THE SUDDEN DEATH of a 16-month-old boy in foster care in Dubin last year was due to a combination of factors including the sedative effect of a drug given to treat his “chesty” condition, an inquest has heard.
The boy, Carson Nangle, was found in an unresponsive state in his cot on the morning of 11 April, 2022.
A sitting of Dublin District Coroner’s Court heard the toddler had been placed in the foster care of his aunt, Rachel O’Neill, from Millrace Walk, Saggart, Co Dublin by Tusla.
The inquest also heard concerns by Ms O’Neill that she was never able to get any recommended vaccinations for the youngster because she was not his legal guardian.
The coroner, Cróna Gallagher, heard evidence that Carson, who was always “very chesty and snotty”, had been unsettled and screaming regularly the previous evening for which he was given a dose of Calpol and an antihistamine, promethazine which is sold under the brand name, Phenergan.
State pathologist, SallyAnne Collis, said post-mortem results on the boy showed the probable cause of his death was a combination of viral respiratory infections, the sedative effect of the antihistamine and the fact that he was asleep lying face down in his cot.
Dr Collis said the toddler had appeared nourished and clean and showed no sign of any injury.
However, the pathologist noted he had chronic inflammation in his air passage and the lining of his lungs which was consistent with respiratory infections.
Dr Collis observed the use of promethazine was not recommended for children under 2 years, while babies lying on their chest was a known risk factor for sudden deaths.
While a genetic cardiac disorder was possible, Dr Collis said no tests had been carried out to check for it, but she believed such a cause was unlikely to be responsible for the boy’s death.
In reply to questions from the coroner, Dr Collis said the sedative effect of the antihistamine would impact on the part of the brain that controls breathing.
She said the amount of the drug given to the boy was “not excessively high” for an adult but there were no recommended levels for very young children.
Asked if any individual factor could have caused the boy’s death, the pathologist said it was difficult to separate them out and she believed it was the combination of factors which compounded each other.
The inquest today was informed that Carson’s mother, Kim Nangle, had been fostered herself by Ms O’Neill’s parents and had grown up with the family.
However, Carson had been placed in the care of Ms O’Neill since he was about three months old because Ms Nangle had a problem with drug addiction.
Ms O’Neill told the coroner that she had originally just agreed to take care of Carson over a bank holiday weekend following a garda raid on Ms Nangle’s home in February 2021.
The inquest heard she and other family members were part of a safety plan that had been put in place by Tusla even before the boy was born which included twice daily checks on Ms Nangle and her son.
Ms O’Neill said Carson was “like a brother” to her own two children.
She described him as “strong and hardy” while also wild.
“As far as I was concerned, he was 100 per cent healthy,” said Ms O’Neill.
Fighting back tears throughout the inquest, she said Carson had eventually fallen asleep around midnight on the night before he died after being restless and screaming for several hours.
When she woke the next morning and went into his room around 10.20am she felt something was wrong as he was not snoring like usual.
Ms O’Neill said she started screaming after she saw that he was purple and motionless and had white foam coming out his mouth.
The inquest heard she tried giving him CPR before paramedics arrived around 10 minutes later.
However, attempts to resuscitate were unsuccessful and he was pronounced dead shortly after 11am.
Her father, Kevin O’Neill, gave evidence of formally identifying his foster grandson’s body in an ambulance outside his daughter’s house.
Ms O’Neill told the coroner that the boy’s restlessness the previous evening was “out of character.”
“I didn’t know what to do with him,” she added.
The inquest heard that Carson had remained with her since February 2021 with Ms Nangle being allowed supervised visits.
Ms O’Neill also expressed concern that she was unable to get Carson vaccinated by a GP because she was not his legal guardian.
She said she had informed Tusla that she wanted to become his legal guardian primarily to be able to access medical care for him but understood it was only possible after she had been fostering him for 12 months.
A solicitor for Ms Nangle, Seona Ní Mhurchú, said Ms Nangle her client provided Tusla with consent forms to allow Carson to be vaccinated.
A senior social worker with Tusla, Michael Melotte, said the child and family agency were satisfied that putting Carson in the care of the O’Neill family was “an appropriate placement.”
Mr Melotte said Tusla was “impressed” with the high level of care and support offered by Ms O’Neill and her wider family.
He agreed with Ms Mhurchú that it was unusual for a child of 16 months not to have been vaccinated.
“It was not brought to our attention at the time that it was an issue,” he remarked.
Under questioning by the coroner, Mr Melotte admitted he could see the problem of a foster carer trying to get medical permission for non-elective surgery on a child in their care “arising as an issue” because they were not a legal guardian.
He believed that Ms O’Neill was not required to wait 12 months before she could have applied to become Carson’s legal guardian as Ms Nangle was consenting to it, but he did not know why it had not happened.
The inquest heard that Tusla was informed by staff at Children’s Health Ireland at Crumlin, where his body was brought, that Carson had died from Sudden Infant Death Syndrome but Mr Melotte acknowledged it was incorrect information based on the evidence.
Ms Nangle, who was in a state of distress throughout the hearing, did not give evidence.
Speaking on her behalf, Ms Ní Mhurchú said Carson was very much loved by her and she thought about him every day and missed him all the time.
She said Ms Nangle had last seen him about a week before he died and she recalled he was “a very happy, playful baby.”
“She wants everyone to know how much he was loved,” Ms Ní Mhurchú added.
Returning a verdict of death by misadventure, the coroner stressed that no blame was being attached to anyone with such a finding.
Dr Gallagher said things were “just too much” for the little boy on the particular night and what happened could not have been prevented.
Offering her sympathy to Carson’s relatives, she said the evidence showed proof of the quality of care that the O’Neill family had provided to the “lively, funny and happy boy.”
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