercreek couple made sure their son slept in a safe crib at home and at the baby sitter’s residence.

“Doctors said it was SIDS, Sudden Infant Death Syndrome. We’ll never know what actually happened to him,” Nick Maloney said. “He was perfect. Luke was our first and only child. We tried to do everything right.”

About 175 children die in Ohio annually due to a sleep-related incident, including about 50 with SIDS listed as the cause of death.

Risk factors explain some of the deaths — lack of prenatal care, the reckless or criminal actions of an adult, an unsafe sleeping environment — in other cases, the child slips quietly away and medical science can’t tell parents why.

“Sleep-related deaths are a problem in big cities, in tiny little burgs and rural communities,” said Merrily Wholf, Child Fatality Review Program coordinator for the Ohio Department of Health. “It has been a big problem in Ohio and it has stayed a big problem.”

In Ohio, all 88 counties are required to review each death of a child younger than 18 whether it be from natural causes or a crime to determine if it was preventable.

The data, including cause and location of death, contributing factors, age, gender and race is reviewed annually to help communities develop action plans to prevent more deaths. Child fatality review boards forge collaborations between agencies that usually work independently: health and police departments, prosecutors, police, educators, social services and others.

“We take charge of speaking for the child whose life was only a moment on this earth,” said Dayton police Sgt. Thomas Flanders, supervisor of the department’s Special Victims Unit and a member of Montgomery County’s Child Fatality Review Board. “In the vast majority of our cases, we’re dealing with an innocent little infant.”

Statewide data shows about 45 percent of sleep-related deaths involve children between the ages of 1 month and 1 year, making safe sleep education a priority in Ohio, Wholf said.

The data doesn’t track the number of children whose lives were saved by efforts such as Montgomery County’s ABCs of safe sleep campaign promoting that children sleep safest alone, on their backs, in a crib.

“That’s what keeps us doing what we do every day. That’s the value of our work,” said Libby Nicholson, director of Care House, a child advocacy center and founding member of the Montgomery County’s Child Fatality Review Board.

“...we don’t know what causes it.”

Nick Maloney considered himself a dad on March 19, 2009, the day before his 29th birthday, when his wife told him they were expecting.

On Facebook, Maloney chronicled the pregnancy and his excitement about the addition to their family.

“We are about to have a new Maloney in the family! First and second ultrasounds were perfect. I cant wait to be a daddy,” he wrote.

When Lucas (Luke) Randall Maloney arrived Nov. 16, the new dad was apprehensive about caring for the child in his wife’s absence, but as the weeks passed he grew more confident.

“Being a dad was the greatest thing I’ve ever done,” he said. “I loved to show him off.”

The couple knew health experts recommend that infants not sleep on their stomachs. But “Luke just cried and cried and cried, whenever we put him on his back,” Nick Maloney said.

Around noon on Feb. 26, while Ashley was working as a medical assistant in a Fairborn doctor’s office and before Nick left for his job at a cement plant, their baby sitter discovered the infant was not breathing. She called 911, then Luke’s parents.

“It was so sudden,” Nick Maloney said. “Everyone at the doctor’s office said right away it was SIDS.”

SIDS is the sudden death of an infant that remains unexplained even after an investigation, including an autopsy, examination of the scene, and review of the child’s medical history. SIDS is responsible for more infant deaths in the United States than any other cause of death during infancy beyond the neonatal period, according to the American Academy of Pediatrics.

The Maloneys want to have another child, but have anxiety that SIDS could strike again.

“I don’t know that we can prevent SIDS, because we don’t know what causes it,” Wholf said. “I have to believe if we reduce the risk factors we can reduce the incidents.”

“Babies can’t scream.”

The Montgomery County Child Fatality Review Board determined 219 deaths of children younger than 18 who died between 2001 and 2008 were preventable. Its counterpart in Greene County found 20 preventable deaths and Miami County, 19. These deaths included accidents, homicides and suicides.

In March 1996, then-Dayton police Chief Ronald Lowe mandated a full on-scene investigation into the death of every child under age 1. Previously, if police and the coroner found no obvious sign of trauma or criminal act, the death was attributed to SIDS.

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Infant safety

The Ohio Department of Health urges parents and caregivers to follow these recommendations as the most effective way to reduce the risk of infant death.

Place infants for sleep wholly on the back for every sleep, nap time and night time.

Use a firm sleep surface. A firm crib mattress is the recommended surface.

Keep soft objects and loose bedding out of the crib.

Do not smoke during pregnancy. Avoid exposure to secondhand smoke.

Maintain a separate sleeping environment. The infant’s crib should be in the parents’ bedroom, close to the parents’ bed.

Offer a pacifier at sleep time.

Avoid overheating.

Avoid commercial devices marketed to reduce the risk of SIDS. None have been proven safe or effective.

Encourage “tummy time” when awake to avoid flat spots on the back of the head and to strengthen the upper torso and neck.

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