The Charlotte Observer and The News & Observer have done a great public service in raising awareness of sudden infant death syndrome (SIDS) and infant suffocation/asphyxiation. Though not enough is known to prevent these tragedies entirely, there is a growing body of information that can help parents and caregivers reduce their occurrence. The challenge is to disseminate the information widely, over and over, until it becomes part of the culture. Thus, the six-day series was most helpful. I do, however, have some disappointments.
First, the series would have been even stronger by starting (rather than ending) with information about the Safe Sleep Campaign, which helps prevent all sleep-related infant deaths. The difficulties in diagnosis of SIDS versus suffocation/asphyxiation are important, but not as important as preventing both tragic types of deaths.
Second, the focus on diagnostic issues distracted from the safe sleep prevention messages. Indeed, the last article makes this point in the touching story of the couple who lost an infant but decided that a diagnosis of SIDS as opposed to suffocation/asphyxiation was unimportant to them. They knew that the concepts of safe sleep were the key in either case, and practiced these concepts successfully when their next child was born.
Third, the articles might have left the impression that the issues of SIDS diagnosis and prevention are not being addressed. Reporters attended many meetings of the N.C. Child Fatality Task Force, a legislative study commission that seeks to prevent child deaths from all causes. The task force places special emphasis on infant deaths, as well as child abuse homicides. This group has been wrestling with the issues of diagnosis, death scene investigation and the development of statewide intervention efforts (such as the Safe Sleep Awareness Campaign) for almost two decades.
This group pushed for recodification of the child protection laws, passage of a child endangerment law (making it easier to prosecute such cases), stimulated the development of the child death scene investigation checklist to which the articles occasionally referred, and helped the Conference of District Attorneys acquire a resource attorney position to provide advice on local prosecutions. The Office of the Chief Medical Examiner helped lead all these efforts, a fact not made clear in the series.
Fourth, the articles made scant mention of the N.C. Healthy Start Foundation, which for two decades has led awareness campaigns and provided educational materials to reduce infant mortality. This has included leadership of the Safe Sleep Awareness Campaign and operation of the Family Health Resource Line. Regrettably, that resource was eliminated during last year's budget crisis, and there are no plans to restore it.
Thankfully, the Safe Sleep Awareness Campaign is still in place. However, it was cut by 40 percent last year (to $150,000) and is now funded on a year-to-year basis, meaning that long-term plans are difficult to make.
Our educational system to prevent SIDS/suffocation has been seriously compromised and is in jeopardy. From the public health perspective, to focus on the nuances of diagnosis while not acknowledging the loss of preventive services is a case of misplaced priorities.
Finally, the majority of states have systems to monitor and respond to child abuse homicides. North Carolina is one of the few states with a statewide child fatality prevention system that monitors and tries to respond to child deaths from all causes. With this system in place, the child fatality rate in our state has declined by more than 35 percent since 1991.
The leader primarily responsible for the establishment of this successful broad-based system is Dr. John Butts, our chief medical examiner. It was he who influenced the General Assembly to focus as widely as possible on all child deaths. This system and the remarkable decline in the child death rate are a legacy any public health professional would cherish. While it is certainly fair to call into question Butts' approach to the diagnosis of SIDS, it is truly unfortunate that the series did not even mention his outstanding contributions to the children and families of our state.
Tom Vitaglione
Co-chair, N.C. Child Fatality Task Force, Raleigh
