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Boy, 4, dies after getting head stuck in homemade double stair gate
25 January 2022, 19:10
A four-year-old boy died after he got his head stuck in a homemade double stair gate, an inquest has been told.
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Draco Chapman died on April 23, 2019, weeks after becoming stuck between two stair gates that had been fitted one above the other in a door frame by his mum, Rachel Chapman, at their home in Norwich, Norfolk.
The four-year-old was found injured on April 2 by one of his older siblings, having got stuck in a gap of about six inches between the two stair gates as he tried to climb over, an inquest at Norfolk Coroner's Court heard on Tuesday.
He was taken to Norwich and Norfolk Hospital where he was placed in an induced coma before being transferred to Addenbrooke's Hospital, in Cambridge, and later a hospice, where he died on April 23.
Draco's death was recorded as accidental by the coroner, who said: "The medical cause of death is catastrophic brain injury and asphyxiation by hanging.
"Draco became trapped by his neck while trying to climb over the lower stair gate and as a consequence of becoming trapped between this and the higher stair gate, this caused him to become asphyxiated and caused cardiac arrest."
The court heard that before his death, Draco had been diagnosed with a heart murmur and Noonan syndrome - a condition which can cause heart defects and developmental delays.
He was one of six children - who all lived with his mum - and was being looked after by an older sibling at the time of the incident while his mother was at a parents' evening.
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Sergeant Graham Green, from Norfolk Constabulary, told the court in a statement that Draco was found injured by his sister and was taken upstairs by an older brother who carried out CPR on him and called the emergency services before his mother arrived home.
He said that when he spoke to the oldest boy about the incident, he described Draco as "lifeless, peaceful and a sweet little boy".
Sgt Green added that as he spoke to the child in the living room, he noticed "Fruit Shoots and McDonald's" on the living room floor.
A statement by Ms Chapman, who was pregnant at the time of Draco's death, described how she arrived home to find what had happened.
"I returned home and expected it to be normal. My oldest child was on the phone to the ambulance screaming that he (Draco) had stopped breathing," she said.
"I went upstairs to do CPR and the ambulance staff arrived and took over."
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Ms Chapman said she had fitted the stair gates on top of one another to keep her children safe and to stop them climbing over it.
She added: "I was pregnant and agreed with the health visitor that I needed help and she made a referral to social services.
"I struggled but knew I needed help. My oldest would help with the children but I had to accept it had got out of hand.
"On April 2, I fitted the second stair gate to stop [the children] from getting out of the lounge and on to the stairs. I thought it would act as a door and keep them safe in the lounge.
"The bottom one didn't work as Draco used to climb over it."
Health visitor Helen Thompson told the court in a statement she had visited the family in March 2019 and noted Draco using a toy box to climb over the stair gate.
She said: "The house had a lot of dirty nappies outside the front door and in the living room there were scraps of bread on the floor.
"Draco dragged a bit of plastic to the gate and she said it was a piece of dismantled table which she took apart because the children were using it to climb over the stair gate.
"When we discussed the safety of the stair gate, I said the children need to be supervised to keep them safe."
A member of staff at the nursery Draco attended told the court in a statement that they had offered to help Ms Chapman after noticing his clothing was dirty, and replacements given to him had not been returned.
She said: "She said she had a huge pile of washing and couldn't get on top of it.
"I had a sense she was very tired and overwhelmed and offered her to bring bags into nursery so we could do it and it would be handled discreetly.
"She never took us up on that. I never had any doubt that she loved her children."
The nursery staff member said when she visited Ms Chapman after Draco's death she said she would do anything to turn back time.
Draco's mother is no longer caring for her other children, the court heard.