Baby died next to drug-using dad
An investigation into the death of a 23-week-old Gold Coast baby in 2015 has uncovered Child Safety's failures to follow up reported concerns about risks to the child and his siblings.
Deputy State Coroner Jane Bentley found Baby J died from category two Sudden Infant Death Syndrome, as a result of co-sleeping with his drug-using father on two sofas pushed together.
Ms Bentley said although Baby J and his family were known to the Department of Child Safety, an investigation begun shortly before the baby's birth was not conducted properly.
She said no action was taken to assess the risk to the child and his siblings, who lived with their violent father and mother, who had psychiatric issues, in a holiday park cabin.
Other concerns reported after Baby J's death were not investigated, the Deputy State Coroner found.
Ms Bentley said while the department's failures did not directly contribute to Baby J's death, it could not be ascertained whether the its involvement with the family may have resulted in a different outcome for the baby.
She said a review team noted that there were "missed opportunities to intervene with the family, which may have created increased safety'' for Baby J.
In early 2015, Baby J was admitted to Gold Coast University Hospital and diagnosed with bronchitis.
Eleven days later, Baby J, who was well and happy, was put to sleep with a sibling in a makeshift bed of two sofa lounges pushed together.
Later that night the baby's father went to sleep with his face and chest facing Baby J, on the sofa chairs.
The next morning the baby was found unresponsive, paramedics were called and unsuccessfully attempted CPR and he was pronounced dead.
Police found drugs and ice pipes, in the house and the father said he had removed a pillow from Baby J's face when he was woken by the mother.
Police identified factors that increased the risk of SIDS death, including bed sharing, sleeping on two couches put together and sleeping with a smoking and drug-using parent.
The department was aware that the father had been jailed for domestic and family violence, the mother had psychiatric issues and neither believed in immunisation.
An investigation and assessment commenced in 2013 and the department received three child concern reports after Baby J's birth, with no action taken.
In September, 2014, the department was told the father was using drugs, screaming at the children and had assaulted their mother and grandmother.
A review team found the department inappropriately found there was nothing to suggest the children were at unacceptable risk of harm.
Ms Bentley said it was known that the family was transient and avoided child services and that indicated probable risk of neglect and physical and emotional harm of the children.
The review team identified a number of missed opportunities for more meaningful intervention with the family.
A child death case review panel found risk to the family as a result of the father's violence and drug use should have been investigated.
The family had moved from place to place and not enrolled their children in schools.
"It is of significant concern that there continues to be no system in Queensland, or nationally, for tracking children from birth to school and through school,'' Ms Bentley said.
"This omission leaves vulnerable babies and children at risk of undetected abuse, neglect and homicide.''
Originally published as Baby died next to drug-using dad: Horror child safety fail