Determining a SIDS death

Medical and legal experts rely on three methods to determine a SIDS death:
1. a thorough death scene investigation
2. autopsy
3. review of infant's and family's medical records and histories.

When a death is sudden and unexplained, investigators, including medical examiners and coroners, call on forensic experts, who apply their expertise in medicine and the law to help determine a cause of death. SIDS is no exception.

In most cases, the death investigation is led by the medical examiner or coroner for the county, district, or State in which the death occurred. Deaths suspected to be SIDS usually require law enforcement officers to conduct a thorough death scene investigation. The medical examiner/coroner gathers information from the death scene and case histories and presents this information to the pathologist (usually board certified or with credentials in forensic pathology). The pathologist conducts or supervises the autopsy and assesses results of the autopsy, death scene investigation, and case histories to determine whether a SIDS death has occurred. The pathologist issues a SIDS diagnosis when there is no other apparent cause for the infant's death (Valdes-Dapena, 1995).

1) A Thorough Death Scene Investigation
Although it may be emotionally painful for the family, a death scene investigation will help shed light on the cause of death by providing a detailed record of the location and circumstances of the death. Therefore, the investigator will attempt to learn as much as possible about the events leading up to the death, even the very moment that the death occurred.

The Centers for Disease Control and Prevention (CDC) have developed guidelines for death scene investigation of a sudden, unexplained infant death (CDC, 1996). Local jurisdictions may use these guidelines or develop their own protocols for investigating sudden unexpected infant death.

Investigators will interview the parent or other individual who was caring for the child at the time of the death, as well as any other family members or adults who were present at the time of the death or before the death occurred. The investigator will ask openended,

neutral questions such as, "Can you tell me what happened?" "How old was the baby?" "What did the baby weigh?" "What time was the baby put to bed?" "When did the baby fall asleep?" "Who last saw the baby alive?" "Who discovered the baby, and what did that person do?" "What position was the baby in when he/she was found?" "Were there covers over the baby's head?" "Was CPR attempted?" "Did the baby share a bed with anyone else?" "What was the general health of the baby?" "Had the baby been ill recently?"

The individual investigating the death will take notes about the appearance of the room where the death occurred; condition and characteristics of the crib or sleeping environment; objects, if any, in the crib; medications at the death scene; and any unusual or dangerous items in the room, such as sharp objects or plastic bags. The investigator may make notes about the behavior of those present at the death scene. The investigator will also photograph the death scene and record the temperature of the room. It is likely that investigators will collect the infant's bedding (e.g., sheets, blankets, etc.), any objects in the crib (e.g., toys or bottles), or any unusual or dangerous items found near the death scene.

2) Autopsy
An autopsy provides evidence of the cause of death through microscopic examination of tissue samples and examination of the body and vital organs. An autopsy is particularly important when a SIDS death is suspected because a definitive diagnosis cannot be made without a thorough postmortem examination. It is estimated that in 15 percent of cases suspected to be SIDS, the autopsy identifies another cause of death, such as a disease or genetic disorder, as well as unintentional injury or unnatural death (Valdes-Dapena, 1995). Also, if a cause (or causes) of SIDS is ever to be uncovered, it is likely that the cause will be detected from evidence gathered from a thorough pathological examination.

An autopsy may help parents and other caregivers deal with the death. According to noted authority Marie Valdes-Dapena, M.D., parents whose child has died need to know why the death occurred; they need to be reassured that their baby's death could neither have been predicted nor prevented (Valdes-Dapena, 1995). Moreover, an autopsy leading to a diagnosis of SIDS will help remove the parents (or caregiver) from potential suspicion of wrongdoing by the legal system and by society in general.

Parents are usually anxious to consult with the pathologist after the autopsy. Discussing the autopsy results often helps most parents accept the reality of their infant's death. The pathologist reviews the autopsy results, explaining in terms the parents can understand how these findings point to a determination of cause of death. The pathologist should also take the time to answer parents' questions, responding with "compassion, understanding, and respect for the parents' dignity and grief" (Valdes-Dapena, 1995).

3) Review of the Infant's and Family's Medical Histories
A comprehensive medical history is essential for a SIDS diagnosis. Along with a death scene investigation and an autopsy, a careful review of the infant's and family's history of disease, previous illnesses, accidents, and behaviors often helps to corroborate what is detected from the death scene investigation and the autopsy.