Written by

Anita Wadhwani

The Tennessean

State health officials note it is the fewest number of child deaths they have had to report in the past five years.

Still, the new data are unlikely to shake Tennessee’s grim foothold on the top 10 list for states in the country with the highest child death rates.

Children are more likely to die in Tennessee before they reach their 18th birthday than in most other states, surpassing the national average of 52 deaths for every 100,000 children. In Tennessee, the average was closer to 66 deaths per 100,000 children, according to U.S. Centers for Disease Control and Prevention data for 2010, the most recent year that national comparison data are available. By 2011, child deaths claimed 60 of every 100,000 Tennessee children.

“While we are pleased to have made improvements in the review process and progress in most areas of reducing deaths, we remain disturbed that too many of our children are dying from preventable causes,” said Dr. John Dreyzehner, commissioner of the Department of Health.

“Most preventable child deaths involve complex societal and medical challenges, requiring a high level of collaborative efforts to make more significant differences,” he said.

The state’s annual report on child mortality comes amid increasing concern by lawmakers, child advocates and others about the role of the state’s Department of Children’s Services in investigating reports of abuse or neglect for children who later died. The controversy prompted former DCS Commissioner Kate O’Day to step down from her job earlier this month.

The Department of Health report released Tuesday noted that 38 children were subjects of open DCS investigations at the time of their deaths.

However, DCS spokeswoman Molly Sudderth said she could not confirm the number of children who died in 2011 who were subjects of DCS investigations. Those deaths are “under review,” she said. Sudderth said she could confirm only that 14 children who were in the physical custody of DCS died that year.

The department has conceded it has misreported child death numbers at least four times in the past six months. On Tuesday, Sudderth said agency officials hope to be able to give an accurate count soon.

Some progress

The report notes that the state’s child death rates have dropped 20 percent between 2007 — when 1,087 child deaths were reported — and 2011.

The report attributes drops in child deaths to a 16.8 percent decrease in sleep-related infant deaths due to suffocation and strangulation.

The report also notes that the state saw a 20 percent drop in the number of African-American child deaths in the same time period. But black children continue to be more vulnerable to deaths than children of any other race in Tennessee, according to the report.

And babies are still more likely to die than any other age group, accounting for 62 percent of all child deaths reported in 2011.

“The first year of life continues to be the most perilous for Tennessee’s children,” the report notes.

Tennessee’s high child death rate is not due to any single factor, but many of its causes can be traced back to poverty, drug abuse and mental health problems, said Linda O’Neal, executive director of the Tennessee Commission on Children and Youth. She also serves on the statewide Child Fatality Review Team, which analyzed the child death data.

“I think one of the factors is violence, which is related often to substance abuse and mental health issues,” she said. “While we rank high in these numbers, we put some of the least amount of state dollars into substance abuse treatment per capita of any state.

“Poverty is high in the state, with a little over one in four children living in poverty. And the stress of poverty, inadequate housing and other stresses in the families can contribute to substance abuse, mental health and child abuse.”

3 recommendations

The report makes three recommendations to prevent future tragedies.

First, state officials recommend an “aggressive campaign to educate infant caregivers in every county of the state on safe sleep practices, with a particular goal on reducing racial disparities.” The Department of Health recommends distributing 80,000 brochures or pamphlets giving advice on how to properly put children to sleep.

The report also recommends more presentations to middle and high school age children on safe driving. Children 10-17 account for nearly two-thirds of all children who die in motor vehicles, according to the report.

And, the report recommends more active participation by state experts in guiding child fatality review teams in each of Tennessee’s 39 judicial districts in more thoroughly and accurately reviewing child deaths.

Child deaths are first reviewed by these local teams, which include representatives from DCS, police and others, who are charged with learning and reporting as many details about child deaths as they can to state officials.

But their reports are sometimes lacking. Although DCS is represented on each fatality team, an earlier draft of the child death report noted that in more than 170 child deaths, there were no notes from DCS or others on whether the agency had been involved in the child’s family before the child’s death.

Those were among the details Department of Health officials spent months tracking to complete their analysis, according to Dr. Michael Warren, director of maternal and child health for the department.

2011 Tennessee child fatalities

The state child fatality review team examined 799 of the 802 total child deaths in 2011, with three cases unavailable for review.

Undetermined are cases in which the investigation of circumstances surrounding a death fail to reveal whether the death was preventable. Unknown cases are those in which information necessary to determine whether the death was preventable is unattainable or unavailable.

Source: Child Fatalities in Tennessee 2011, Tennessee Department of Health