Sudden death of toddler in Dublin caused by multiple factors, including sedative effect of antihistamine

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 April 11th, 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.

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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 postmortem 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 on Tuesday 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 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.

She said Carson had eventually fallen asleep at about 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 about 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 her client provided Tusla with consent forms to allow Carson to be vaccinated.