A smart change on infant deaths

For years, North Carolina got in the way of preventing babies’ deaths. Now it’s taking a step toward fixing that.

A 2010 Observer investigation found that the state medical examiner attributed hundreds of possibly preventable deaths to sudden infant death syndrome, or SIDS, despite the baby dying amid risk factors such as unsafe bedding or sleeping with other people.

In 2008, more than half of baby deaths investigated by the state medical examiner’s office were attributed to SIDS. In 2012, the most recent data available, only 5 percent were labeled SIDS.

What changed? No miraculous cure for SIDS emerged. Rather, the medical examiner’s office, under the leadership of current Chief Medical Examiner Deborah Radisch, began labeling a majority of the deaths as undetermined or having “ill-defined” causes.

Here’s why that’s important: SIDS is not preventable. Suffocation is. By routinely calling a baby’s death SIDS, state officials had been masking the dangers of putting a baby in unsafe sleep conditions. By now employing that diagnosis only in the very rare instances it’s warranted, medical examiners can help caregivers understand the dangers of sleeping with infants or placing them to sleep on their stomachs.

They also allow prosecutors to bring charges against abusive or neglectful caregivers when appropriate. SIDS diagnoses had been used to block criminal charges when babies died.

Radisch’s predecessor, John Butts, long argued that the state would only be adding to families’ grief by suggesting they had done something to kill their child.

But in the 2010 Observer story, the chief medical examiner in St. Louis explained why chalking up preventable deaths to SIDS was wrong. “The whole thrust is to prevent deaths,” Dr. Mary Case said. “You can’t prevent deaths if you don’t know why they died.”

In North Carolina, we still don’t have a very good handle on why babies die. Nearly two-thirds investigated by the state medical examiner are labeled undetermined. Some of that is unavoidable, given that a dying baby is likely to have been moved before investigators get to a scene.

But part of the problem is that in North Carolina’s underfunded system, medical examiners don’t go to the scene of infant deaths about 19 of 20 times, reporters Ames Alexander and Fred Clasen-Kelly found. Given that, it’s no wonder that North Carolina would not be able to determine the cause of death. Some other states go to the death scene almost every time. It’s symptomatic of a medical examiner system that depends on near-volunteers to perform death investigations, for children and adults alike.

New parents are created every day, so the education effort around safe sleep habits for babies can never end. But Radisch deserves thanks for instigating an important change.