The National Center for Fatality Review and Prevention (National Center), housed within MPHI’s Center for National Prevention Initiatives (CNPI), recently published an article in Pediatrics. Pediatrics is an official peer-reviewed journal of the American Academy of Pediatrics. The journal is ranked in the top 100 most-cited journals in science and medicine. Four MPHI employees worked to develop the article, titled “Improving Consistency in Classifying Child Maltreatment for Sudden Unexpected Infant Deaths.” These MPHI employees are Dr. Patti Schnitzer (Data Systems Consultant), Sasha Mintz, MPH (Senior Epidemiologist), Esther Shaw, MSIS (Senior Data Analyst), and Dr. Abby Collier (Director).

Part of the National Center’s mission includes developing the National Fatality Review-Case Reporting System (NFR-CRS). This system is used by child death review (CDR) teams in the US to classify and document the deaths reviewed, which then serves to inform the development of prevention strategies, determine legal culpability, redirect blame from caregivers, or substantiate child maltreatment (CM).

The National Center’s goal with this article was to develop guidelines for CDR teams to improve consistency in CM and distinguish between exposure to hazards and neglect for sleep-related sudden unexpected infant deaths (SUID). To accomplish this goal, cases of sleep-related SUID between the years of 2004 and 2018 were identified through the NFR-CRS. These cases were then analyzed for associations between multiple variables, including exposure to hazards, neglect, CM, sleep environment hazards, supervisor impairment, and child welfare action.

Key Findings:

  • 25,797 cases of SUID were identified as fitting the criteria of the study. 51% of these cases were determined to be related to CM by CDR teams.
    • 15% of the SUID cases related to CM were classified as neglect.
    • 69% of the SUID cases related to CM were classified as exposure to hazards.
  • Sleep environment hazards were found to be strongly associated with classification of both exposure to hazards and neglect.
  • Supervisor impairment and child welfare substantiation were also found to be strongly associated with classification of both exposure to hazards and neglect.
  • Compared to exposure to hazards, neglect was found to have no strong association with sleep environment hazards.
  • Sleep-related SUID was approximately twice as likely to be classified as neglect when the supervisor was impaired, or child welfare action was taken.
  • The guidelines recommend classification of exposure to hazards when sleep environment hazards are present.
  • The classification should be elevated to neglect if the supervisor was impaired, or child welfare substantiated the death.
  • The study drew the conclusion that among sleep-related SUID, classification of exposure to hazards is based on presence of sleep environment hazards, whereas neglect is based on supervisor impairment and child welfare action.

Based on the findings of the study, the team developed a 3-step guideline for classifying sleep-related SUID:

  1. Determine if the death meets the sleep-related SUID criteria.
  2. Determine if any criteria-meeting sleep hazards are present.
  3. Determine if criteria for neglect are met.

For more information on the article, visit:
Improving Consistency in Classifying Child Maltreatment for Sudden Unexpected Infant Deaths | Pediatrics | American Academy of Pediatrics