Four children under the age of 5 died of overdoses in Baltimore in 2023 — the smallest and least suspecting victims in an epidemic that remains unrivaled across major American cities.

Since 2020, 15 have died. All but two cases involved fentanyl, according to a Banner analysis of autopsy data obtained from the Office of the Chief Medical Examiner.

The epidemic’s young victims include Journey Sharp, a 2½-year-old girl who was found dead on Jan. 15, 2023, in the West Baltimore apartment where she lived with her mother.

An autopsy found multiple types of fentanyl in her system and said she had been “exposed to illicit drugs.”

Journey loved Baby Shark. The catchy tune about a family of friendly sharks was practically the toddler’s theme song. She could sing every word. She danced whenever she heard it.

At her funeral, two giant Baby Shark balloons floated feet from the tiny white casket where she lay in a light blue dress. Her hair was done in pigtails.

Members of Journey’s family are still seeking justice in her death, which authorities ruled a homicide. The investigation remains open.

Journey’s grandmother and aunt believe that Journey’s mother — their daughter and sister — is responsible for her death.

“I think [Journey’s mom] blames God for Journey dying, but the reality is that she’s responsible,” said Jennifer Stafford, Journey’s grandmother.

She and Rachell Portilla, Journey’s aunt, believe Journey’s mom left drugs in a place where Journey could get into them.

In May, The Banner and The New York Times reported that overdoses have killed nearly 6,000 people in the past six years, the worst overdose crisis ever seen in a major American city. The crisis has trickled down to claim some of Baltimore’s youngest lives.

A Banner analysis of autopsy data found that the number of children 5 and under in Baltimore who have died of an opioid overdose has grown higher over the last four years.

Minors who die of overdoses generally fall into two groups: teenagers who experiment with recreational drugs and toddlers who inadvertently consume them, said Brian Schultz, a pediatric emergency physician at Johns Hopkins Children’s Center.

After the four children under the age of 5 who died in Baltimore in 2023, the next-youngest overdose victim was 17.

For the youngest children, who tend to “grab everything, put everything in their mouth,” the dangers are especially high, Schultz said. If even a “very small amount” touches a child’s hand, and they go on to touch their mouth, “that’s all it’s going to take.”

Experts point to fentanyl’s growing presence in drugs for driving the increase in child overdose deaths in Baltimore and nationwide.

Before 2020, a child 5 years old or younger had never overdosed from fentanyl in Baltimore City. Since then, 13 of the 15 overdoses involved fentanyl.

That number could be higher because fentanyl is so potent. Some autopsies, Schultz said, might list another opioid as the cause of death even if the victim died from a small amount of fentanyl that was also present.

The number of teens overdosing has drastically increased even though drug use among teens is down, according to Dr. Stephen Sandelich, a pediatric emergency medicine physician at Penn State Health Children’s Hospital. His research focuses on adolescent substance use and the mental health effects. He said fentanyl is the most likely reason that mortality rates are on the rise.

“This is a signal that we’re seeing that this problem is trickling down and affecting children [of all ages],” said Dr. Christopher Gaw, a pediatric emergency physician at Nationwide Children’s Hospital.

These children, he said, are “unintended casualties of the opioid epidemic.”

Gaw led a study on a national level that examined 731 fatal poisonings among young children that occurred between 2005 and 2018 in 40 states. His team found that opioids have become the most common agent in poisoning death in the country.

In Maryland, the number of teens 13 to 17 who died has increased from four in 2014 to 19 in 2023.

The only way to prevent child overdoses is to reduce opioid addiction through community-wide harm reduction strategies, Gaw said. This could range from initiatives that encourage safe storage of substances, keeping more naloxone on hand and linking people with medication-assisted treatment.

Journey’s case, like many others, is complicated.

Journey’s mother has long struggled with heroin addiction, Portilla said. Journey’s father is serving a prison sentence for assault.

In the months before the toddler’s death, Portilla began to notice “dark rings” around her sister’s eyes, evidence, she thinks, of the strain of being a single mother struggling with addiction who worked full-time as a delivery driver.

When asked if cases of negligence are ever ruled as homicides, the Chief Medical Examiner’s Office said that it depends on the medical examiner’s opinion and discretion.

A spokesperson for the Baltimore state’s attorney declined to comment on the open investigation into Journey’s death.

Neither Portilla nor Stafford has spoken with Journey’s mother since the funeral, although they have spotted her walking around West Baltimore. Dark rings still encircle her eyes, they say.

Journey’s mother could not be reached for comment.

To keep Journey’s memory alive, Portilla got a tattoo on her left arm: a cartoon baby shark, Journey’s name inscribed above its head. She and Stafford have vowed to release Baby Shark balloons every year on her birthday.

Portilla also encased Journey’s ashes in two heart-shaped necklaces — one for each of Journey’s parents.

But the necklaces still sit in Stafford’s bedroom, untouched.