On September 2, 2022, a 2-month-old female child died after her father fell asleep with her on his chest during the night. The father had taken the child from her bassinet around 2-3 AM to console her, then lay down in bed holding her and unintentionally fell asleep. He woke around 6:35 AM to find the child facedown, blue, and not breathing. Despite calling 911 and attempting CPR, the child was pronounced dead at 7:30 AM at the hospital. The medical examiner found no evidence of trauma or abuse and presumed the death resulted from positional asphyxiation due to the unsafe sleep environment. The child had been in her father's sole care since birth because her mother suffered from untreated bipolar disorder and schizophrenia, with an Order of Protection barring the mother from unsupervised contact.
Contexts/Conditions
Is there any mention of child drug ingestion or overdose?
Is there any mention of a drowning incident (either intentional or accidental)?
Is there any mention of a firearm incident?
Is there any mention of inappropriate supervision (e.g., child wandered off and drowned)?
The fatality report states that the allegation of Inadequate Guardianship was substantiated against the father: "ACS determined that the father failed to provide a minimum standard of care when he failed to adhere to safe sleep practice." The father fell asleep while holding the infant and rolled onto her, failing to maintain appropriate care and supervision of the child, which constitutes inappropriate supervision.
Is there any mention of inflicted injury? (e.g. slapped, punched, kicked, choked)
Is there any mention of malnutrition, starvation, or dehydration?
Is there any mention of medical neglect?
Is there any mention of a motor vehicle crash or incident?
Is there any mention of a murder-suicide incident?
Is there any mention of outdoor elements (including hot car deaths)?
Is there any mention of prenatal substance exposure (including fetal alcohol syndrome or neonatal abstinence syndrome)?
Is there any mention of sexual abuse?
Is there any specific mention of shaken baby or abusive head trauma?
Is there any mention of prolonged abuse or torture (including restraints, captivity)?
Is there any mention of an unsafe sleeping environment?
The fatality report explicitly and repeatedly references an unsafe sleeping environment. It states: "The medical examiner presumed the death was the result of positional asphyxiation due to the unsafe sleep environment." It also states: "ACS determined that the father failed to provide a minimum standard of care when he failed to adhere to safe sleep practice." The father fell asleep with the child on his chest and the child was found facedown, blue, and not breathing.
Individuals Involved
Was an adoptive parent or guardian involved in the death?
Was a biological father involved in the death?
The fatality report identifies the father as the "Alleged Perpetrator" in the household composition table. The allegation of Inadequate Guardianship was substantiated against him. The report states: "ACS determined there was evidence to substantiate the allegation of Inadequate Guardianship against the father regarding the subject child. ACS determined that the father failed to provide a minimum standard of care when he failed to adhere to safe sleep practice." The household composition identifies him simply as "Father" (i.e., biological father).
Was a biological mother involved in the death?
Was a day care worker, babysitter, or nanny involved in the death?
Was a female paramour or friend involved in the death (e.g., girlfriend, stepmother)?
Was a foster parent involved in the death?
Was a male paramour or friend involved in the death (e.g., boyfriend, stepfather)?
Was another adult relative involved in the death? (e.g., grandfather, aunt)
Was a sibling involved in the death?
Child Characteristics
Was the child adopted?
Was the child homeschooled (including "cyberschooling") or taken out of school?
Was the child in foster care at the time of the incident?
Was the child living with relatives at the time of the incident (but not parents)?
Is there any mention of a neurological developmental child disability? (e.g., autism, intellectual disability, nonverbal)
Is there any mention of a physical child disability? (e.g., feeding tube)
Is there any mention of prematurity or low birthweight?
Is there a history of child protection reports prior to death (for this child or siblings)?
The fatality report documents a prior CPS report dated 06/22/2022 involving the same child as the alleged victim, with allegations of Inadequate Guardianship and Parents Drug/Alcohol Misuse against the father, and Inadequate Guardianship against the mother. The report was indicated. The report states: "The family was known to ACS as there was an open Preventive Services case at the time of the subject child's death, which had been open since 6/22/22, as well as multiple historical investigations."
Does the child have a history of foster care (but not in care at time of incident)?
Is there a history of a sibling death (separate incident from this death)?
Parent/Caregiver Factors
Was an adult charged or arrested for the child's death?
Is domestic violence by the parent/caregiver referenced?
Is there any mention that the death occurred in a temporary shelter or while homeless?
The fatality report states that "ACS interviewed the father in the independent living facility where he and the subject child resided." An independent living facility may constitute a form of transitional or supportive housing, though the report does not explicitly characterize it as temporary shelter or transitional housing. The term is ambiguous without additional context.
Is an intellectual disability of the parent/caregiver referenced?
Is the mental health of the parent/caregiver referenced?
The fatality report extensively references the mother's mental health. It states: "The mother had an extensive psychiatric history, was diagnosed with bipolar disorder and schizophrenia and was not receiving treatment for the conditions." Additionally: "The mother's mental health had been declining rapidly and ACS worked with community-based services to assist in mental health treatment, bereavement counseling." Furthermore: "the mother had been admitted inpatient to a mental health facility. Follow-up revealed the mother displayed disorganized behaviors, had not made progress in her treatment, and there was no discharge date."
Is a history of arrests or criminal charges for the parent/caregiver referenced?
Is substance use by the parent/caregiver referenced?
The fatality report references substance use by the father in the prior CPS history. The report states: "A subsequent report was received and alleged the father used illicit substances while caring for the child." The allegation of "Parents Drug / Alcohol Misuse" was listed against the father in the 06/22/2022 SCR report, though it was ultimately unsubstantiated with the finding that "There was no evidence he was using illicit substances." Nonetheless, substance use by a parent/caregiver is clearly referenced.
Notable Details
The fatality report reveals several notable contextual details. The child had been placed in the father's sole care because the mother's severe mental health conditions (bipolar disorder and schizophrenia) rendered her unable to care for the child; an Article 10 Neglect Petition had been filed against the mother and an Order of Protection barred her from unsupervised contact. The father was residing in an "independent living facility" with the infant, and a preventive services case had been open since the child's birth. Despite the father being engaged in parenting services and reportedly aware of safe sleep guidance, he fell asleep with the child on his chest, leading to her death. The initial FASP was completed 7 days late, which was cited as a compliance issue. The overall case illustrates the challenge of a young infant in a single-parent arrangement with limited support infrastructure, where the sole caregiver was a relatively new parent receiving services in a congregate living setting.
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