130 Little Cries~Study 3. Nature & Types of Fatalities: Toward Prevention (1)~

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1. Age of Infants and Causes of Death

The nature of fatality naturally varies between those that occur to infants of two to five months of age who are incapable of moving about and those that occur to infants of one year or older who are ambulatory.

Fatalities of Infants of First Five Months of Age

The result of our study reveals, as to be expected, that infant fatalities are concentrated in their third through fifth months when they are naturally vulnerable. Infants in this age group cannot protect themselves from hazards around them, and must rely solely on caregivers for their well-being and safety. A momentary slip in the caregiver’s attention to the infants’ safety can produce a result that would adversely affect the quality of infants’ lives.

We have heard time and time again media reports of “infants of 3-to-5 months of age dying while sleeping face down.” We believe that this fact suggests that no lessons have been drawn from these fatalities so that theory and practice of childcare remain inadequate. It also reflects the fact that public nurseries in the past have seldom provided day-care for infants in this age group, and that the great majority of infants have been cared for at nurseries with less-than-ideal childcare environment.

Under present conditions, infants of one year or younger who need safer and sounder childcare environment are largely cared for at nurseries with lower quality of nursing–those other than public day-care centers or licensed private day nurseries. This is indeed tragic for those infants who need nursing care outside their home.

The pros and cons of the prone sleeping position are still being debated. Finding so many cases of fatalities occurring while infants sleep face down, we believe that we should pay close attention while infants are sleeping in this position.

>From the results of the study, we conclude that nursery caregivers should pay heed to the following points concerning the care of infants of 2-5 months of age and their prone sleeping position.

(1) Since infants beyond certain months can turn over by themselves while sleeping, it is not necessary to shun prone sleeping completely. As a rule of thumb, however, infants should be allowed to sleep face down after they have learned to raise their heads easily in that position.

(2) Firm mattresses should be used. Sheets should be used in the form of closed cases. Do not use pillows (even when babies sleep supine).

(3) Do not put babies who have just been weaned to sleep face down.

(4) When a baby is put down to sleep face down for the first time, keep an eye on him with closest attention.

(5) For the care of infants of 2-to-5 months of age, assign a sufficient number of caregivers, who are instructed to pay particular attention to infants who turn over in sleep and those who appear to have a touch of cold or unusually sluggish bodily movements.

Fatalities of Infants over Six Months of Age

Fatalities of infants of six months to one year take many different shapes. As infants learn how to walk about, unthinkable types of accidental deaths can occur. An example is the death of baby Takehiro Tokoro, who died of suffocation when his crib string caught a crib post.

Special care should be taken when infants are unwell–for example, when they are suffering from bronchitis, pneumonia or common cold. In such a case, the vital resistance of their bodies is lowered. The results of our study show that a combination of the above condition with aspiration of gastric contents including undigested milk, prone sleeping, and covering of the head with bedding materials, may produce a fatal outcome.

In six cases, the results of autopsy showed pneumonia, which is the leading cause of death in this age group. It is thus of utmost importance that caregivers have a good grasp of the physical conditions of infants under their care. They should pay closest attention to infants who are sluggish in bodily movements. They should also have access to a medical professional whom they can consult at a moment’s notice.

Fatalities of Infants over One Year of Age

Fatalities of infants over one year of age are mostly caused by such accidents as falls, drowning, and burns.

To prevent these accidents, it is necessary to take precautionary measures by imagining all sorts of possibilities. These measures include, among others: inspection of emergency exits on the second floor, inspection of the ladder rungs of slides (so that infants’ heads don’t get caught in them), inspection of the distance between cribs (so that infants don’t fall off between cribs and get their heads caught by them), making sure that the bathroom door is locked when the bathtub is filled with water, and making sure there is an adequate number of caregivers supervising children’s outdoor activities.

Infant fatalities in this age group, as those in younger age groups, occur almost always when the victims are not being watched by a caregiver. It is therefore important to establish a system of childcare where chidren are watched by caregiver(s) at all times.

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