Infants and toddlers are newest victims of Canada's deadly fentanyl crisis

Twenty-month-old Amelia liked to play with zippers.

One February morning in 2019, the toddler woke when her mother returned to the bed the two had been sharing in a rented room in a Kitchener, Ont. home. Amelia didn’t have her own crib.

It was around 10 a.m. Her mother had just used drugs in the bathroom, and then slipped a baggie with what was left of the blue-coloured substance inside a zipper pocket on the front of her sweater. She thought the opioid in her possession was fentanyl. Later testing determined it was, in fact, carfentanil, a fentanyl cousin 100 times more potent than fentanyl that vets use to tranquilize very big animals.

She’d used earlier, at 2 a.m., while her young daughter slept. With Amelia now awake, she put on an Elmo video, pulled out a puzzle for her daughter to play with and then fell back asleep.

When she woke a few hours later, her toddler was lying on top of her, her body limp, her lips blue. T here was a wet baggie on the bed and, near the baggie, a baby’s soother.  

Her screams for help alerted others in the house, who called 911. Despite life-saving attempts by first her mother then first responders, Amelia was pronounced dead in hospital at 1:30 p.m. that day.  

Her right hand was stained blue.  

Amelia was one of at least 26 infants, pre-schoolers and kindergarteners who have died from opioid overdoses in Ontario since 2017, most from fentanyl toxicity and most in their own homes, poisoned by their parents’ drugs.

A recently published review found 10 fatal opioid poisonings in children under 10 in Ontario over a four-year span, from 2017 to 2021. The youngest was nine months old, the oldest, three months shy of turning five.   

All 10 had previous child protection services involvement. At least seven came from households with prior police involvement.

“Yet still these deaths occurred,” lead author Dr. Michael Rieder, a pediatrician and professor at Western University’s Schulich School of Medicine and Dentistry in London, said in a statement.  

In the years since his team’s study stopped, at least 16 more children in the same age group — under 10 — have died from opioid poisoning in Ontario, according to data provided to National Post by Ontario’s chief coroner, Dr. Dirk Huyer.  

The loss of an innocent child’s life from an opioid overdose, preventable deaths that, in some cases, have led to manslaughter charges, isn’t a tragedy unique to Ontario: Alberta recorded 11 fatal opioid poisonings in children under 10 between 2017 and 2024. In Saskatoon, a 16-month-old baby and both her parents died from suspected drug toxicity over the span of just six months in 2023, the CBC reported.   In Winnipeg, three children — a three-month-old and two one-year-olds — died of fentanyl related overdoses in 2022 and 2023, according to the public broadcaster.    

British Columbia’s Coroners Service was still compiling statistics on child opioid poisonings in response to a request from National Post at deadline.

However, in March, a five-year-old was hospitalized after apparently overdosing on fentanyl at a home in Mission. The child was in the bathtub when she handled a jar containing fentanyl, “and began exhibiting signs of distress soon afterwards,” Mission RCMP said. The adults in the home called 911 after her breathing changed and she began vomiting   

Paramedics needed multiple doses of naloxone to revive her.   

A 42-year-old Sault Ste. Marie man is currently facing manslaughter charges in a case involving a fentanyl overdose of a child in September 2023. 

“Societies get judged by how they take care of their kids,” Rieder said in an interview. “This is not a good judgment on us.”  

His research team’s results are unique since they found child welfare services were involved with every case prior to the child’s death. By comparison, one U.S. study of 731 fatal drug poisonings in children five and under across 40 states found only one-sixth had an open child protection service case at the time of death. In that study, opioids accounted for nearly half of the deaths.   

Often the prevailing sentiment among social workers is that a child’s best place is with the family, said Rieder. “As a pediatrician of 38 years, I beg to differ,” he said.    

“I think it’s usually with your family … In many cases, sadly it is not.”    

While adults account for most fentanyl and other opioid-related deaths, an average of 20 a day in Canada last year, the “staggering effect” on pediatric mortality — child deaths — has been overlooked and neglected, Rieder and his colleagues reported.  

Fentanyl kills babies and young children the same way it kills adults.  

Like all opioids, the drug acts on the body’s central nervous system, causing sedation and euphoria. In sufficient doses, it also slows breathing and heart rate. As breathing slows, the body’s cells become stressed from lack of oxygen and a buildup of carbon dioxide. “Eventually the heart just packs it in and says, ‘Enough is enough. I’m going to stop,’” Rieder said.   

“The opiate puts you to sleep and convinces your brain to stop breathing.”    

The difference is that it takes just a trace amount of ingested fentanyl to kill a young child.    

“It doesn’t take much,” Rieder said. “It doesn’t take gram quantities to do it.”   

For their study, his group used anonymized data from the Office of the Chief Coroner of Ontario, relying on case notes to try to understand the circumstances surrounding the deaths to “better the potential for intervention” and keep more kids from dying, the authors wrote in the June issue of Pediatrics & Child Health, the flagship journal of the Canadian Paediatric Society.   

The case notes, however, provide only a broad overview, and are as brief as they are heartbreaking: 

An 11-month-old was found without vital signs — pulseless — under a living room table.  Plastic baggies and drugs were found on the scene.  

An infant was discovered “fully unresponsive by mom” on a mattress on the floor where the two had been sleeping at a friend’s house. White powder and syringes were scattered about.    

A toddler fell asleep in a bed shared with two older siblings. During the night, a sister noted the toddler’s “stiffening and eyes rolling back.” A parent and two other adults in the house had used heroin the night before.    

A caregiver woke from a nap with a baby and found the infant with “cyanosis,” blue from lack of oxygen. There was vomit in the bed. Police found a bag of fentanyl outside the bedroom.   

In Amelia’s case, a scrap of tinfoil with drug residue was found in her car seat cupholder.

Her father had been arrested on drug charges days before her death. Her mother had stopped using and had stayed clean for several years after she became pregnant with Amelia, even contacting family services herself during her pregnancy for help to stay sober, but then relapsed into daily fentanyl use weeks before Amelia died. A family member had contacted local family and children’s services, but both parents denied she was using again. “Further attempts” to schedule visits became difficult when the mother failed to respond, court heard. Contact was eventually made, and a home visit scheduled for the day Amelia died, but her mother left a voice message at 5:50 a.m. that morning, cancelling the visit.

Both fentanyl and carfentanil were found in Amelia’s blood.

The mother, who had been sexually abused by an uncle when she was a child, went into foster care at 12 and started using crack cocaine at 14,  pleaded guilty to criminal negligence causing death. In December 2019, she was sentenced to four years less time served.

“No sentence will bring Amelia back, but the sentence imposed must reflect that a young life has been lost in these tragic circumstances,” Justice Melanie Sopinka said in delivering her decision.    

Fentanyl alone, or in combination with other drugs, was the primary drug of toxicity in the Western study. In most cases, fentanyl was found in the child’s play or sleeping area. A common narrative was that the child was found unresponsive after being put down for a nap.  

With opioid poisonings, children can look sleepy at first.    

In the case of the youngest infants, drug powder may have contaminated baby formula, Rieder said.   

“With opioid overdose, you don’t die right away — I think they put the baby down, thinking it was going to be OK, they went to sleep and woke up, and everything wasn’t OK.”    

Historically, prescription meds caused most childhood opioid deaths, said the study’s first author, Dr. Katrina Assen, a pediatrician at the Alberta Children’s Hospital in Calgary. “Now we’re switching to fentanyl.”  

Seven children in their study were white; three were Indigenous. The households were often small, cluttered, untidy and disorderly. There were often a lot of people living in them — five on average. The mean age of the children that died was just under two, an especially “exploratory age,” the authors wrote. When kids transition from age two to four, they “climb anywhere and eat everything,” Rieder said.  

As a former foster parent, Rieder said he knows from his own experience that child protection services are under-resourced, over-stressed and facing a scarcity of foster families. “I think because of resource constraints children are often in situations in which they might be potentially in harm’s way,” he said.   

Half the deaths his group found were classified as accidental; for the other half, the manner of death was deemed “undetermined.”   

“When you have an unexplained drug toxicity in a child, you just can’t always say whether it got into them accidentally because of something somebody did or was there intentional provision of that substance to the child,” Huyer, Ontario’s chief coroner, said.    

“It’s very difficult to answer those questions at times.”   

Addiction is a horrible disease, Rieder said. “It wires you badly. People in drug-using homes, in drug-using circumstances, make decisions that do not seem rational. They do it because the addiction drives them,” he said.     

“In homes where there are drug users and kids, I think (child protection services) need to consider these facts when making decisions. … We have to make some decisions that are unpleasant.”   

Should drug-associated material be found in a household, “action by CWS (child welfare services) workers should be taken forthwith,” and at a minimum require education on safe drug storage “and follow up visits to ensure that these steps are put into place,” Rieder and his co-authors wrote.    

In a statement to National Post, the Ontario Association of Children’s Aid Societies said if a report of neglect or abuse is received, the first step is assessment of safety concerns and to identify potential risks to children in the home.   

“ If concerns are identified, CAS’s will work with the caregivers to create safety/mitigation plans and monitor these until the risk is reduced to a level (where) child protection intervention is no longer required,” the statement said.   

“For substance use issues, these plans could be a number of things along a continuum of intrusiveness, spanning from harm-reduction strategies to removal of children from the home and other legal intervention.”    

National Post      

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