Report: Almost 100 CT children under 3 died from non-natural causes in 2½ years. Here are the reasons.

The youngest children are the most vulnerable to dying from non-natural causes in Connecticut, according to a report released Tuesday by the Office of the Child Advocate.

There were 97 children younger than 3 years old who died from accidents, homicides and other causes in the 2½-year period ending Aug. 8, 2022, half of them 3 months old or younger. Eighty-five were less than 12 months old, according to the report.

The majority of children younger than 1 year who died because of an accident or undetermined reason had unsafe sleep environments, based on the American Academy of Pediatrics’ safe sleep recommendations, the report states. These children usually were in an adult-size bed, often sleeping with a parent.

“A new development in child fatalities” was death by fentanyl ingestion, totaling eight of the 97 children. The Office of the Chief Medical Examiner, in ruling these as homicides, classifies them as pediatric neglect.

Among the recommendations in the report were to make it easier for families on Medicaid, who account for 80% of the deaths, to enroll in the Women, Infants and Children program, since less than half of the deaths were children receiving those benefits.

Of 20 accidental deaths, 14 were the result of asphyxia because the airway was blocked while sleeping with an adult. Those children averaged 6.6 months old. Three were determined to be the result of physical neglect by the Department of Children and Families.

Two accidents were the result of toddlers, about 2 years old, being backed over by a motor vehicle at home. No neglect or abuse was found in these incidents.

Fentanyl poisoning on the rise

The average age of children who died from fentanyl poisoning was 12.9 months, ranging from 4 weeks to 27 months. 

“Work continues to understand the mechanism of ingestion in fatal pediatric Fentanyl cases,” the report states. “OCME officials indicate that breast-feeding is not a mechanism of ingestion injury. Even trace amounts, however, of Fentanyl, e.g., residue left on a utensil that is later used to prepare a bottle of formula, can be lethal to young children.”

In seven of the fentanyl-related deaths, a parent was the caregiver at the time. A grandparent was the caregiver in the eighth case. DCF cited the caregivers for physical neglect.

Six of the fentanyl ingestion deaths occurred in 2021. According to the report, “Notably, from June 2021 through May 2023, there have been over 20 DCF-generated Critical Incident reports on children under age 3 reported to DCF due to suspected ingestion of opioids and concerns of abuse/neglect by a caregiver.”

Most children survived because first responders or health care professionals administered naloxone. 

“The threat of fatal/near-fatal opioid ingestion for children remains active, implicating a continued need for effective and easily accessible treatment options for caregivers with young children, expanded naloxone distribution/training efforts, along with safe storage messaging and intervention efforts,” the report states.

The six remaining homicides were the result of drowning, smothering or suffering a head injury. No drugs besides fentanyl were involved in childhood deaths.

The average age of children who died by homicide — caused by another person — was 10.6 months. Nine of the children were male, according to the report.

Most of the deaths with undetermined causes, including sudden unexpected infant deaths, were related to “unsafe sleep environment, e.g., sleeping prone, sleeping side-facing, co-sleeping, sleeping with items such as blankets/pillows/plush toys, overheating/overdressed, or with other sleep environment risk factors,” according to the report.

The 76 children under 1 year old who died in unsafe sleep environments were an increase from 52 in 2016-18, but the proportion sleeping in an adult bed, 56%, remained the same.

“Sleeping on a couch or armchair can be particularly dangerous for infants,” the report states. “Infant deaths associated with an unsafe sleep environment are by far the most common cause of preventable death in young children.”

Other factors related to sudden unexpected infant deaths include “pre-term birth, low birthweight, lack of prenatal/medical care, smoking (which has been found to greatly increase a baby’s risk for fatality), alcohol and drug use during pregnancy, and absence of breastfeeding,” the report states.

Parental use of medication or substances that reduce the ability to respond is a ““very high risk” factor for SUID, according to the National Institutes of Health.

Half of these children were younger than 2.4 months, and 63.5% were male.

DCF investigated 54 of these deaths and determined there was physical neglect in 13 cases.

A total of 37% of non-natural deaths were recorded in Hartford (12), New Haven (11) and Bridgeport (eight). Those were followed by Waterbury, with five, and New Britain and Meriden, with four.

Recommendations

Closing the gap in WIC program enrollment was reported as the No. 1 way to reduce early childhood deaths. State officials said they are addressing the issue by  participating in the development of Connecticut’s health service portal, Health.CT.gov, and exploring the feasibility of automating outreach to families when a child is born that receives Medicaid. Currently there is no automated process for enrolling eligible pregnant women and/or infants in WIC benefits.”

Another recommendation was to increase home visits by the Office of Early Childhood, which “has been advocating and taking steps in recent years to develop a state-wide universal home visiting program,” the report states. “The agency has assessed the need for home visiting as greatly exceeding the capacity of current programs.”

A need also was identified to increase the number of child-care settings, which were seen as inadequate.

The report suggests new approaches to reach parents concerning unsafe sleep environments, given the high number of deaths from that cause, such as emphasizing “suffocation” in revised messaging.

To reduce deaths caused by fentanyl ingestion, the report recommends increased distribution of naloxone to people’s homes. “It is reasonable to assume that young children may come into contact with substances/baggies/patches that contain Fentanyl and ingest the substance through hand-to-mouth or object-to-mouth behavior,” the report states.

Sarah Eagan, Connecticut’s child advocate, and Dr. Kirsten Bechtel, co-author, did not immediately return calls for comment.

Ed Stannard can be reached at estannard@courant.com.