PHOENIX -- More infants died in Arizona last year from unsafe sleep environments than motor vehicle accidents.
A new report released Friday about child fatalities in the state also found:
- Fewer children younger than 18 took their own lives;
- Drowning deaths for children were down;
- More newborns died of complications of prematurity as the number of mothers getting prenatal care dropped.
It also shows a sharp increase in the number of children who died because of abuse and neglect, up from 71 in 2012 to 92 last year. In fact, Dr. Mary Rimsza, who chairs the state's child fatality review program, said the mortality rate of child abuse victims nearly doubled in the last six years, from 3 per 100,000 children in 2008 to 5.6 in 2013.
Of particular note, Rimsza said, is that nearly half of those were cases where there had been no prior reports to Child Protective Services.
"In those cases, we often felt it was preventable on the basis there were people who knew that the child was being abused and action wasn't taken,' she said. "To report it to the Hotline is critical.'
Rimsza said there was a drop in child fatalities from abuse in cases which were spotted by "mandatory reporters' like doctors or teachers.
"The majority of these cases aren't ones that come to the attention of medical personnel,' she said.
"They're kids too young to be in school for a teacher to report it,' Rimsza continued. "So it really is dependent on people in the family, a neighbor, to report it.'
Rimsza said the issue of infants dying in unsafe sleep environments comes down to parents knowing where to put a child down for a nap or the night -- and where not to do that.
"For example, putting them on a couch, in an adult bed, letting them sleep in the car seat, places other than a crib,' she detailed. "Chairs. We find everything.'
Car seats? Rimsza acknowledged it's not unusual for an infant to fall asleep while being driven somewhere.
"That's OK,' she said. "We don't expect you to wake your baby up.'
But she said that parents and caretakers sometimes will let a child sleep all night in a car seat, even when there's a crib available.
"What happens in that environment -- and it depends on the age of the child -- is the positioning in the car seat,' Rimsza explained.
"Maybe they put some pillows or blankets around,' she said. "It can lead to asphyxiation.'
The bottom line, said Rimsza, is if a parent who is not going to be immediately around should put a child in the only safe place: a crib.
That goes to the issue of "co-sleeping,' where parents bring the infant into bed with them -- or even without them, putting them in to their own beds.
"The beds don't have the kind of mattress that is suitable for an infant,' Rimsza said. She said those who are too young to roll over can get "trapped' in the mattress or covers.
And with an adult in the bed -- especially one who may have been drinking or using drugs and therefore less aware of his or her activities -- the risks are increased the infant could be crushed.
But there are precautions even if the infant is placed in a crib.
The report says 28 babies died because they were placed on their side or stomach. The only proper position is putting the infant on its back, with no extra bedding or toys, including pillows, blankets, comforters, sleep positioners, stuffed toys or other soft objects the crib.
The Arizona Department of Health Services also says any sheet should be fitted tightly over a firm mattress that fits tightly into the crib.
Follow Howard Fischer on Twitter at @azcapmedia.
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