Dana Fong wants to help others make sure what happened to his granddaughter Ashley does not happen to anyone else.

Grandfather joins
‘crib death’ crusade

Simple precautions can save
babies from sleep-time suffocation


By Helen Altonn

Dana Fong wants to make sure the tragedy that struck his family -- the unexpected death of his 3-month-old granddaughter in January -- does not happen to anyone else.

It was believed at first, he said, that Ashley died in her sleep of sudden infant death syndrome, a catch-all category for the mysterious deaths of healthy babies in their sleep.

"There is nothing you can really do about SIDS, so everyone was very, very sad, but there was nothing we could do about it."

A thorough investigation and autopsy by the Medical Examiner's Office determined, however, that the baby died of suffocation, Fong said.

She was found dead lying on her stomach on a quilt on the floor where the baby sitter had placed her, he said.

Since 1992 the American Academy of Pediatrics has advised putting infants to sleep on their backs on a firm surface to reduce the risk of SIDS, sometimes called crib death, which doctors think may be linked to breathing.

Fong said his daughter had spoken to the baby sitter about putting the baby on her stomach, but she was "old school. ... As far as the knowledge she had, it was OK to put the baby on her stomach."

He said he wrestled with how to deal with the death of his only grandchild and decided to join the Safe Sleep Hawaii Committee and "go out on this crusade to make sure it doesn't happen to another individual." After hearing Fong's story, "You could tell we're not getting the message out," said Gwen Palmer, coordinator of the state Health Department's Child Health Promotion Services in the Maternal and Child Health Branch.

So a group was formed with Fong and organizations and agencies concerned with families and safety, and they are developing a plan "to get information out to everybody -- those at high risk as well as the general population, grandmothers who baby-sit and other child-care givers."

Policy changes are needed in child care licensing, Healthy Start home visits, administrative rules and other programs to sustain the education effort, Palmer said.

The unexplained infant death rate dropped in Hawaii and across the country after the U.S. Public Health Service, American Academy of Pediatrics and other concerned groups launched a Back to Sleep campaign in 1994 to warn against prone sleep positions and soft bedding.

Hawaii still has about 15 infants dying in their sleep each year, said Dr. Linda Rosen, medical director for the DOH Family Health Services & Emergency Medical Services System Branch and a chairwoman of the Keiki Injury Prevention Coalition.

That's about half of what it used to be, she said, but not as good as it could be, according to speakers at a recent conference on "Unexpected Infant Death: Solving the Mystery."

The Hawaii State Child Death Review Council and Maternal and Child Health Branch sponsored the meetings to review the system, continuing problems and ways to address them.

Dr. Kanthi von Guenthner, Honolulu's chief medical examiner, said more thorough investigative and autopsy techniques have contributed to the decrease in SIDS-classified infant deaths.

Previously, she said, "Most of these infant deaths were classified as crib deaths or SIDS, and no one really knew what those kids were dying of. ...

"We're not at the point of finding the cause of every single death," she added. "SIDS is still with us."

However, medical examiners tend now to leave sudden deaths "undetermined" rather than call them SIDS, she said. Or they are classified as "accidental" or attributed to other known causes which were not apparent a few years ago without proper investigations and autopsies, she said. While SIDS is a specific determination after all examinations have been exhausted, the "undetermined" category leaves the issue open.

Von Guenthner said 28 baby deaths in 1989 were classified as SIDS, while in 1999 there were two SIDS cases, both on the neighbor islands, she said.

Rosen is a member of the Child Death Review Council, participates in most neighbor island reviews and reviews all cases on the master list. The review system began in November 1998 to analyze all deaths of children under age 18, except those related to a medical condition, to identify risk factors.

She said a better system has been developed to collect data through the reviews, and a full-time nurse coordinator, Susan Anderson, has been hired to help the teams. The council is now completing reviews of deaths in 2000.

"We'll soon have a good five years of data, which will provide us with the opportunity to do much more analysis and describe more recent trends more accurately," Rosen said.

"We're collecting variables that aren't just basic things on the death certificate, but tell the circumstances and risk factors, the position of the baby, bedding and pillows -- all these types of things often are not recorded and certainly were not analyzed previously."

Demographic information also is being gathered about where the children lived, the community and background, she said.

"Hopefully, several public health efforts will come together to improve our ability to develop strategies and prevent the deaths."


infant deaths

Follow these guidelines of the Safe Sleep Hawaii Committee and American Academy of Pediatrics to prevent sudden infant deaths:

>> Put babies to sleep on their backs on a hard surface.

>> Avoid soft fluffy loose bedding, pillows, quilts and comforters and toys in the baby's sleep area.

>> Don't put babies to sleep on waterbeds, sofas or other soft surfaces.

>> Avoid maternal smoking and drug use during pregnancy.

>> Prevent smoking near the baby.

>> Don't keep the baby too warm, which can cause overheating.

>> Make sure cribs or beds meet safety standards.

>> Don't have any kind of plastic over the mattress or anywhere near the crib.

>> Don't leave the baby near anything that can cover the face and head.

>> Prevent "overlaying," which occurs when a person sleeping with an infant rolls onto the infant and unintentionally smothers the child.

State Health Department

E-mail to City Desk


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