What is Sudden Infant Death Syndrome? (SIDS)

The sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.

Sudden Unexplained Infant Death Investigation  "SUIDI"

5200 Sudden Unexpected Infant Deaths in the United States per year:

               53% are SIDS or SUIDI

               14% Asphyxia

               10%Infection

                  8% Unexplained (not SIDS)

                  7% Homicides

 

Reporting Guidelines of

Sudden Unexplained Infant Death Investigation

involve the following:

Sleeping Environment:

     Asphyxia

     Sharing sleep surfaces

     Change in sleep conditions

     Hyperthermia/hypothermia

     Environmental hazards (CO, chemicals, etc)

     Unsafe sleeping condition

Infant History

     Diet

     Recent hospitalizations

     Previous medical diagnosis

     History of acute life threatening events

     History of medical care without diagnosis

     Recent fall or other injury

     History of religious, cultural, or ethnic remedies

     Cause of death due to natural causes other than SIDS

Family Information

     Prior sibling deaths

     Previous encounters with police or social service agencies

     Request for tissue or organ donation

     bjection to autopsy

Examination

     Pre-terminal resuscitative treatment

     Death due to trauma (injury), poisoning, or intoxication

Investigator Insight

     Suspicious circumstances

     Other alerts for pathologist’s attention

     Description of circumstances (what happened?)

 

Who speaks for the Child?

     Law Enforcement

     Prosecuting Attorney

     Emergency Medical Services

     Coroner’s Office

     Children and Family Services

     Pediatricians

     Emergency Room Staff

Case Example:

Deputy John Jones arrived at the scene and was met by Police Officers who escorted him to where the infant was found to be unresponsive by the mother.  The child was supine in a wooden crib - the bedding was consistent - a mattress and at least one sheet of unknown fiber.

Examination of the body found the child to be clothed in a simple shirt, disposable diaper and a jumper with the decedent’s right arm out - extended upwards and away at a rough angle of 120 degrees.  The infants face was observed to be blanched on the left forehead, cheek, mid and left mouth, chin, and noses.  Light purple colored lividity was present on the right side of the face with sparing noted in the left peri-orbital cavity.  The lividity appeared fixed, and potentially consistent with child spending some of the post-mortem interval in a supine position.  The child was found face down by the mother.  An EKG pad was seen on the right chest.

The 3-month old infant was last scene alive during a 2200 hours bottle feeding by the mother, who says she returned the infant to the crib, positio being on his back.  Police dispatch say the child was discovered at 0730 hours, with our office contacted at 0745 hours.

Questions that would be asked by the Investigator:

• What was the child's past medical history, specific to gestational term, recent infection, or respiratory problems?
• Was anyone else home or could have seen the child between 10pm and 7:30am?
• Any recent colds or illness?  Has the child been feeding?
• Does the child have siblings?  Anyone else in the crib?
• Was there any other artifacts or items in the crib?  Any pets?
• Was there any other blankets, sheets, or clothing present at the time of discover?
• Can you describe more specifically how the child was found?  If I gave you a doll, could you replicate the position?
• Is there any chance the child could have fallen between the bedding and the crib?
• Did the child suffer any recent injuries or falls?
• Are there any medications or unused formula I could examine?

 

What items might be considered evidence?

• Collection of bedding, clothes, bottle, or any objects in the crib.  Photograph entire scene and room.
• Collection of medications and last oral intake like the bottle.
• Run report of first in EMS unit describing actions and changes to the scene.  Interview them if necessary
• Report of Law enforcement and initial contact report with child support services.
• Bring the crib if positional asphyxia is suspected or the crib is viewed in poor/unworking condition.

  

Why Do We Speak for the Child?

• Justic: Guilty are prosecuted and the innocent are exonerated
• Prevention: Educating the community
• Closure: For the family’s understanding and healing
•  

How Will We Speak for the Child?

Interviewing witnesses

• Entry - Questions concerning the history of events that took place prior to the death, such as: Recent Contacts, Activities and Behaviors.
• Event - The last few days leading up to the death, such as: Scene Temperature/Heating and Cooling Systems, General Scene appearance, sleeping room and general area, sleeping surface, bedroom furnishings, and poweerd appliances in sleep area.
• Exit - Before leaving the scene of the event, explain to the family or next-of-kin what has been done in the investigation and why.  Also, encourage family members to ask questions.

Doll Reenactment

Placer - re-enact and photograph location and position in which infant was placed        

 

Last Known Alive - re-enact and photograph location and position

Finder - re-enact and photograph location and position in which infant was found

The investigator would then photograph these positions in which the infant was found.  Once the photographs have been taken and checked, the investigator must focus on verifying the sleep environment.  Any pets and other animals that might have been present in the sleep environment should be documented as well.