Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) is the "sudden death of an infant under one year 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" (Willinger, M., et al., "Defining the Sudden Infant Death Syndrome (SIDS): Deliberations of an Expert Panel Convened by the National Institute of Child Health and Human Development," Pediatric Pathology 11:677-684, 1991). SIDS is unexpected, usually occurring in apparently healthy infants ages 1 month to 1 year. Most deaths from SIDS occur by the end of the sixth month, with the greatest number taking place between ages 2 and 4 months. SIDS is the leading cause of death in the United States among infants between the ages of 1 month and 1 year, and is second only to congenital anomalies as the overall leading cause of death for all infants under 1 year of age (National Sudden Infant Death Syndrome Resource Center, 1993).

In sudden, unexplained infant deaths, investigators, including medical examiners and coroners, use the special expertise of forensic medicine (the application of medical knowledge to legal problems) to arrive at a diagnosis. A definitive SIDS diagnosis cannot be made without a thorough autopsy—including microscopic examination of tissue samples and vital organs—that fails to point to any other possible cause of death. Also, if the cause of the infant's death is ever to be uncovered, it will be from evidence gathered during a thorough pathological examination. Often, the cause of an infant's death can only be determined by carefully collecting and evaluating information from the death scene and conducting forensic tests. Investigators should also carefully review the child's and child's family's history of previous illnesses, accidents, or behaviors. Review of these details may further corroborate what is detected in the autopsy or death scene investigation. Investigators should be sensitive, yet thorough. Criteria for distinguishing SIDS from death caused by child abuse are presented in table 3. The following is a list of key points relative to SIDS:

• SIDS is a diagnosis of exclusion following a thorough autopsy, death scene investigation, and comprehensive review of the child and his or her family's case history.
  
  
• SIDS is a definite medical entity and is the major cause of death in infants after the first month of life, with most deaths occurring between the ages of 2 and 4 months.
  
  
• SIDS victims appear to be healthy prior to death.
  
  
• SIDS currently cannot be predicted or prevented, even by a physician.
  
  
• SIDS deaths appear to cause no pain or suffering; death occurs very rapidly, usually during sleep.
  
  
• SIDS is not child abuse.
  
  
• SIDS is not caused by external suffocation.
  
  
• SIDS is not caused by vomiting and choking or by minor illnesses such as colds or infections.
  
  
• SIDS is not caused by the diphtheria/pertussis/tetanus (DPT) vaccine or other immunizations.
  
  
• SIDS is not contagious.
  
  
• SIDS is not the cause of every unexplained infant death.