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Babies account for one-third of all deaths of Alberta foster children

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on Wed, 02/26/2014 - 13:33
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Babies account for one-third of all deaths of Alberta foster children

More than half of infants died in their sleep or due to prematurity, yet government has few policies to address these issues

Between January 1999 and June 2013, 18 babies in foster care died in their sleep. In at least six cases, records show the child’s foster parents employed “unsafe sleeping practices” such as co-sleeping, sleeping on unsafe surfaces, and having toys and blankets in a crib. These can increase the likelihood of sudden, unexpected infant deaths.

The names of the mother and child in this story have been changed to comply with an Alberta law that prohibits identifying children who have received government care.

LAC LA BICHE — This is what the mother of a dead baby remembers.

The police came and said her six-month-old daughter, Angel, had died in her sleep at her foster home. The mother ran into the bathroom and filled her palms with panicked tears. She did not believe it.

“I remember the house being quiet. It felt like the walls were caving in. I could hear my own heartbeat,” Jodi said. “It was the worst possible thing you could ever feel.”

Her knees buckled at the funeral home when she saw the tiny casket. “I realized then that it was real, that she was going to be in there.”

She remembers picking out a white bonnet to hide the bruises on Angel from when her bassinet collapsed on her, and tucking beaded moccasins into the casket.

One in three children who dies in foster care in Alberta is a baby. In 2009, this six-month-old baby girl died after the bassinet she was sleeping in collapsed. This photo has been altered to comply with Alberta law prohibiting the identification of children in care.

In 2009, this six-month-old baby girl died after the bassinet she was sleeping in collapsed. This photo has been altered to comply with Alberta law prohibiting the identification of children in care. Credit: Supplied.
“When I touched her, she was like a rock,” Jodi said. “It was, just, so cold.”

A fire-keeper tended a fire for two days. Elders passed a pipe. Drummers drummed. As she watched the casket descend into the earth, Jodi thought: “My baby is going in the ground, she is going to be alone.”

“The elder said, in Cree, that your grandmother is here and she is taking Angel with her right now. That brought me comfort,” she said.

“But I was so scared that she was by herself, in the dark.”

One in three children who dies in government care in Alberta is a baby, a startling figure given infants account for one in 10 children in care.

Between January 1999 and June 2013, 145 foster children died in Alberta, and 57 of them were babies, a joint Edmonton Journal-Calgary Herald investigation found.

Eighteen died in their sleep, often after a foster parent employed unsafe sleeping practices. Fourteen died from the consequences of premature birth. Another 14 died from chronic illness.

Eight died by accident or homicide, two died for unknown reasons, and one died from untreated pneumonia.

Experts say many of these deaths were preventable, but government has few rules on where and how foster children sleep, and infant deaths related to sleep and prematurity are rarely subject to review.

Instead, fatality inquiries and ministry investigations focus on high-profile homicides and accidents, including a bathtub drowning, a blind cord hanging, and six cases of cranial trauma.

“I haven’t seen anything come back to say there is a systemic issue with infants,” Human Services Minister Dave Hancock said in a recent interview. “Each case is unique and you have to look at it and learn from those cases, and we do.”

The province has no process to study death trends among children in care. “There are only so many, and the people who are involved can fairly easily determine across them what’s happening,” Hancock said.

Angel is one of 18 Alberta foster children who died while sleeping.

At first, police told Jodi that Angel died from Sudden Infant Death Syndrome. She later learned the baby died from “positional asphyxiation” after her bassinet collapsed.

“It was even worse when they told me that she had suffocated,” Jodi said. “She was awake. ... She suffered.”

In six of the deaths, records show foster parents employed what experts call “unsafe sleeping practices,” which increase the odds of sudden death. Such practices include co-sleeping, sleeping on unsafe surfaces such as sofas, sleeping on the stomach or with blankets in the crib.

In 2009, a baby was found face-down in her crib with a blanket around her head. In 2011, a baby died from “self-asphyxiation.” In 2013, a foster mother brought an infant to bed and found the baby tangled in her bedsheets the next morning.

Three infants died during lengthy, unattended naps. Seven were sick, or had recently visited a doctor. In 2009, a baby died of untreated pneumonia while sleeping on a makeshift bed on the floor. In 2011, another died sleeping in an infant carrier with loose sheets — the autopsy concluded: “The infant’s sleep environment was not completely safe.”

In 2003, a foster mother ignored warnings not to put a baby to sleep on his tummy. After the baby died, his doctor said: “That’s probably what killed him.”

By definition, Sudden Infant Death Syndrome is unpredictable; it is listed as a cause of death when doctors cannot find another explanation.

Yet risk factors are well known.

In 2005, a ministry review of eight SIDS deaths found all of the babies showed at least three of those risk factors, including poor prenatal care, maternal smoking, co-sleeping, aboriginal heritage and male gender. A 2011 medical examiner’s report found co-sleeping was a factor in half of all unexplained infant sleeping deaths between 2005 and 2010. A similar 2005 B.C. study found unsafe sleep practices in 83 per cent of infant deaths over 18 months.

Nobody knows why these factors and practices increase SIDS risk, but University of Calgary pediatrics professor Ian Mitchell said that shouldn’t matter.

An 1854 cholera outbreak ceased after a doctor noticed most of the sick drank from the same well, he said. Scientists didn’t yet know about germs, but taking the handle off the water pump stopped the spread.

“When I tell this story, my message for SIDS is that you can stop it without knowing all the fine details. ... Why does quitting smoking work? Why does sleep position work? I don’t know, but it works,” Mitchell said.

Still, rules that govern sleep practices for foster babies are limited.

The safety checklist used for licensing foster parents contains two lines about safe infant sleep: Each child must have a separate bed with a suitable mattress, and cribs or playpens must meet government standards.

Policy requires caseworkers to tell foster parents a crib must be free of pillows and blankets, and foster parents are not allowed to smoke around foster children. However, a safety assessment does not check for these items.

There are no rules about co-sleeping and sleep position, and foster babies are not assessed for SIDS risk.

“When a child is apprehended, you and I are the parents, along with everybody else,” Mitchell said. “The government is now the parent ... The  standards have to be the highest possible standards.”

The province has taken some steps to reduce SIDS deaths.

A new Safe Infant Sleep policy comes into effect in January 2014, when health-care professionals will be required to promote universal safe sleep guidelines for all new Alberta mothers. The policy expands on a campaign launched in 2012.

Alberta is also adopting a B.C. program that trains and supports people caring for babies exposed to drugs and alcohol. In 2013, the program was piloted in Edmonton and Saddle Lake, but a provincewide implementation date has not been set.

On Nov. 8, the government announced foster parents who purchase a crib can be reimbursed up to $500.

Jodi was ready for her fourth baby. She set up a crib, bought supplies, saw a doctor and tried to stay sober. She wanted to take her baby home and get her other children back from foster care.

On July 16, 2009, she was on a bus to Edmonton when she realized the baby was coming six weeks early. She walked to the hospital, and Angel came quickly.

“They tested me. I did drink that day, of all days. I drank a six pack to myself,” Jodi said. “They found it in my baby’s system, and my kids before that, that happened, too. So they didn’t even give me a chance to  explain.

“I didn’t drink before that, and I decided to drink that day, and then I ended up having her.”

Angel was apprehended at the hospital.

Like 14 babies who died between 1999 and 2013, Angel was premature. It is not clear whether prematurity played a role in her death, but experts say many deaths related to prematurity could be prevented with stronger interventions.

“If you can intervene early enough ... then we really believe we can lower the pre-term birth rate, just through simple behavioural changes,” said David Olson, a professor of obstetrics and gynecology at the University of Alberta who has studied pregnancy and prematurity for more than 30 years.

Death records for two of the 14 premature babies cite inadequate prenatal care as a factor in the child’s death.

Officials say government cannot legally intervene until a child is born, but the ministry offers voluntary prenatal support to expectant mothers. Some women who have had children with fetal alcohol disorder can take part in a three-year, home visitation program shown to reduce substance abuse and increase use of birth control.

A U.S. program that brings at-risk mothers together for monthly meetings on prenatal care resulted in a 33-per-cent reduction in premature births, according to a 2007 study in the Journal of Obstetrics and Gynecology, Olson said.

One in three children who dies in government care in Alberta is a baby, a startling figure given infants account for one in 10 children in care. Here, family members mourn the death of a baby girl who died in foster care in early 2010.

Alberta government investigations into prematurity and sleep deaths are rare.

A policy in effect until 2009 automatically ruled out an in-depth internal review when a child died for medical reasons; current policies are not documented.

Between 1999 and 2010, no fatality inquiries into sleep deaths occurred. Since then, the province has called six such inquiries. Two are scheduled for 2014, including Angel’s.

The internal summary of her case was completed in August 2010. It noted bassinets in Canada were unregulated and the ministry had no policy for their use. Since then, Health Canada has passed stringent regulations. The ministry still has no policy.

The review also revealed Angel slept in the bassinet for six months because she had no crib — a clear violation that went unaddressed.

The report reiterates foster children must have their own bed, and says “this does not include hammocks, bassinets or playpens.” The report was never made public, and this prohibition is not reflected in policy.

Jodi shared her story because she doesn’t want other parents to suffer. Her life has unravelled since Angel died. She continues to struggle with alcoholism. The pain and guilt are insurmountable.

This is what she wants to remember:

“She was wise, in her eyes,” she says of Angel. “The last time I saw her, when I put her down to put her stuff on her, she grabbed my pinkies and she wouldn’t let go.

“She was saying goodbye to me.”

It is impossible to make an apples-to-apples comparison of the mortality rate between infants overall in Alberta and those in provincial care.

This is partly because the infant mortality rate is calculated by using the number of births and deaths over a set period of time; by contrast, the number of infants in care changes from month to month.

It is also because the data that underpins this story is based on incomplete death records released by the provincial government after a four-year legal battle with the Edmonton Journal.

When possible, we extracted key details from the records, including the child’s age, but in many cases, the government provided only the years of birth and death. In these cases, we calculated ages based on a birth and death date of Jan. 1, which results in imprecise ages.

With this context, it is worth noting that the mortality rate for Alberta-born infants under one year was 1.6 per 1,000 live births between 2001 and 2010 — the most comparable figures available.

As of September 2013, there were 830 children in care in Alberta under 18 months old. Our data shows that on average, between 1999 and 2012, four infants died in care per year. Taken together, the death rate of infants in care is 4.8 per 1,000 apprehensions.

By Karen Kleiss, Edmonton Journal