Child Death Review: Evidence for National Safety Initiatives Mary D. Overpeck, Dr.P.H. Manager, New Mexico Office of Injury Prevention Previously with: U.S. Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau

Examples of CDR Data Uses at a National Level 2005 Omnibus Transportation Act SEC POWER WINDOW SWITCHES. The Secretary of Transportation shall upgrade Federal Motor Vehicle Safety Standard 118 to require that power windows in motor vehicles not in excess of 10,000 pounds have switches that raise the window only when the switch is pulled up or out. The Secretary shall issue a final rule implementing this section by April 1, 2007.

Safe Sleeping for Infants

Why Not Use Causes Shown on U.S. Infant Death Certificates? Inconsistent investigations and cause classification of sleep-related deaths among more than 2000 medical examiner and coroner systems Cause classification uses International Classification of Disease (ICD) ICD sleep-related death data are incomplete, inaccurate, and not specific enough Death scene reenactments are informative

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State Reviews of Sleep-Related Deaths by Manner/Cause Manner/CauseNo. of States SIDS12 Suffocation/strangulation11 Medical conditions5 Undetermined for cause or intent8 Other (selected)7

Sleep Surface Where Infant Was Found n = 1,501 from 9 States Bed mattress Crib/bassinet Couch/chair Playpen Waterbed Other places Don’t know 39% 23% 15% 2% <1% 10%

Relationship of Caretaker at Time of Death n = 640 from 6 States Biological parents81% Other relative5% Child care provider11% Other3%

Co-sleeping/Bedsharing?* Almost half of 1,486 deaths in nine States involved co-sleeping and/or bed sharing – No or don’t know in remaining deaths If co-sleeping, sleeping with 1+ adults? – About 80% of co-sleeping included adults *Some information collected only for the SIDS diagnosis and bed sharing rather than for “co-sleeping”

Multiple Risk Factors* for Sleep-related Deaths Various States Reporting Prone position: 35% (8 States) Blankets/pillows/toys: 30% (7 States) Sleeping with others: 48% (9 States) *More than one factor may be present

Conclusion: Safe Sleep Evidence Preliminary CDR survey  sufficient evidence that separated sleeping surfaces could prevent deaths Conference consensus  need to address safe sleeping arrangements, including use of bassinets, cribs, or co-sleepers Followup survey of CDR teams will address: Result differences based on case review criteria How often cribs/bassinets were available but not used Reasons available cribs/bassinets were not used Location of deaths when cribs/bassinets were not available