Preventable Child
Fatalities
Presented by
Jennifer Combs, MSN, ARNP
September 25, 2015
Objectives
• Learner will be able to describe three
preventable types of child fatalities that
occur in Broward County
• Learner will be able to list three nursing
interventions to help prevent a child fatality
• Learner will be able to describe the
#Saferby4 campaign
Overview
• Through FIMR and Child Abuse Death
Review we know that Broward County has
babies and children dying each year that
did not have to die
• Sleep related infant deaths, non-traffic
vehicular deaths, drowning deaths
• All these deaths have one thing in
common: 100% preventable!
Kids and Cars the Hidden
Dangers
• Each year in the United States countless
numbers of children are injured or die as a
result of non-traffic vehicular incidents.
• These deaths are 100% preventable
• From 1998-2014 in Florida, 68 children
have died senselessly from heat stroke
• As healthcare and social service
providers, we have the ability to help
prevent these deaths
2014 Non-traffic Fatalities
USA
• Heatstroke: 32
• Underage Driver: 16
• Back-overs: 71
• Drowning: 3
• Front-overs: 63
• Power Window
Strangulation: 2
• Vehicle set in motion: 5
• Fall from Vehicle: 1
• Other: 1
• Total: 194
Vehicular Heat Stroke
• Vehicular heat stroke is largely misunderstood by
the general public. The majority of parents are
misinformed and would like to believe that they
could never “forget” their child in a vehicle.
• The most dangerous mistake a parent or caregiver
can make is to think leaving a child alone in a vehicle
could never happen to them or their family.
• In over 50% of these cases, the person responsible
for the child’s death unknowingly left them in the
vehicle
Green House Effect
• The inside of a vehicle heats up VERY quickly! Even
with the windows cracked, the temperature inside a
car can reach 125 degrees in minutes.
• Cracking the windows does not help slow the
heating process OR decrease the maximum
temperature
• 80% of the increase in temperature happens in the
first 10 minutes
• Children have died from heatstroke in cars in temps
as low as 60 degrees.
Green House Effect
Contributing Factors
• A child’s body overheats 3-5 times faster than an adult body.
• Change in normal daily routine, lack of sleep, stress, fatigue,
distractions, hormone changes, worry… symptoms that ALL
new parents experience!
• Rear-facing car seats look the same whether there is a baby in
it or not.
• Quiet, unobtrusive little passengers.
Age of Victims
• Eighty‐seven
percent (87%) of
children who have
died from vehicular
heat stroke are age
3 and younger.
• Fifty-four percent
(54%) of heat stroke
deaths in vehicles
involve children age
one and younger.
How Could this Happen?
• Forgotten Baby Syndrome (FBS): an involuntary
failing of the parent’s working memory due to stress
and fatigue.
• Poor parenting was not a contributory factor in the
baby’s death. Always, the parent is found to have
been under a great deal of pressure (job loss, marital
trouble, lack of sleep) which led to the collapse of
the brain functions that normally help parents keep
track of a quiet sleeping baby in the backseat of the
car.
• A different memory system kicks in, a sort of
autopilot setting, and it is this that causes the baby
to be left behind in the car.
Awareness
Sleep Related Infant Deaths
• Last year 2014, nearly 300 babies never
celebrated their first birthday in
Broward County. ~200 fetal deaths and
~100 infant deaths
• In 2014, there were 21 babies that died
in unsafe sleep environments
• That is a whole kindergarten class….
• These sleep related deaths were 100%
preventable!
SIDS vs Sleep Related
deaths
What’s the difference?
SIDS and SUID
• SUID: Sudden Unexpected Infant Death
• SUID includes accidental sleep related
deaths and SIDS
• Reducing Risk versus Prevention
• Important to know the difference between
the two when educating the patients,
families and the community
SUID
Unexplained
Explained
Known
Diagnosis
Accidental
Suffocation &
Strangulation
Trauma
Poisoning
Drowning
SIDS
Undetermined
What is SIDS?
Sudden Infant Death Syndrome (SIDS) is
the sudden death of an infant younger
than 1 year of age that remains
unexplained after a thorough case
investigation, including:
– Performance of a complete autopsy
– Examination of the death scene
– Review of the infant’s and family’s clinical
histories
Current Theories on SIDS
• Malfunctioning chemical receptors in
the brain (Serotonin receptors)
• Genetic factors
• Arousal defect
SIDS is NOT…
• Preventable, but the risk can be reduced
• Caused by vomiting and/or choking
• Caused by DPT vaccine or other
immunizations
• Contagious
• The result of child abuse or neglect
• The cause of every unexpected infant death
SUID Risks Summary
• Stomach sleeping
• Soft sleep surfaces, pillows, toys and loose
bedding
• Overheating during sleep
• Maternal smoking during pregnancy and
second hand smoke in the baby’s
environment
• Bed sharing with an adult or with other
children
Sleep Related Deaths
• Are 100%
preventable!!!
• Accidental
Suffocation and
Strangulation in Bed
(ASSB)
• Falls under SUID
• Types:
–
–
–
–
Suffocation
Wedging
Entrapment
Strangulation
Bumper Pads
• Should be removed
from crib
• Suffocation hazard
• Babies burrow into
corners
• Banned in Chicago
and in the state of
Maryland
Suffocation from Bed
Sharing
Crib Wedging
Dangerous Places to Sleep
In Broward County….
It’s Always Swimming Season
Water, water, water…
In Broward County:
• 124,580 residential pools
• 4,250 community pools
• 23 miles Atlantic coastal
beaches
• 165 miles of intra-coastal
waterways
• Countless ponds, lakes, spas,
above ground and portable pools
• Buckets, garden ponds,
bathtubs, toilets, ice chests,
containers
Drowning
• The process of experiencing respiratory distress
as a result of becoming submerged or immersed
in liquid.
• Leading cause of death
among children ages 1 – 4
• Florida loses more children under age five to
drowning than any other state In 2013, Florida
had the highest unintentional drowning rate in
the nation for the 1–4 year old age group with a
drowning rate of 7.54 per 100,000 population
Nonfatal vs Fatal
Nonfatal
No
Morbidity
or
Fatal
Morbidity
Nonfatal Drowning
• For every fatal drowning, there are at least
five children who require hospitalization
for a nonfatal drowning
Drowning Is….
•
•
•
•
Unintentional, Not Accidental
Preventable
Predictable
Sometimes drowning is intentional as a
result of harm being deliberately
inflicted, such as child maltreatment,
suicide or homicide
Swift and Silent
Predictable
• Infants:
Bathtubs, buckets, other containers of liquid
• Toddlers:
Swimming pools
• 5 years and older:
Lakes, canals,
ponds, ocean, rivers
If They Only Knew….
Knowledge
Prevention:
Adult
Supervised
Knowledge
of the
hazard
Protective
Barriers:
Last line of
Defense
If All Else
Fails . . .
Proper
Response
Common Thread: Prevention
• As you can see vehicular
nontraffic deaths, accidental
sleep related deaths, drowning
deaths all have one thing in
common: they are all 100%
preventable!
Frontline
• As healthcare providers and social
service providers we have the unique
opportunity to be able to start the
education process with families from the
time of the first prenatal visit whether it is
in the clinic setting or private OB office.
• Education should continue throughout
the pregnancy, delivery and back into the
community after discharge from hospital
Where?
• People will not think to start the education process
as early as the prenatal setting but it should be early
and consistent!
• Settings for delivering the message:
• Prenatal care: clinic/OB office
• Childbirth classes
• Delivering hospitals: L&D, antepartum units, NICU,
postpartum, nursery
• ER: when a pediatric patient comes in, it is a great
teaching opportunity
• Pediatric units, Pediatrician offices, Outpatient
surgicenters
Out of the Box Settings
• Nurses are everywhere
• Opportunities outside of clinical setting:
Schools
Medical daycare
Nurses for sports teams
Girl Scouts, Boy Scouts
Anyplace where there are children, there
exists the opportunity for education!
Educate not just adults, but the kids too!
How to deliver message
• Incorporate into
hospital policies
• Childbirth education
packets
• Discharge packets
from NICU, nursery,
Peds, ER
• Waiting rooms
• Pediatrician
• WIC
• Healthy Start
• #Safer by Four
• Hands on
participation in
prenatal and
discharge classes
• Brochures in pool
stores, baby stores,
daycares, toy stores,
libraries
• STRONG LANGUAGE
Kids and Cars Nurse
Interventions
• Again start prenatally
• In delivering hospital,
we talk about car seat
safety, it should be
about car safety as a
whole
• Pediatricians
• Daycare
• Social service
agencies
Safety Tips
•
•
•
•
Always keep cars locked
Keys out of reach
“Spot the Tot”
If child goes missing, always check trunk
and car
• “Look Before You Lock” - Get in the habit
of always opening the back door to check
the back seat before leaving your vehicle
• Daycare plan for dropping off baby
Safety Tips
• Never leave children alone in or around cars; not
even for a minute.
• Put something you'll need like your cell phone,
handbag, employee ID or brief case, etc., in the back
seat so that you have to open the back door to
retrieve that item every time you park.
• Keep a large stuffed animal in the child's car seat.
When the child is placed in the car seat, put the
stuffed animal in the front passenger seat. It's a
visual reminder that the child is in the back seat.
Safe Sleep Tips
• Education needs to begin prenatally
and continue through delivery,
postpartum and beyond discharge into
the conmmunity
• Consistency, consistency,
consistency!!!
• Model Behavior
• Childbirth classes, discharge class
Safe to Sleep
• Baby should sleep always on their back
alone in a crib or pack-n-play
• Firm mattress with tight fitting crib sheet
• NO pillows, blankets, toys, stuffed
animals
• No smoking
• Avoid overheating; ideal temp 70-72
• Encourage breastfeeding
• Pacifier with each and every sleep
Safe to Sleep
•
•
•
•
•
Room sharing
NO BED SHARING!!!!!
Use overhead fan; NO standing fans
Educate all caregivers, not just parents
Do not purchase products that claim
they prevent SIDS
Drowning Prevention
• ADULT SUPERVISION
• Constant, capable adult supervision
• Cannot leave children unattended even
in the house
Drowning Prevention
• Water safety and
drowning prevention
• Prenatal visits:
• Do you have pool? Live
by a canal? Body of
water?
• Bath tub safety
• Pool fence: think ahead
to start saving money
for
• Toys out of pool
• Empty buckets:
Haitians, Hispanics
• Toilet locks
• Planning ahead
• Community pool:
locks? barriers?
• Can you swim? Don’t
wait till baby comes
• Baby and child swim
lessons
• Door alarms
• Do the locks work on
your doors? Windows?
#Saferby4
• Program launched this year in Broward
County by the Department of Children and
Families and Healthy Mothers, Healthy
Babies Coalition of Broward to address the
issue of preventable deaths focusing on
infant sleep related deaths and drowning
deaths of children up to age 4
• Goal is to have every child celebrate their
4th birthday!
#Saferby4
• Cities sign a pledge to become a
#Saferby4 community
• They are committed to raising
awareness and promoting education on
how to prevent drowning and sleep
related deaths within their cities
How can my city become a
#SaferBy4 Community?
• Much like seat belt safety took time, this will too.
• Use your voice and sphere of influence!
• Educate yourself on the risk factors, and repeat,
repeat, repeat the messages of prevention in
every venue.
• Empower your police and fire to become Safe
Sleep and WaterSmart cities.
Thank You!