Dec. 1The deaths are rare, but so preventable.
They happen to infants on too-soft couches and water beds. In beds with pillows and fluffy blankets and adults on either side. In positions of affection that restrict breathing, such as a mother's arm draped over her baby's chest.
At one time, they might have been tagged as Sudden Infant Death Syndrome, an unexpected death of a child with no illness. But more precise medical investigations driven by state and federal initiatives are showing that some babies die from accidental suffocation.
Sometimes a parent rolls over on an infant sleeping in the same bed. Or a baby in an adult bed scoots to the edge and gets caught between the bed and a wall.
If the parents or caregivers have certain characteristics- if they've been drinking or smoking or even if they are overweight the risk escalates.
Now health workers are on a crusade to stop such deaths. The effort involves a new program to help parents, as well as a better state system for tracking suffocation cases.
Dr. Leah Bush, Virginia's chief medical examiner, said that during the past few years, investigators have become more precise in teasing out accidental suffocations from SIDS cases, using dolls for re-enactments and more detailed forms to interview parents about sleep practices.
"What we have found is that in the past, when investigators weren't sure, rather than worry about making a parent feel guilty, they'd call it SIDS."
While that may have spared caregivers' feelings, it didn't spread awareness of unsafe sleep practices.
A new category, called Sudden Unexplained Infant Death, could help change that. It includes a more meticulous investigation to pinpoint the cause of death and not just assume SIDS.
The first full year of that coding is reflected in 2007 statistics, which showed 41 SIDS deaths in Virginia, according to Anna Noller, a forensic epidemiologist with the chief medical examiner's office.
Investigations of 12 other deaths produced enough evidence to show that the babies died by accidental suffocation.
Overall, 43 infant deaths fell into the SUID category in that year, of which 22 involved unsafe sleep conditions but lacked evidence to show suffocation. Those are numbers that previously would probably have been classified as SIDS cases, which dropped from 64 in 2006.
The solution to unsafe sleep situations can be as simple as a crib.
CHIP/Healthy Families, a Chesapeake human services agency, recently launched a free crib campaign called "sleeptight Hampton Roads."
One day in mid-November, Bianca Ansbro, a supervisor and case worker with the agency, lugged a new crib still packed in its box from the trunk of her car.
She knocked on the door of a pink trailer on a gravel road in Chesapeake. Inside, 2-month-old Joshua Palillero was slumbering in the crook of the arm of a sofa.
At the time, he was too young to roll over, but that wouldn't be true for long.
Ansbro explained in Spanish to his 23-year-old mother, Maria Palillero, the idea behind the sleeptight program and why it's important for Joshua to sleep in a crib. She showed her how to set up the crib which can be converted to a portable playpen while explaining other safe sleep practices:
Always place the baby on his back to sleep, she said, even for naps, rather than his stomach or side. Don't use fluffy blankets or pillows or put stuffed animals in the crib. Make sure that Joshua's face isn't covered by a blanket during sleep, and that he doesn't get too warm.
Joshua has slept with his parents in their bed since they brought him home from the hospital two months ago.
Palillero said she thought it was working well because the baby stayed warm and she was able to keep him close. The family didn't have money for a crib, and their tiny bedroom didn't have room for one anyway.
As the baby got bigger and squirmier, though, she realized he needed a crib.
Ansbro has been meeting with Palillero since July, about a month before Joshua was born. She'll visit to talk about health and safety issues once a week until Joshua is a year old.
Palillero and her husband, who works in construction, have lived with her husband's relatives in the trailer for about eight months. Six adults and three children share the small space with two Chihuahuas.
The good thing about the crib is that it's portable, so Palillero can use it in different rooms of the trailer and easily take it with her if she and her husband move.
It's also small enough to fit next to their bed.
Trish O'Brien, executive director of CHIP/Healthy Families, said that over the years, case workers have noticed that families who couldn't afford cribs were using dresser drawers, laundry baskets, even cardboard boxes.
This year, the agency joined forces with Towne Place at Greenbrier shopping district and local radio and TV stations to raise money for cribs.
So far they have bought about 80, which they plan to distribute to families throughout Hampton Roads. During a radio thon to raise money, one woman called from her hospital bed, not to make a donation, but to say she needed a crib for the baby she had just delivered.
Betty Wade Coyle, who is part of this region's child fatality review team, said that not only parents but also baby sitters and relatives who care for babies need to be educated about safe sleep practices.
The team reviewed a case earlier this year, for instance, in which a baby in a home day care died after being put down for a nap in an adult bed. The baby rolled off the edge into a pillow against the wall.
Another challenge has been the popularity of the "family bed" concept. The practice of parents sharing their bed with their baby is seen by many as a good bonding experience, especially among women who breast-feed their babies. There are also cultures where sleeping with children is more common than in the United States.
While it may work well for some families, it's not good public health policy across the board, because there are so many situations in which the practice can go awry.
"Parents don't rationally think, 'Well, I've had two drinks, so I better not sleep with my baby tonight,' " Coyle said.
Though the American Academy of Pediatrics strongly encourages breast-feeding, it advises that for safety's sake infants be returned to a separate sleeping place such as a crib or bassinet after feeding.
The number of SIDS cases is going down statewide and nationally. Part of that decrease is due to the "Back to Sleep" campaign begun in the early 1990s that encouraged parents to put their babies to sleep on their backs. B etter investigations and classifications of deaths also are driving those numbers down.
Coyle sees the need for a similar campaign to stress other safety tips, such as clearing cribs of fluffy blankets, pillows and stuffed animals.
"People think they're loving their baby by buying these beautiful things, but they're putting them in danger."
Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com
