Buncombe County child-fatality review: 20 deaths in 2023; perinatal conditions, unsafe sleep and youth suicide highlighted

Dr. Jenny Molendor, chair of the Buncombe County Child Fatality Prevention Team, told the Buncombe County Board of Health at its April meeting that the team reviewed 20 deaths of county-resident children in 2023 and identified perinatal conditions as the leading cause.

The review showed five extremely premature births and two deaths associated with placental abruptions. Illnesses (including genetic conditions and cancers), accidents (including a pedestrian struck by a vehicle and one fatal anaphylactic reaction) and sudden unexplained infant deaths also appeared among the reviewed cases. The team reported that 60 percent of the child fatalities in 2023 occurred in children younger than 1 year of age.

The report also examined an increase in youth suicides documented in 2022 that continued into 2023; local data through the first two quarters of 2024 showed a decline from that 2022 peak. The team noted that in Buncombe County the most common method of youth suicide has been by hanging. Team members stressed that suicide prevention requires addressing isolation, stigma and access to mental health care, and said prevention work needs to include BIPOC and LGBTQ+ youth.

Why this matters: infant mortality and youth suicide are leading public-health priorities. Dr. Molendor said North Carolina's infant mortality ranking is poor, and that local disparities persist: Black infants in Buncombe County were nearly three times more likely to die before their first birthday than white infants over a recent five-year comparison (the county's disparity ratio increased from 2.36 to 2.96 for the 2019''23 period).

Recommendations and follow-up: the team recommended restarting a countywide safe-sleep public campaign that was delayed by Hurricane Helene, expanding training for first responders to identify and advise caregivers about safe sleep, and supporting paid family leave through the county's legislative advocacy channels. The team noted it receives a small annual state allotment (about $1,600 in 2024) and used that money to produce signs and magnets promoting the 988 Suicide & Crisis Lifeline.

Legal and structural changes: Molendor briefed the board on statutory changes stemming from 2023 appropriations language that reorganizes local child-fatality review teams; starting July 1, 2025, counties will have a single local child-fatality review team structure as defined by the state law referenced in the team's report.

Board action: the chair asked for and received board approval to appoint Casey Locke as the board's representative to the county child-fatality review team. The motion to approve the appointment was made from the chair, seconded, and adopted by voice/hand vote; the meeting record shows the motion carried but does not list a numerical tally.

What the report does not assert: the team's role is review and recommendation; the report identifies system gaps and recommends actions but does not, by itself, create county policy. Molendor said the team aims to identify service-delivery gaps and make evidence-based recommendations for prevention and policy changes.

Outlook: the county will pursue the safe-sleep campaign and coordinate with community partners on suicide-prevention activities. The board designated Casey Locke as its representative and the team will continue to monitor trends and push for the recommended actions.