A new report examining deaths of young children in Connecticut over the past several years found that babies and toddlers are dying of fentanyl overdoses — a new concern in the state — and that unsafe sleep deaths have remained an issue.
Despite multi-agency efforts to reduce infant deaths associated with unsafe sleep, Connecticut has not seen a meaningful decline in deaths of this type over the last decade. These types of deaths remain the leading factor in preventable infant fatalities, according to a new report from the Office of the Child Advocate.
The report also offers new information on a growing effect of the opioid epidemic in Connecticut: more babies are dying from fentanyl overdoses than ever before — nearly 10% of the deaths examined involved the drug.
The Office of the Child Advocate, a state group that monitors the well-being of children in Connecticut, released its report Tuesday on the results of a study on deaths of kids under the age of 3. The study examines about 100 unnatural cause deaths from 2019 to 2022.
Children under a year old are at highest risk of preventable death, according to the report.
Eight children died from ingesting fentanyl in the time period examined. They were all between four and 27 months old. Fentanyl overdose deaths had not previously been recorded in this age group, according to the OCA report.
This only scratches the surface of the problem, child advocate Sarah Eagan said. More teenagers and older kids overdosed, some of whom died. And the report doesn’t include reports of children who overdosed but didn’t die.
“The state should be looking at its infrastructure — Medicaid, nutrition, home visiting, clinical treatment, child care support, housing stabilization,” Eagan said. “And it’s doing stuff and all these things, but we want to do more. We want it to be accountable, we want them to think about it from a child safety and survival lens.”
Fentanyl overdoses among babies and toddlers are a relatively new phenomenon. But health officials have been working to educate the public on safe sleep practices for years, as new research has shown that there are certain factors that are tied to what’s now called sudden unexpected infant death, previously known as SIDS or crib death.
More than 60 of the deaths included in the study were related to unsafe sleep, according to Eagan.
Fourteen babies died because of positional asphyxiation while they were co-sleeping with an adult. In 43 cases, children were sleeping on an adult-sized mattress. Other risks included babies sleeping on their stomachs, having objects such as blankets or pillows in their sleeping area and couch sleeping, according to the report.
The federal government launched a campaign in the 1990s to educate parents on safe sleep practices that was effective for a while. But Connecticut saw the number of deaths plateau, which Eagan says means the government needs to do more.
In addition to sleep environment other factors such as low birth weight, frequent changes in sleep environment and lack of prenatal care can put babies at risk for sudden unexpected infant death, Eagan said. Many of those stem from poverty, lack of stable housing and lack of access to health care, she added.
“Agencies working with, serving, supporting families and engaging them in programs of recovery, need to be thinking always through a two-generational lens,” Eagan said. “Who are the children in the household? Who’s helping them?”
About 81% of the children who died were enrolled in Medicaid, but only about half were getting Women, Infants, and Children Nutrition Program Benefits. Many were involved with the court system, the Department of Mental Health and Addiction Services, the Office of Early Childhood or the Department of Children and Families.
Eighty-three of the child fatalities were investigated by DCF, and 30 led to a substantiation of physical neglect, physical abuse or medical neglect.
“The families of the majority of children in this report received no prior supportive intervention by DCF,” said Commissioner Vannessa Dorantes in a written statement sent through a spokesman Tuesday. “This report serves as a reminder to raise awareness of conditions related to safe sleep and safe storage for everyone who has, cares for, knows or is related to very young children who require our utmost care & attention.”
The report recommends revising and strengthening the state’s safe sleep public health campaign and heightening fentanyl injury prevention efforts.
In a written statement, the Department of Public Health expressed support for all efforts to reduce fatalities.
“DPH programs work closely with each other and statewide partners on efforts to reduce infant and child fatalities, including efforts around safe sleep, including through the provision of data to support partners, funding to implement activities into public education or outreach,” spokesman Chris Boyle said in the statement.
In addition to education, the state should continue giving out Naloxone, an emergency medication used to treat overdoses, the report says. They should also expand messaging on recognizing overdoses in children and how to safely store medications, especially opioids.
The report also recommends creating a statewide plan to prevent infant and toddler deaths.
Other systemic interventions could include more investments in early childhood supports and services including home visiting, clinical services for caregivers with young children and expanding WIC enrollment.
DCF has recently launched pushes to educate families and caseworkers about the dangers of fentanyl overdoses. In October 2022, Michael Williams, the deputy commissioner of operations at DCF, sent a memo to all staff about short-term interventions.
“Fentanyl related poisoning in children has increased within the last year,” Williams’ memo read. “Fentanyl becoming potentially fatal in young children has challenged not only us here in Connecticut, but child protection systems across the nation. Early detection of fentanyl use in the home is essential to ensuring the safety of children.”
The department also assembled a “multidisciplinary group of senior leaders,” and consulted with experts to revise the substance use disorder policy, Dorantes said.
The department’s leaders also had a summit on a child safety practice model late last year and started Fentanyl Learning Forums so that staff can discuss best practices for working with families dealing with fentanyl use.
Another recent report from OCA on the death of a young girl named Kaylee from a fentanyl overdose noted several problems within the department, including provision of adequate services and safety planning for families.
In many cases, state interventions have worked, Eagan said. For example, distributing Naloxone has prevented many deaths.
“Our observation is that Connecticut is still in the throes of an opioid crisis,” she said.
Families struggling with opioid use can call the Substance Use Access Line at 1-800-563-4086 or call 211 for information about other services.
The Department of Public Health has information online on safe sleep practices for infants. Boyle’s statement said infants should be on their backs, in their own bed on a firm mattress without pillows, blankets, toys or other soft objects nearby.