The state's top health official said Wednesday there's a simple, cost-free way to prevent dozens of children from dying each year: Let them sleep alone.
Will Humble said some of the more than 830 child deaths in Arizona last year were probably not preventable.
He said some are difficult to spot ahead of time, like incidents of child abuse -- especially if there was not a prior report that there was trouble in the home. Other deaths are a matter of enforcing existing laws that require infants to be in special car seats and teens having to wear their seat belts.
But he said 64 of the deaths last year, due to what the state calls co-sleeping, were clearly unnecessary.
"I know how it happens,'' the state health director said. "I had kids myself.''
The nature of infants, he said, is to "get fussy'' in the middle of the night.
"The easiest thing to do is bring them into bed with you,'' Humble said. "They quiet down and everyone gets a good night's sleep.''
Breast feeding also is easier.
"But f you look at the data in this report, it just shows you that it's not safe,'' he said.
The comments come as the state released its 19th annual Child Fatality Review Program report detailing what killed those younger than 18 in Arizona last year.
On the bright side, the figures show that the number of children dying has been declining steadily for the last five years. But Humble said the data is far more telling.
"When I look at the report, I look at not just the numbers of deaths and not just what's preventable, but what are the strategies that we can use with the resources that we have to really make a difference here,'' he said. Humble said of all the causes of death in the study, preventing co-sleeping deaths is "the low-hanging fruit.''
Preventing other deaths, he said, is far more complex.
The report says 39 children took their own lives last year. While most of these were teens, the list includes a 7-year-old.
Humble said the best intervention is for others to recognize the signs of depression early, "and do something about it.'' That means reaching out to the local mental health system but also, for those who are not family members, telling the parents.
He conceded, though, it's not all that simple to determine whether a teen is clinically depressed or, quite frankly, just acting like "a cranky teenager.''
"It takes some kind of training,'' Humble said.
He said his agency is urging hospitals to have at least one person in each emergency room to have someone available who has had some mental health training. Humble said that ensures there is a review when a teen shows up with an injury to determine whether it was simply an accident "or whether there is something else at play.''
The annual report also pointed up something else: Of 35 children last year who died due to abuse, there were no reports filed with Child Protective Services in 24 of these cases.
That is not an unusual situation. State officials say the first inkling they had of any problems of nine of the 16 fatalities this year to date was when the child died.
Stacy Reinstein, the deputy child welfare administrator for the Department of Economic Security, said that lack of prior knowledge is a problem.
"What we want the community to remember is the importance of reporting because Child Protective Services can't be involved in that family's life until we act,'' she said.
She acknowledged that outside observers may be loath to report something to a government agency that they cannot determine is child abuse. But Reinstein said they should err on the side of caution and contact the child abuse hotline where an expert can determine if further action is needed.
"A lot of times the apartment manager or neighbor that calls, they have a lot more information than they think they might,'' she said. That can include whether there is a pattern, based on things like the number of times they hear a parent yelling at a child.
Humble said there are situations where people don't report things that they should.
"Sometimes people are afraid to do it because they'll injure a relationship they might have,'' he said. "Some people don't know what to do, where to call.''
Humble said there is one other big area of child deaths where he thinks prevention can make a big difference: premature births.
"The number one killer of kids in Arizona is being born too early,'' he said, with prematurity linked to 199 of the deaths last year. Humble said that's why there's a focus on "preconception health.''
"That means young women in their reproductive years need to take care of themselves because you never know when you might get pregnant,'' Humble continued. "The healthier you are when you get pregnant, the better off you'll be in terms of having a good outcome and making sure that your kid comes to term at 39 weeks and not earlier.''
He said that means avoiding substance abuse, maintaining a healthy weight and having good nutrition.
"Those kinds of things are really at the core of really making a dent,'' Humble said.