2009 Report of the Paediatric Death Review Committee and Deaths Under Five Committee released



    TORONTO, June 1 /CNW/ - Dr. Bert Lauwers, Deputy Chief Coroner for
Investigations and Chair, today announced the release of the combined 2009
Report of the Paediatric Death Review Committee and the Deaths Under Five
Committee.
    Working under the leadership of the Office of the Chief Coroner for
Ontario, the purpose of the Paediatric Death Review Committee and the Deaths
Under Five Committee is to assist the Office of the Chief Coroner in the
investigation and review of deaths of children and to make recommendations to
help prevent deaths in similar circumstances. Committee members include
coroners, medical and child welfare experts, police, Crown attorneys and
pathologists.
    The 2009 report contains data from deaths reviewed in 2008 when the
Paediatric Death Review Committee examined the circumstances surrounding the
deaths of 138 children between the ages of 0 and 19 years. The Deaths Under
Five Committee reviewed 96 deaths. The purpose of the reviews is to
objectively analyze the circumstances leading up to, and surrounding the
deaths and to develop recommendations aimed at preventing deaths in similar
circumstances. The review does not assign blame or responsibility. Most of the
recommendations suggested by the committees through the reviews are focused on
promoting best practices within the child welfare and medical systems, and
educating the public on child safety measures.
    The results noted in the 2009 report are consistent with those of
previous years, which have shown that the most vulnerable ages for paediatric
deaths are for infants under 12 months and children aged 12 to 18 years. The
involvement of a Children's Aid Society did not appear to be a factor in the
majority of child deaths. In cases where there was involvement by a Children's
Aid Society, most deaths could not have been foreseen or prevented by the
agency.
    Upon review of the cases presented to the Paediatric Death Review
Committee and Deaths Under Five Committee, common themes for the prevention of
similar deaths emerged. The following themes identified in the 2009 report are
consistent with the findings of previous years and should be of particular
interest to parents, caregivers, child welfare agencies, health-care
professionals and government ministries:

    
    1.  Unsafe sleeping environments - Infants should sleep alone, on their
        backs and on a surface specifically designed for infant sleep. The
        Paediatric Death Review Committee stresses the importance of not bed-
        sharing, particularly with infants under the age of 12 months.
        Examples of unsafe sleeping environments include: adult beds,
        couches, armchairs and infant swings. The sleeping environment should
        not contain bumper pads, toys, pillows or covers designed for adults.

    2.  Adolescent suicide - There is a continuing and concerning trend of
        adolescent suicide especially in northern aboriginal communities. A
        review of nine suicide deaths of children from the ages of 12 to 17
        years over a 10-month period at the Pikangikum First Nations
        community highlights the need to examine the conditions facing this
        and other communities. The committee found that the consequences for
        these children include substance abuse, poor academic achievement,
        learning disabilities, problem-solving skills and poor impulse
        control culminating in desperation and hopelessness and ultimately,
        suicide.

    3.  As the majority of children die while in the care of their families,
        prevention strategies and educational messages need to be aimed at
        the general public and parents, in particular. Issues facing families
        such as domestic violence, substance abuse and mental health concerns
        are prevalent in the cases reviewed with evidence of chronic neglect,
        partly related to poverty, but also to parental capacity problems.
    

    "All of the citizens of Ontario share a mutual responsibility to create a
safe and healthy environment for our children. Opportunities for improvement
will continue to be enhanced by the cooperative and appropriate sharing of
information and collaboration between all parties that have a direct interest
in child health, welfare and safety; all of us working together, in the
interests of our children," said Dr. Lauwers.
    The 2009 Report of the Paediatric Death Review Committee and the Deaths
Under Five Committee is being released today at a conference hosted by the
Ontario Association of Children's Aid Societies. The report is available
online at: www.oacas.org or by contacting the Office of the Chief Coroner
locally at 416-314-4000 or 1-877-991-9959.

    
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                                                      Disponible en français
                                                              ontario.ca/mcs
    





For further information:

For further information: Dr. Bert Lauwers, Deputy Chief Coroner for
Investigations Chair, Paediatric Death Review Committee and Deaths Under Five
Committee, Ministry of Community Safety and Correctional Services, (416)
314-4000

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