Anchorage Daily News

Some of the babies suffocated in their sleep, on plastic bags, balloons or laundry carelessly left too close. Seven died after being hit, thrown, dropped or kicked. Two infants were shot; two others, starved.

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In all, according to newly compiled state statistics, 114 Alaska infants died over an 11-year-period as a result of abuse, neglect or "gross negligence."

It's a disturbing tally, especially considering that all the deaths could have been prevented, at least in theory, said Brad Gessner, an epidemiologist with the state Division of Public Health.

Public health researchers are trying to learn more about the circumstances of troubled Alaska families.

They want ways to intervene before it's too late, before the toddler's arm is twisted by an at-wit's-end mom, before the baby is put down for a nap on a couch, dangerous because an infant so easily can get wedged into a corner.

Their ultimate goal: Reduce Alaska's high rate of child abuse and neglect.

As it stands, no agency is responsible for a comprehensive assessment of child abuse and neglect here, Gessner said.

The state Office of Children's Services, for instance, is responsible for situations within a family, but OCS usually has no authority if a baby sitter hits a toddler, or a health aide fails to recognize a critically ill infant, or a teacher has sex with a student.

Law enforcement investigates child abuse, but many situations dangerous to children stem from bad judgment rather than criminal intent.

No one has the complete picture. "Not just how many cases occurred," Gessner said. "Who are the risk groups? Who are the people doing the abuse? Where is the abuse occurring? What interventions are being done? What evidence is there that the interventions work?"

So the state is launching the Alaska Surveillance of Child Abuse and Neglect program, part of the state Division of Public Health.

"If you don't know accurately where you are starting from, you can't measure accurately whether what you do makes a difference," said Cathy Baldwin-Johnson, a doctor who chairs a task force that tries to improve the state's response to child abuse, particularly sexual abuse. She also is medical director of Alaska CARES, a clinic that provides exams and helps investigate sexual abuse.

The new project is sorely needed, she said. The director of the Office of Children's Services agreed.

"More accurate information may be gained through multiple measures," Tammy Sandoval said in an e-mail. "Sometimes children die from maltreatment and officials learn that their family has had no contact with OCS or law enforcement prior to their current tragedy."

Jared Parrish, director of the new program, said the project will start with deaths but once the system is set up, will look at all reports of abuse, neglect and negligence.

People usually know what abuse looks like, but the line between neglect and negligence is less clear. Putting a pillow over a crying child's mouth is abuse, Parrish said. Putting a child to nap next to a plastic bag is neglect, a failure of the caregiver. Putting the baby on a waterbed or couch is negligence -- even if the parents didn't mean for the child to be hurt, they didn't take reasonable care, Parrish said.

A long-standing committee, the Alaska Maternal and Infant Mortality Review, already uses a variety of sources including medical records, death certificates, autopsy reports and police reports to figure out why babies die. But it hasn't done so with the same scrutiny of abuse and neglect issues that Parrish is using. And it is only beginning to look at cases of older children, Gessner said.

Parrish's research begins with the committee's work. He also is linking with other sources, such as OCS records, Medicaid records and questionnaires the state already sends to a sampling of new mothers every year as well as follow-up surveys when the children are toddlers.

The research isn't being compiled to prosecute or target families, but to create a system for tracking harm to children and what can be done about it, Gessner said.

Researchers want to see what sorts of common threads show up. Alcoholism, drug abuse, mental illness, domestic violence among parents -- these are well-known signs that children may be at risk. But others may be more subtle, Gessner said. For instance, are home-schooled kids more or less likely to be abused? Does that vary by whether they are in a rural or urban area?

Maybe better education and support for new parents is needed. Gessner, a pediatrician who treats patients at a clinic one afternoon a week, said he'll talk bluntly to a 16-year-old new mom, emphasizing that it's never OK to physically discipline an infant.

Maybe researchers will learn more about who to target for drug and alcohol treatment. Some of the deaths involved parents so drunk or high, they didn't realize they had rolled over on their baby, smothering the child.

Some of the mothers were beaten while pregnant and then gave birth prematurely to babies who soon died. Should public health officials do more to encourage doctors to ask pregnant women about violence in the home?

It's not just parents who need help. Doctors or health aides in some cases failed to recognize how ill a baby was. "We're looking at the community and how it affects children," Parrish said.

Find Lisa Demer online at adn.com/contact/ldemer or call 257-4390.

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