Social workers will be routinely alerted to investigate all unexplained infant deaths in Massachusetts for signs of abuse and neglect, according to new state guidelines scheduled to go to police, firefighters, and hospital workers by the end of the year.
The recommendations are meant to improve investigations of deaths attributed to Sudden Unexpected Infant Death, the leading cause of mortality among children between the ages of 1 month and 1 year in Massachusetts. They will also apply to other unexplained child deaths.
While police often alert the Department of Children and Families to unexplained deaths, the new guidelines are intended to assure that all infant deaths are reported to the agency. Emergency workers will be advised to notify DCF social workers whenever they encounter the unexplained death of a baby, according to Carlene Pavlos, a state Department of Public Health official.
The recommendations are part of a 55-page report (PDF) recently released by the state Child Fatality Review Team, a group cochaired by the public health department and the Office of the Chief Medical Examiner.
Each year, dozens of Massachusetts children die suddenly and unexpectedly. In 2009 and 2010 combined, 90 infants under the age of 1 died, according to the report. Risk factors involve what are known as unsafe sleep conditions — such as putting children to sleep on their belly, sleeping with an adult, or with excessive bedding. Black non-Hispanic infants were three times as likely to die as white non-Hispanic babies between 2001 and 2010, the report says.
But the new guidelines — released in a report filed on the medical examiner’s website earlier this fall — already are prompting concern from some families and groups involved in the prevention of unexpected infant deaths, which include sudden infant death syndrome, or SIDS, as well as accidental suffocation and entrapment, and other unexplained causes.
Among them is Milford Police Chief Tom O’Loughlin, who lost his 3 ½-month-old son, Michael, to SIDS on the Monday before Thanksgiving in 1992. He said the new directive could cause unnecessary pain for families suffering from the death of a child.
“If there are no facts and circumstances that indicate neglect or abuse, I don’t believe that the family should be subjected to a DCF investigation,” O’Loughlin said.
The fatality review team was created by the Legislature in 2000 to examine deaths of children and recommend ways to prevent future tragedies. While the advice cannot be legally mandated without a law change, the guidelines will create a baseline for emergency personnel when considering whether to report a death to social workers, Pavlos said.
According to the report: “The recommendation, which will be distributed to mandated reporters statewide, states that any unexplained death of a child establishes reasonable suspicion of abuse or neglect and advises reporting these deaths” to DCF.
Representatives of the Office of the Chief Medical Examiner were not available for comment.
DCF officials said they encourage anyone concerned about the safety and well-being of a child to file a report. However, DCF spokeswoman Cayenne Isaksen said that when it comes to sudden infant deaths, the agency is most focused on educating families and caretakers about reducing risks, referring interested parties to visit www.mass.gov/SafeSleep to learn more.
The recommendations come four months after a New England Center for Investigative Reporting story published in the Boston Globe found that children supervised by state social workers die suddenly and unexpectedly at a rate at least twice that of infants statewide — suggesting more should be done to educate caretakers to protect some of the state’s most vulnerable children.
Diana West, a spokeswoman for the Illinois-based La Leche League International, a breast-feeding support group, said the new policy would unfairly target breast-feeding mothers who espouse bed-sharing, because state health officials warn that bed sharing increases the risk that infants could suffocate. The group maintains it is safe when mothers avoid other risk factors, such as smoking, using drugs or alcohol, or allowing a baby to overheat.
“Deeply grieving parents will now have to go through an investigation that presumes guilt and assumes something nefarious was done to the child,” she said.
Death investigations should be left to the state’s medical examiner and law enforcement, West said.
But Pavlos, director of the Bureau of Community Health and Prevention at the state health department, said the recommendations would help create consistency in child death reporting. She said emergency workers are conscious of being sensitive to families who have lost a child. At the same time, she, too, said the state is most concerned about getting the word out about safe sleep.
Although the state Child Fatality Review Program is supposed to file reports annually, this is the first study since 2011, when the group examined child deaths between 2006 and 2008. Authors said the unfunded program is hindered by a lack of resources and delays in receiving death certificates. The program includes 11 local groups directed by county district attorneys who submit information and recommendations to a state team.
Other key recommendations on infant deaths that come from state and local teams urge:
- Coordination between the Department of Public Health and hospitals, along with others, to direct safe-sleep messages to different groups, including people who do not speak English, immigrants, and grandparents.
- Adoption by law enforcement of standard protocols to handle death-scene investigations of children who die suddenly and unexpectedly.
- Launching of a multimedia public education campaign, headed by the Department of Public Health, to teach families about safe sleep.