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More Action Needed to Prevent Infant And Child Deaths

Lives Saved But More Action Needed to Prevent Infant And Child Deaths

The Child and Youth Mortality Review Committee (CYMRC) estimates nearly 3000 lives have been saved in the past 20 years because of efforts to prevent sudden unexpected death in infants (SUDI).

A dramatic reduction in SUDI deaths has reduced the annual death toll from 200 to 60, which CYMRC attributes to a highly successful ‘back to sleep’ campaign.

The Chair of CYMRC, Dr Nick Baker, says those numbers, added up over two decades, represent a significant number of people still alive who might otherwise have died.

He is heartened by that and by the latest figures from Statistics New Zealand which show infant deaths and the infant mortality rate were at record lows in 2012. The full Statistics New Zealand media release is available at

However, he says the CYMRC’s latest special report, released today, shows more needs to be done to keep the most vulnerable members of New Zealand’s communities safe from harm. The report, Unintentional suffocation, foreign body inhalation and strangulation, is available from the Health Quality & Safety Commission’s website at

“There has been some fantastic work happening within communities and with health professionals and others in recent years, and this is having a positive impact on infant death rates,” he says. “At the same time, it’s clear that too many babies and young children are continuing to die from preventable harm, so the challenge to us all is to really take on board messages about the best ways to keep our children safe.”

The CYMRC report says death from traumatic asphyxia caused by suffocation is one of the three leading causes of unintentional injury deaths in New Zealand. The report looks at three main types of death: suffocation in the place of sleep, inhalation of food or foreign bodies, and external pressure on the neck or face.

Dr Baker says the report provides a tragic reminder of just how dangerous everyday objects such as curtain cords, ropes, pillows and mattresses can be.

“Things can change in an instant where babies and children are concerned,” he says. “It is not uncommon for deaths to occur when young ones are in unfamiliar surroundings, less actively supervised than usual, busy with other activities, or in the presence of intoxicated or distracted caregivers. This reinforces the importance of good routines and safety measures around children to ensure they are safe.”

The report says 50 of the 79 deaths it looked at arose from unintentional suffocation in bed, underlining the need to provide babies and young children with safe places to sleep.

“We were especially concerned to see that the rate of death in Maori and Pacific infants is significantly higher than for European infants,” says Dr Baker. “We’re not sure exactly why this is, although differences in the rate of smoking during pregnancy may be a factor. We know that infants exposed to cigarette smoke in pregnancy tend to be smaller and are more prone to suffocation.”

He says there are some very practical things people can do to help prevent SUDI, including putting babies to sleep on their backs, make sure their rooms are smokefree and not too hot, giving them plenty of room to breathe, and providing a sober caregiver.

The CYMRC report makes a number of recommendations which Dr Baker says support current government initiatives to improve support for vulnerable children, enhance smoking cessation programmes, put in place better systems to engage across the health system, increase the availability of safe sleeping spaces, encourage policies and staff training in district health boards (DHBs), and place greater emphasis on the safety of cots and bassinettes.

The CYMRC, which operates under the umbrella of the Health Quality & Safety Commission, reviews deaths of children and young people aged 28 days to 24 years, and provides advice on how to prevent further deaths.

Last year the Commission wrote to all DHBs asking them to prioritise the prevention of SUDI. In the report just released, CYMRC says it will convene a meeting of key agencies in product safety with a view to improving the flow of information about deaths and injuries, supporting enforcement of mandatory safety standards for cots and bassinettes, and providing cot safety information to both retailers and purchasers. It is also calling for better coordination across a range of government and other agencies and the inclusion of SUDI prevention messages in antenatal courses and other child injury prevention initiatives.

Dr Baker says information collected for the CYMRC report has already been used to influence new Ministry of Health choking guidelines, and is contributing to the development of training resources and safe-sleep programmes around New Zealand.
“Each number in this report represents a tragic loss for families and whanau around New Zealand, and we hope that our investigations of infant and child mortality, and our support for actions which aim to keep children safe, will help to prevent further deaths of these types,” he says.

For a copy of the report, visit

Additional background information

The CYMRC recommends the following as best practice to help prevent unintentional suffocation, foreign body inhalation and strangulation:
To prevent death in place of sleep by suffocation:

1. Safe sleep for babies should be everyone’s priority.
2. In the first year of life, always place baby to sleep on their back.
3. In the first year of life, baby should sleep on a firm, flat and level surface with no pillow.
4. In the first year of life, baby should have their own sleeping space.
5. In the first six months of life, baby is safest when sleeping in the same room that their parents sleep in.
6. Parents should be informed of the risks from bed-sharing, particularly parents who smoke.
7. Eliminate smoking, drugs and alcohol.
8. Never allow anyone to smoke in the baby’s bedroom or in the car with the baby.
9. Every baby needs a sober caregiver. Do not share a bed with your baby if you have consumed alcohol.
10. Do not share a bed with your baby if you have taken any drugs.
11. Baby should never sleep on a sofa, alone or with an adult or child.
12. Parents of young infants are often tired. Therefore, be careful where you lie with your baby in case you accidentally fall asleep with baby in an unsafe sleeping space.
13. Baby should not be left to sleep in car seats or capsules, except during car travel.
14. Broken cots are dangerous cots.
15. Ensure that the mattress in the cot is the appropriate size and fits the cot without gaps that could trap or wedge a baby.
16. Ensure that bedding cannot cover the infant’s face.
17. Ensure the cot is away from walls and windows and is free-standing in the room.
18. Safe sleep routines are important, especially if away from home or at a social gathering.
19. Some infants have died from the use of products that restrain the infant’s movements during sleep. These products must be used with caution as they have been associated with deaths.
20. Encourage breastfeeding.
21. Access the safety of sleep spaces from first principles using the list on page 17.
Foreign body inhalation

1. Toddlers should be supervised at all meal times and encouraged to concentrate on the activity of eating only. This must be in all places, including large social gatherings where people can easily be distracted and there are lots of children.
• If toddlers are excited and running around, they might choke.
2. When children are eating, they shouldn’t be doing anything else.
• If children are playing or running while they eat, they might choke.
3. Be cautious when feeding toddlers small, round, hard or elastic foods like sausage, grapes or apple.
• These foods need to be sliced or grated to make choking unlikely because they are more likely to cause choking and death.
4. Be on the lookout for choking hazards in the home. Vacuum and sweep the floors regularly, check the baby’s sleep space for loose or broken parts, and keep items that could be choking hazards out of baby’s reach.
Unintentional strangulation and suffocation

1. Be aware of loose cords around the home and the risk of strangulation. This includes parts of the baby’s clothing, such as bibs or pacifier ties.
• Cords that can fit around your child’s head could become entangled and cause suffocation.
2. Curtain cords should have a safety device to cover them or to keep the cords together so that they do not form a noose, or they should be kept out of the reach of children. Cots should be placed at least 10cm away from the windows and other hazards. Curtains with an open weave, in which a baby can be caught, should be avoided.
• Hanging curtain cords and loose fabrics have caused deaths by strangulation.
3. If children are playing with ropes or cords, make sure they never put a rope around their own neck or chest or someone else’s neck or chest.
• Dangerous play with ropes or cords, such as homemade flying foxes or climbing with rope or cord, can lead to unintentional strangulation.
4. It is also important to be cautious when digging in sand or dirt.
• Children or young people can become trapped in unsupported dirt or sand holes, particularly while digging in sand dunes or cliffs.

Attributes of a safe sleeping space for infants
A safe sleep space should be:
1. Free from other people who might overlay the infant – sleep arrangements need to make sure that if someone else moves while sleeping, the infant will still be able to breathe easily with a clear airway.
2. Free of gaps that could trap or wedge – there should be no gaps that might trap an infant, wedge them and make breathing hard or impossible.
3. Firm – so the infant’s neck does not flex and compromise the airway, and the face cannot get buried in the surface if the infant rolls into the prone position.
4. Flat – so the infant does not suffer compromise to the airway or breathing by rolling over, tipping out, inversion of sleep space or becoming wedged.
5. Free from objects that might cover the face or cause strangulation or neck flexing – nothing should be put near that could cover the face during sleep or impair breathing. This could include pillows, bedding, sleep restraint apparatus or low-hanging mobiles.
6. Free to breathe – infant has no restriction of chest movement from pressure on the chest, tight wrapping or heavy bedding.
7. Free from tobacco smoke – babies should sleep in environments that are totally smokefree.
In safe sleep spaces, infants should be:
1. Back to sleep – infants should always be placed on their backs to sleep.
2. Smokefree – always allow babies to breathe air free of smoke.
3. In parents’ room – babies are safest when sleeping in the same room that their parents sleep in for the first six months of life.
4. At a comfortable temperature, avoiding overheating – too many layers or too much heat from others can distress babies.
5. Looked after by a sober caregiver – someone who is ready and alert to meet their needs.


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