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

• Back-overs: 71

• Front-overs: 63

• Vehicle set in motion: 5

• Underage Driver: 16

• Drowning: 3

• Power Window Strangulation: 2

• 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

SIDS

Undetermined

Explained

Accidental Suffocation & Strangulation

Known Diagnosis

TraumaPoisoningDrowning

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

It’s Always Swimming Season

In Broward County….

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

Water, water, water…

Drowning

• The process of experiencing respiratory distress as a result of becoming submerged or immersed in liquid.

• Leading cause of deathamong 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

Morbidity

or

NoMorbidity

Nonfatal vs Fatal

Nonfatal

Fatal

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

Knowledge

Prevention:Adult

Supervised

Knowledge of the hazard

If All Else Fails . . . Proper

Response

ProtectiveBarriers:

Last line of Defense

If They Only Knew….

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:

SchoolsMedical daycareNurses for sports teamsGirl Scouts, Boy ScoutsAnyplace 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!