Suffocation ruling may alter crib, SIDS theories Quilt covered faces of 5-month-old boys in Md. day care home

July 10, 1998|By Diana K. Sugg | Diana K. Sugg,SUN STAFF Staff writer Chris Guy contributed to this article.

In a finding with national implications, Maryland's medical examiner ruled yesterday that two baby boys who died in a Stevensville day care provider's home accidentally suffocated.

Dr. John E. Smialek said that a quilt had been placed near the infants' heads to protect them from falling out of a double bed. But the babies apparently moved enough to cause the blanket to fall on them and cover their upper bodies.

Accidental suffocation is a slow death that occurs over several minutes, one that Americans recognized in babies as long as a century ago but have ignored in recent years. Experts predicted the Stevensville case will alert the public to the danger of soft bedding -- the very items that parents and day-care providers believe will keep infants warm and safe.

"This is a very important case, and I think it may lead to a change in the way we view SIDS [sudden infant death syndrome] and in our advice to parents. It may ultimately save lives," said Dr. Bradley Thach, a professor of newborn medicine at Washington University in St. Louis.

The country's leading researcher in this field, Thach believes the guidelines for baby sleep positions may need to be changed to forbid comforters over babies. A 1995 study by the Consumer Product Safety Commission revealed that up to a third of the about 6,000 babies who die of SIDS every year were found face down, their noses and mouths covered by soft, fluffy bedding. CPSC officials believe they may actually have suffocated.

In the Stevensville case, Stacy Russum, a day-care provider, had put 5-month-old Matthew Harrison and Ian W. Denny to sleep on their backs on a double bed. She put the quilt near their heads as a protective barrier, but when she checked on the infants nearly 90 minutes later, their faces and upper bodies were covered by the quilt, according to Smialek and other officials.

Oxygen slowly used up

That caused a fatal process known as rebreathing. Babies whose faces are covered by soft bedding exhale into a pocket of air, increasing the levels of carbon dioxide, and, as they inhale, decreasing the oxygen. The babies became unconscious, Smialek determined, and then died.

The medical examiner interviewed people at the scene, did complete autopsies, evaluated environmental factors and ran tests for poisons. He also used microscopic studies to rule out infections, and checked organs and tissues. No natural diseases or injuries were found.

"The manner of death is accidental," said Smialek's statement. He declined to comment further.

Re-enactment not done

Russum's attorney, Harry M. Walsh Jr., said Smialek had been in his law office Wednesday and yesterday, asking to do a re-enactment in the home.

"It was odd to us, that this was such a hotly debated issue just in recent days and weeks, and all of a sudden we get a report," Walsh said.

On Walsh's advice, Russum and her husband, Wesley, refused a re-enactment, saying they had already been questioned and requestioned. "I do not believe that there was a consensus among the experts that suffocation was the cause of death," Walsh said.

State revokes home license

The Department of Human Resources, which regulates child-care providers, revoked Stacy Russum's license yesterday, citing three major violations: unsafe bedding, lack of appropriate supervision and caring for more children than allowed.

The babies had been placed together on the bed, but DHR requires that each child be provided with an individual, age-appropriate resting space. That means a crib for each baby.

Care providers are also supposed to be within sight or sound of children at all times, and regulations specify visual checks on sleeping children at least every 15 minutes. The infants were in an upstairs bedroom not approved by the state's Child Care Administration, and Russum told its staff that she didn't check on the infants for nearly an hour and a half.

In the third violation, Russum was caring for at least 10 children, including her own. Regulations say providers can care for no more than eight. Russum had a license for six children, according to Linda Heisner, executive director of the Child Care Administration.

Mothers seek stricter laws

The mothers of the two infants were in Annapolis yesterday, lobbying state officials to approve tighter regulations and more money for DHR. Dawn Denny and Elaine Harrison called the meeting "a good first step" toward improving oversight of more than 14,000 day-care operators in Maryland.

The mothers, who spent nearly two hours with legislators, DHR Director Alvin C. Collins and Heisner, vowed to return to the State House when the General Assembly convenes in January.

"To think that we could help even one baby makes it better," Harrison said. "This is a kind of healing for us."

Blanket-use study suggested

At the National Institute of Child Health and Human Development, officials said last night that several countries have instituted recommendations against placing heavy blankets over or near babies.

Researchers will have to reconsider whether blankets over babies or babies' heads are dangerous enough to merit a change in national recommendations, said Dr. Marian Willinger, special assistant for SIDS. Current guidelines call for babies to be placed in a crib, on a firm, flat mattress, without any puffy comforters or quilts underneath them.

"This case should alert people that these things can happen," Willinger said.

But SIDS activists warned it's still unclear how many SIDS deaths may actually be incidences of accidental suffocation.

"There are those families for whom soft bedding was not even in the picture, who were doing everything right, and for whom the babies are still dying," said Phipps Cohe, spokeswoman for the Baltimore-based SIDS Alliance. "For the bulk of SIDS deaths, the causes still remain unknown."

Pub Date: 7/10/98

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