Online Program

Is Co-Sleeping Child Neglect? A Case Study of Sleep—Related Death Investigations from the Illinois Department of Children and Family Services

Tuesday, November 3, 2015 : 12:50 p.m. - 1:10 p.m.

David Polsky, J.D., Office of the Inspector General, Illinois Department of Children and Family Services, Chicago, IL
Allison Rosenthal, Department of Community Health Sciences - School of Public Health, University of Illinois at Chicago, Chicago, IL
Background: In 2011, Illinois DCFS began investigating and indicating caregivers for Death by Neglect when an infant died while co-sleeping or in unsafe-sleep environments, if the caregiver had previously received information about safe sleep. This happened even when no evidence of substance use or other factors suggesting abuse or neglect was found. The policy, which was suspended in 2014, in effect labeled co-sleeping parents as “negligent,” despite the absence of legal precedent and ongoing debate in the health community about the risks and benefits of co-sleeping. 

Methods: We reviewed public records for all allegations of Death by Neglect due to unsafe sleep practices in 2011-13, along with subsequent administrative appeals. We also used publicly available data sources from 2012-14 to assess the impact of this policy.

Results: From 2012-2014, the OIG reinvestigated 143 cases involving infant deaths, of which 75 (52%) were sleep-related deaths, and 55 (38.5%) involved co-sleeping.  In 35 (64%) of the co-sleeping deaths, caregivers were indicated for abuse or neglect. 6 of the 35 caregivers appealed the decision and had their indicated findings overturned. Scrutiny of the case summaries revealed inconsistencies in how guidelines for indicating caregivers were applied. DCFS did not collect systematic data on all AAP-recommended safe-sleep practices, including breastfeeding and room-sharing. 

Conclusion: The 2011 policy did not have legal standing, was a narrow interpretation of the AAP safe-sleep guidelines, and unfairly burdened poor families who often lacked access to safe-sleep environments. Preventing sleep-related deaths should be addressed as a public health issue.

Learning Areas:

Advocacy for health and health education
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Explain current treatment of co-sleeping infant deaths by child welfare system Illustrate inconsistent treatment of families under the former practice Identify problematic implementation issues of the old practice including the imposition of safety plans requiring the temporary removal of surviving children from the home, and reduced employment opportunities for individuals “indicated” for Death by Neglect Differentiate between a retroactive and punitive child welfare response and a proactive public health approach to infant co-sleeping deaths that seeks to provide targeted education to families

Keyword(s): Breastfeeding

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an attorney with the Office of the Inspector General for the Illinois Department of Children and Family Services who has conducted extensive research and analysis of issues related to infant deaths attributable to unsafe sleep environments--particularly the ways in which public health, medical, legal, and child welfare systems have addressed these issues. I have developed and conduct trainings for young parents to teach them about the dangers of unsafe sleep environments.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.