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Why do children die? New Idaho team searches for links

Brooklyn, 18 months old, is dipped into the water by her mother, Carrie Wiltsie, during a water babies class in Twin Falls, Idaho.
Laurie Welch Twin Falls Times-News

BURLEY, Idaho – The death of any child warrants a closer look to search for ways to keep Idaho’s children safer.

And there are many, the new Idaho Child Fatality Review Team concluded this spring.

The state needs campaigns to educate parents about the infant health risks of smoking in the home, and about safe storage of guns and medication. Child care facilities should have policies for safe sleeping position. Baby sitters should call 911 — not a friend or relative — as the first response in an emergency. And parents should supervise young ATV riders, even when the law doesn’t require it.

Those are among a long list of recommendations from the review team, established by the Governor’s Task Force on Children at Risk in 2013 under executive order from Gov. C.L. “Butch” Otter. For its April report, the team screened all 168 deaths of Idaho children younger than 18 in 2012 and pulled 78 of the cases for full review.

The team requested medical, law enforcement and coroner reports and records from other agencies to look for common links or circumstances.

Until Otter’s order, Idaho was the only state in the nation without a child fatality review team.

• • • 

Sixteen-month-old Jaci Darrington of Declo, Idaho, was a determined, busy toddler with brown eyes and curly brown hair when she slipped away from baby sitters on April 22, 2011, and drowned in the Snake River.

Left unattended for a few minutes, Jaci either opened the outside door or found it cracked open, turned backward to navigate down stairs and silently walked into the swift, turbid river.

Her mother, Krissy Darrington, said she’d left Jaci and her older sister, Ellie, with young sitters to coach an out-of-town softball game. She never imagined tragedy would claim her precious child.

Four and a half years later, Darrington said, it still feels like it happened yesterday.

Earlier in the day, the sitters took Jaci for a ride on a four-wheeler by the water. Later, back inside the home, the sitters were distracted while they prepared for a camping trip. One went to the garage and left Jaci in a room with Ellie and other children who were watching television. Jaci was not there when she returned, but she thought another sitter had taken the toddler to change her diaper.

Jaci, however, took the opportunity to go back to the river.

“She really loved the water,” Darrington said. “That’s where she wanted to be.”

Friends, family, community members and rescue teams swarmed over the area looking for her. They found her tiny footprints at the river’s edge.

Her body later was discovered caught in the root of a tree — the same tree where Krissy had posed for maternity pictures on a happier day.

“You can’t turn your back on a child for a minute because they will get away from you even if you think someone is watching them — as a parent you have to make sure. As a parent it’s your responsibility, it’s not anyone else’s responsibility,” Darrington said. “Assuming is your worst enemy. Don’t ever assume someone else has them.”

• • • 

The loss of any child tugs at the heart of pediatrician Paul McPherson, a member of the Idaho Child Fatality Review Team.

“The first thing that jumped out at me when I moved here in 2011 was that Idaho was functioning without a child fatality review board,” said McPherson, who practices at St. Luke’s Children’s Hospital in Boise.

Idaho had a review team that produced four reports from 1997 to 2000, but it was disbanded mainly due to fear of violations of the federal Health Insurance Portability and Accountability Act, which tightened restrictions on how private health information could be shared, said Kirt Naylor, chairman of the Governor’s Task Force on Children at Risk.

The task force lobbied for legislation to establish a child death review team, but the bill failed. So the governor’s office issued the 2012 executive order.

“We did not know what preventable causes of death were killing Idaho’s children,” McPherson said. “In order to get a good handle on what’s happening now, you have to get a handle on what’s happened in the past. Now we can look at those numbers with a greater degree of certainty.”

In-depth analysis of the cases revealed areas where law enforcement, coroners, medical personnel, public health districts, child caregivers and parents can make improvements to reduce the risk of an accident claiming a child’s life.

“It’s not easy being on the team. A lot of these cases are bad and brutal,” said member Al Barrus, former Cassia County prosecutor.

One area of concern: death certificate coding by coroners, law enforcement and state agencies. Although some ground has been gained, there continue to be instances of incomplete investigations and misclassifications of infant deaths, the team reported.

In Idaho, McPherson said, coroners do not have to be medically trained, and there is a lack of uniform policy on autopsies.

Barrus said coroners are among elected officials who “really shouldn’t be elected.”

“Coroners undergo more formal training now and they really need to, because often they are left to make decisions that would be tough for professionally trained people to make,” Barrus said.

The team also discovered shortfalls in child care facility procedures for safe infant sleep, and there were infant deaths classifieds as SUID, sudden unexpected infant death, which were really cases of infant smothering, McPherson said.

Cassia County Coroner Craig Rinehart said infant deaths cross socioeconomic lines and often don’t have clear-cut explanations.

“Some of these cases are so disturbing,” Barrus said. “In some of these infant deaths the child is being taken care of by good parents, but sometimes they are living in just awful circumstances. They are coded as SIDS but that is clearly not what the facts say. In some cases they were sleeping with a parent or they fell off a mattress and suffocated against a wall.”

The team said a child death should be coded as SUID only if other causes are ruled out.

“That is one of the really big things that came out of this,” Barrus said.

• • • 

Suicide among Idaho children needs serious attention, too, McPherson said. Suicide is the second-rated cause of death in the state for children older than 1.

The rate increased significantly between 2003 and 2012, and in Idaho it is consistently higher than national rates.

Accidents are the leading cause of death in ages 1-19, according to Idaho Department of Health and Welfare’s 2013 vital statistics report on mortality. Suicide ties with pneumonia as the fourth cause of death in ages 5-9; suicide ties for second place with influenza and pneumonia in ages 10-14; and it is the second leading cause of death for ages 15-19.

Congenital malformations, short gestation and low birth weight, and SUID are the top three causes of deaths for children younger than 1.

“Our hope and purpose in this is to find some common causes or threads so we are able to prevent some of these deaths,” Barrus said. “Looking at these cases like this allows us to break it down, and it gives us a better picture of what happened.”

Barrus said the key recommendations will be forwarded to state agencies, coroners and law enforcement around the state so they can develop programs and education campaigns.

“You have to define and identify a problem correctly in order to correct it,” McPherson said. “I think education of the different entities and organizations will be very important. Most of them do great work, but there are areas that we need to tweak.”

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