Child and Youth Mortality Review
Child and Youth Mortality Review Committee releases Fifth Report
The report released today by the Child and Youth Mortality Review Committee shows continuing reductions in many types of deaths but highlights a continuing toll of preventable deaths. The report examines deaths of babies aged from four weeks through to young adults aged up to 25 years and focuses on some key areas, such as Sudden Unexpected Death in Infancy (SUDI), drowning, unintentional injury in young people during the risk-taking years, youth suicide and systems improvement.
"A major improvement in deaths from Sudden Unexpected Death in Infancy (SUDI) has occurred since the early 1990s with the annual death toll dropping from 200 a year to 60. Sixty is still too many and a large number of deaths could be prevented if every baby slept safely every sleep,” said Dr Nick Baker, Chair of the Committee.
"The Committee is recommending a major push to reduce this toll by better supporting families to keep their infants safe. The development of a toolkit for health workers is recommended, to bridge the gap between what is known and advised - and what actually happens for infants. The toolkit would aim to remove the real barriers that prevent families - especially vulnerable families - from putting advice into practice"
Fences around private pools have been a great success story in New Zealand, helping to drop the annual number of drowning deaths for young children in pools from 11 per year to two to three a year.
“Children no longer die in unfenced pools,” Dr Baker says, “they die when the protective barrier (the fence) breaks down - often when it is not maintained, or has been altered or damaged.”
The Report recommends that pool fencing legislation is strengthened to include the need to check fences are safe. A 'warrant of fitness' for pool fences is suggested. “December is the worst month, every pool needs a check now to make sure it is safe for summer, even if children are not normally around, for example at their grandparents' house."
The Report states that the most common health threat for young people is injury. After the relative safety of the middle years of childhood (from 5 to 14 years) a sudden increase in death, especially for young men, occurs from age 14 onwards. Dr Simon Denny, a youth health physician has co-authored this section of the report. Dr Denny says that taking risks is a normal part of development, “as a society we must work to make the environment in which our young people grow up less hazardous, while providing them with the opportunity to develop competence in managing risk without dying.”
The report recommends zero tolerance for alcohol for young and novice drivers and a new approach to youth injury that focuses on making this developmental phase less dangerous as a whole, rather than focusing on particular risks.
"While good routinely collected data is available for deaths there is frequently a lack of information about serious and permanently disabling injury. Permanent injury of a child can be a tragedy that carries enormous human and financial cost. A brain damaged infant can cost $20,000,000 over their lifetime for additional care. It is therefore recommended that New Zealand develop better information systems that link and collect data on injuries, perform surveillance, and report. This is very important to help plan injury prevention priorities.” Dr Nick Baker said.
The final chapter of the report discusses opportunities for system improvement. It is noted that services do not always work together to provide coordinated collaborative care and information sharing, and it is too easy for service gaps to form, especially at times of transition. The Local Child and Youth Mortality Review Groups in DHBs have provided a valuable to link local services and they can develop solutions for issues that are highlighted during death reviews. The current restructuring of the health system provides an opportunity to better support a holistic approach to child and youth health to increase leadership, collaboration and coordination, with a reduction in service gaps. Services should focus on keeping children and young people at the centre of their concerns and strengthen work across sectors.