By Sarah Ladd for the Kentucky Lantern, part of States Newsroom.
Broadcast version by Nadia Ramlagan for Kentucky News Connection reporting for the States Newsroom-Public News Service Collaboration

Easy access and exposure to guns and drugs are killing Kentucky children. 

That’s according to the Child Fatality and Near Fatality External Review Panel, which released its 2024 report last week. 

Kentucky toddlers — four years old and younger — are ingesting substances and dying at “an alarming rate,” the report found. 

Of the fatal overdose and ingestion cases the panel reviewed for 2023, most — 80% — were “potentially preventable,” according to the report. The majority of substances kids ingested in 2023 were opiates, including the powerful synthetic fentanyl. 

In one case, a 1-year-old ingested fentanyl and died. Officials who responded found a “bag of crystal methamphetamine in the bed where the child and mother were sleeping” and oxycodone, an opioid, in the closet. 

Dr. Melissa Currie, a Norton Children’s child abuse pediatrician and member of the panel, said ingestion cases in Kentucky’s children concern her because of “how sick the kids are getting and potentially dying.” 

“It’s getting worse,” she told the Lantern. 

The panel is also tracking a substance called xylazine, which was found in 5% of the cases. This non-opioid sedative or tranquilizer, mainly used in veterinary services, has been increasingly found in the heroin and fentanyl supply.

The Child Fatality and Near Fatality External Review Panel was created in 2012 to conduct comprehensive reviews of child deaths and serious injuries from abuse or neglect. The independent panel of physicians, judges, lawyers, police, legislators and social service and health professionals meets regularly to analyze such cases. It produces an annual report on its findings and recommendations for improvements. 

Among other recommendations, the panel says kids need substance screenings when getting medical care and the state needs to “conduct an aggressive public safety campaign targeting proper medication safe storage.”

The panel reviews just the “small portion” of cases that attract official attention, Currie pointed out. 

“We’re only reviewing those where someone had a concern for abuse or neglect, sufficient to, No. 1, call and make a report, and, for No. 2, (Child Protective Services) to actually accept it for investigation,” she said. “And so that automatically whittles down the number. So I think it’s really helpful to understand that the total numbers in the report are only a fraction of the kids that are actually … having ingestions of, if not illicit substances, then, at least, dangerous substances.” 

That includes, she said, some unregulated THC products purchased at gas stations and wrongfully assumed to be safe. 

“We’re seeing kids who are coming in, getting a hold of what parents are, I think, reasonably assuming are legal substances — that should still be kept out of reach of children,” she said. “There’s no question about that.” 

Gun deaths — accidental and other

The panel once again is asking lawmakers and policymakers to find ways to encourage safe storage for guns to keep them out of the hands of children.

In 2023, the panel reviewed 12 cases of gunshot injury — 11 of which were fatal — involving children. Of those 12 incidents, nine were preventable, the report states. 

There were four cases of homicide, which means a caregiver was the shooter, four of suicide and four of accidents. The average age of children involved in gunshot suicide or homicide is 14 years. Accidents typically occur among children as young as 3. 

In all these cases, the report states, unsafe storage of guns was a risk factor. Rep. Kim Banta, R-Ft. Mitchell, filed a bill this year to hold parents civilly liable for unsafe storage of guns if minors in their care obtain access and cause harm. It’s been assigned to the House Judiciary Committee but has yet to get a hearing. 

In one case reviewed by the panel, a 7-year-old fatally shot his 4-year-old brother while playing with a .410 shotgun in a game of “cops and robbers.” The children regularly played with the gun, which was loaded and beside the refrigerator. 

While the number of children who died and nearly died from incidents involving guns has declined following the worst years of the COVID-19 pandemic (2020 and 2021), there are still more than in 2019. 

The decline itself is “hopeful,” the report says, but “it is important to note the panel has reviewed 79 firearm incidents in the last five years resulting in 54 deaths, and 25 near fatalities. The near fatalities often result in lifelong complications, including profound disabilities.” 

Those can include, Currie said, developing a limp, living with a brain injury from lack of oxygen, requiring a feeding tube, living life from a bed or in a wheelchair and more. 

“It can be devastating,” she said. “Widespread brain injury from lack of oxygen applies to our opioid ingestions as well. Those kiddos can stop breathing and suffer tremendous damage to their brain from the lack of oxygen over and above the damage that the drug itself is doing.” 

Education component is ‘huge’ 

How sick or injured a child will be from ingestion or gunshot depends on many factors, Currie with Norton said. Those include the type of substance, how much a child got, if they inhaled or ingested it, where they were shot and more. Some can become symptomatic within seconds, while others take hours. 

When it comes to drugs and substances, Currie said, “their outcome largely is dependent on someone recognizing that they may have had an ingestion” and getting them help quickly. Narcan, even if it’s expired, won’t hurt a child, she said. If a child is having trouble breathing, call 911. 

“If a caregiver … is on medication-assisted therapy for opioid use disorder — so, someone is taking buprenorphine containing products like suboxone or methadone — I highly recommend that all of those homes should have Narcan,” she said. “Narcan is never going to cause harm to a child.”

Parents and caregivers not fully realizing the lethality of drugs and guns is a “huge” issue, Currie said. 

“We know that some folks who are thick in the throes of addiction are not in a mental space to think about the wellbeing of others, including their children, who they may love very, very much, but not be capable of placing their safety as a priority due to the effects that addiction has on a person,” she said. “That’s one layer. The other complexity layer is that guns have, unfortunately, become a political issue. And so if education is provided in a way that is perceived as being political, then folks aren’t able to hear it and incorporate it and do the right things to keep their kids safe.” 

Panel policy recommendations

The 103-page report lays out a roadmap for improving the safety of Kentucky’s youngest citizens. 

Some of the recommendations made by the panel include:

• The Cabinet for Health and Family Services should convene a workgroup to create a standardized safe drug storage guideline for all providers and the public.


• The Department for Public Health should conduct an aggressive public safety campaign targeting proper medication safe storage and saturating these critical tools throughout Kentucky communities. The campaign should also encourage the use of fentanyl and xylazine testing strips and Naloxone in pediatric ingestions.


• The Department for Community Based Services should create a Practice Guidance Specific to Safe Storage of Medication.


• The governor’s office should convene a task force with the goal of developing and implementing a robust Plan of Safe Care to address the needs of substance-exposed infants and their caregivers.


• The Kentucky General Assembly, through the Judiciary Committee, should explore model legislative strategies to encourage and support safe storage of firearms. This would include Child-Access Prevention and Safe Storage Laws, funding for evidence-based prevention education and provision of gun locks with every firearm sold to give responsible gun owners the tools to securely store weapons. 


• The Child Abuse and Neglect Prevention Board should work collaboratively with community partners to fund and raise awareness regarding safe storage practices of firearms.

According to Currie, “the potential to make the problem better is huge if we educate the right people and we get the right policies in place, the right statutory language in place.”




Sarah Ladd wrote this article for the Kentucky Lantern, part of States Newsroom..


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Ohio's child care system is under strain and a new national report highlighted how Medicaid helps support the workforce behind early childhood care, especially in rural communities.

Medicaid provides critical coverage for child care providers, many of whom are low-paid and often go without employer-based insurance.

Brittany Boulton, vice president of the policy and advocacy organization Groundwork Ohio, said it is especially vital for rural families.

"Cuts to Medicaid would make these problems far worse and leave thousands of Ohioans and rural families without access to coverage and care," Boulton pointed out.

A report by the Georgetown University Center on Children and Family Studies said 30% of children in rural Ohio rely on Medicaid for health coverage, placing the state among the top 10 nationally for rural child enrollment.

National experts warned access to health care is essential not only for children but also for those who care for them.

Daniel Hains, chief policy and professional advancement officer for the National Association for the Education of Young Children, said there is a clear link between health coverage and workforce stability. He noted about 16% of early educators lack insurance and those who do have coverage are more likely to stay in the field.

"We need more highly qualified, well-supported, well compensated early childhood educators, with 25+ percent of early childhood educators relying on Medicaid for their own health insurance," Hains noted. "With the critical supports the program provides for their education and for the children and families they serve."

Ohio's child care sector has lost nearly 6,000 workers since the pandemic began and Groundwork Ohio said access to Medicaid helps retain educators in a field facing critical staffing shortages.

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A refundable child tax credit aimed at helping families with young children was proposed in Gov. DeWine's budget but was stripped out by the Ohio House.

Advocates said it is not too late for lawmakers to restore it and offer families some financial relief.

Lynanne Gutierrez, president and CEO of the advocacy group Groundwork Ohio, said the funding is critical.

"This is a really strong policy that acknowledges the needs of families," Gutierrez explained. "It won't solve everything but it is an almost billion dollar investment. So his largest, single largest investment in young children and families that has been proposed in his tenure."

If passed, the child tax credit would be Ohio's largest direct state investment in young children to date, providing up to $1,000 per child under age seven, at a time when more than eight in 10 Ohio parents said inflation is forcing them to cut back on groceries.

Opponents argued the state cannot afford it but polling by Public Opinion Strategies showed nearly five of six Ohio voters support a state child tax credit, including majorities across party lines, with more than four of five Republicans, nearly eight in 10 independents, and almost 95% of Democrats. Support grew even higher when respondents learned it had been supported by both Presidents Biden and Trump.

Guillermo Bervejillo, research manager for the Children's Defense Fund of Ohio, called it a bipartisan policy.

"Nearly 20% of children in Ohio are living in poverty currently," Bervejillo pointed out. "That's 470,000 kids. A refundable child tax credit would have directly put money into the hands of those most in need and who are taking care of children."

Supporters said the Senate now has a chance to restore it in the final budget version, due by July 1. They are encouraging families to contact legislators, write letters or attend a rally June 17 at the Statehouse in support of the credit.

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The lack of quality child care for infants and toddlers costs Colorado nearly $3 billion each year in lost earnings, productivity and revenue but an initiative in Mesa County shows what is possible when local governments, businesses and civic groups team up.

Keller Anne Ruble, client success manager for the software firm BridgeCare, said officials saw huge demand for child care in the town of Clifton, but no providers. So they built a new facility that provides child care and also trains new caregivers.

"So that they can meet the needs of working families and invest in their early care workforce pipeline," Ruble explained. "And because of that investment, they now have 270 seats at this child care center, and they've completely eliminated their child care desert."

Budgetary constraints imposed by Colorado's Taxpayer Bill of Rights make it much harder for the state to invest tax revenues in initiatives such as the one in Clifton. The state also recently froze enrollment in the Colorado Child Care Assistance Program. Over the past 15 years, Colorado's economic growth has dropped from fifth in the nation to 41st, according to the 2025 Colorado University Leeds School of Business report.

Half of Colorado parents said they have quit jobs, worked fewer hours and taken unpaid time off. In 2023, more than 10,000 moms left the workforce, all because of a lack of child care.

Ruble emphasized when the cost of child care is too high, many parents just cannot afford to go to work.

"Families across the country are spending up to 60% of their income on child care," Ruble pointed out. "That's equivalent to a second mortgage or a second rent payment."

Children younger than age 3 are experiencing one of the most crucial periods of brain development and Ruble stressed investing in quality care is important for their long-term health.

"When young children have high-quality, enriching early experiences with trusted caregivers, it sets them on a strong foundation for growing, flourishing into thriving adults that contribute to our workforce and our society," Ruble asserted.


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