 Responding to a Sudden, Unexpected Infant Death:
The Professional's
Role
Introduction
Parents and families who experience the sudden,
unexpected, and unexplained death of an infant are faced with
an enormous sense of loss, sorrow, and confusion. Immediately
after the baby's death and in the weeks
and months that follow, parents, other family members, and
caregivers will interact with many health and social service
professionals. Some of these individuals—police,
fire, rescue squads, and emergency medical technicians—respond
to the emergency call for help. Others—emergency
room doctors and nurses, medical examiners, pathologists, and
coroners—try to find out why the baby died.
Still others—funeral directors, clergy,
public health nurses, and bereavement counselors—are
there to help the parents and other family members get through
the sad and difficult days that follow the death of an infant.
It is not surprising that at times, having to deal with these
individuals can be quite overwhelming. This fact sheet provides
a brief overview of the various professionals involved when
a sudden infant death occurs, as well as their responsibilities
and how these professionals can help.
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First on the Scene
When a parent or caregiver finds an unresponsive
baby, he or she usually phones "911"
for help. Most often, the first responder is a police officer,
firefighter, or other emergency medical services personnel—sometimes
all three. Whoever arrives first will examine the baby and
may start cardiopulmonary resuscitation. They also examine
the baby's surroundings and take notes that
help in determining the cause of death. Bedding, potentially
hazardous objects, medicines, formula, and other items may
be collected. Depending on the community, the infant may be
transported to the nearest hospital emergency department or
remain at home until the medical examiner or coroner arrives.
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At the Hospital
When efforts to revive the infant are unsuccessful,
emergency room staff (usually a doctor or nurse) is responsible
for telling the parents and/or family members that the baby
has died. Because the death is such a devastating event, nurses
and/or special counselors at the hospital often provide emotional
support and guidance.
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Autopsy
In many communities, the law requires an
autopsy in cases of sudden and unexpected death. Although it
may be emotionally difficult for parents, an autopsy may help
answer questions about what caused the baby's
death. An autopsy is very important when a sudden infant death
syndrome (SIDS) death is suspected because a final diagnosis
cannot be made without a thorough postmortem examination.
Some ethnic and religious groups forbid autopsies.
In these situations, the family may wish to talk with their
clergy, spiritual leader, or a mental health counselor. These
individuals may be able to help the parents and other family
members reconcile the need for an autopsy with their cultural
beliefs, values, and practices.
In most cases of sudden, unexpected infant
death, the cause and manner of death are determined by the
medical examiner or coroner for the county, district, or State
where the death occurred. The autopsy is conducted or supervised
by a specialist (pathologist) who reviews the medical aspects
of the death. If possible, parents are notified of the preliminary
autopsy results within 24 to 48 hours of the death. Once the
autopsy report is available, the doctor should explain the
results of the autopsy to the family, often reassuring them
that the baby's death could not have been
predicted.
Sudden Infant Death Syndrome is the sudden death
of an infant under 1 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 (Willinger et al., 1991).
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Death Scene Investigation
Staff from the medical examiner/coroner's
office or law enforcement agency will collect information about
the location and circumstances at the time of the infant's
death. The investigator will try to learn as much as possible
about the events leading up to the death—even
at the very moment the death occurred. The investigator will
interview individuals who were caring for the baby. Some typical
questions that are asked include, "What
time was the baby put to bed?" "Had
the baby been ill recently?" "When
did the baby fall asleep?" "Were
the covers over the baby's head?"
Answers to these questions will help investigators
find out what happened when the baby died, hopefully shedding
light on the cause of death. It is very important to remember
that the investigator is not trying to blame anyone for the
baby's death, but is simply trying to determine
how the baby died.
Coroner
A coroner is an appointed or elected public official in a particular
community, county, or region. The coroner is responsible
for making inquiries into certain types of deaths but does
not have to be a physician. The coroner verifies the cause
of death and may employ physicians, pathologists, or forensic
pathologists to perform autopsies.
Medical Examiner
A medical examiner is the physician responsible for the investigation
and examination of victims whose deaths are sudden, unexpected,
or violent. The medical examiner is expected to use his or
her medical training and expertise to evaluate the medical
history, circumstances of the death, and autopsy examination.
Pathologist
A pathologist is a physician specially trained in diagnosing
disease and determining the cause of death by laboratory
examination of body fluids, cell samples, and tissues. Usually,
the pathologist (or forensic pathologist) conducts the autopsy.
Forensic Pathologist
A forensic pathologist examines victims whose deaths are sudden,
unexpected, or violent. The forensic pathologist is an expert
in determining cause and manner of death.
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The Days Ahead
Sudden, unexpected death—especially
the sudden, unexpected death of an infant—strikes
at the heart of everyone's sense of order
and security. The grief and sorrow felt by the parents, other
family members, friends, and other caregivers are normal responses
to the death. It can take a long time for the family to regain
the desire and energy to move on.
Some communities have responded to these
challenges by developing an outreach program for families whose
baby has died suddenly and unexpectedly. These programs provide
professional case management, counseling, referral, and support
services. In some locales, a community health nurse, social
worker, or trained community outreach worker visits the family
in their home. In some States, the program works with the medical
examiner or coroner, contacting the family immediately after
the death. Families can contact their local health department
about these types of services in their community.
During the grieving process, a mental health
professional (psychiatrist, social worker, psychologist, or
grief counselor) can help the parents and family express feelings
that need to be released. These professionals can answer questions
and help parents cope with the changes in their lives caused
by the loss of their child. Some families may seek the help
of their clergy, specially trained pastoral counselors, or
other spiritual guidance.
For More Information,
Please Contact
National SIDS/Infant Death Resource Center
(NSIDRC)
8280 Greensboro Drive
Suite 300
McLean, VA 22102
Phone: (866) 866-7437
Phone: (703) 821-8955 (local)
Fax: (703) 821-2098
Email: sids@circlesolutions.com
http://www.sidscenter.org
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Other Resources
American Board of Medicolegal Death Investigators
Room 512
1402 South Grand Boulevard
St. Louis, MO 63104
Phone:(314) 268-5970
Fax: (314) 268-5695
http://www.slu.edu/organizations/abmdi
Association of SIDS and Infant Mortality
Programs (ASIP)
8280 Greensboro Drive
Suite 300
McLean, VA 22102
Phone (800) 930-7437
Fax: (703) 902-1230
http://www.ASIP1.org
The Compassionate Friends
PO Box 3696
Oak Brook, IL 60522-3696
Phone: (877) 969-0010
http://www.compassionatefriends.org
First Candle/SIDS Alliance
Suite 210
1314 Bedford Avenue
Baltimore, MD 21208
Phone: (800) 221-7437
http://www.firstcandle.org
MISS: Mothers in Sympathy and Support
PO Box 5333
Peoria, AZ 85385-5333
http://www.misschildren.org
National Association of Emergency Medical
Technicians
PO Box 1400
Clinton, MS 39060-1400
Phone: (800) 34-NAEMT
http://www.naemt.org/
National Association of Medical Examiners
430 Pryor Street SW
Atlanta, GA 30312
Phone: (404) 730-4781
Fax: (404) 730-4420
http://www.thename.org/
National Funeral Directors Association
13625 Bishop's Drive
Brookfield, WI 53005
Phone: (800) 228-6332
http://www.nfda.org/
National SIDS & Infant Death Program Support
Center (NSIDPSC)
Suite 210
1314 Bedford Avenue
Baltimore, MD 21208
Phone: (800) 221-7437
Fax: (410) 415-5093
http://www.sids-id-psc.org
National Fetal and Infant Mortality Review
Program (NFIMR)
PO Box 96920
Washington, DC 20090-6920
Phone: (202) 863-2587
Fax: (202) 484-3917
http://www.acog.org/goto/nfimr
SHARE Pregnancy and Infant Loss Support,
Inc.
National Share Office
St. Joseph Health Center
300 First Capitol Drive
St. Charles, MO 63301-2893
Phone: (800) 821-6819
Fax: (636) 947-7486
Email: share@nationalshareoffice.com
http://www.nationalshareoffice.com
References
Association of SIDS and Infant Mortality
Programs. (2001). The Unexpected Death of an Infant or
Child: Standards for Services to Families. Minneapolis,
MN: Association of SIDS and Infant Mortality Programs.
Arnold J, McClain ME, Shaefer SJM. (1997). "Reaching
Out to the Family of a SIDS Baby." In: Woods,
JR and Woods, J.L.E. (Eds), Loss During Pregnancy or the
Newborn Period. Pitman, NJ: Jannetti Publications, Inc.
Centers for Disease Control and Prevention. "Guidelines
for Death Scene Investigation of Sudden, Unexplained Infant
Deaths: Recommendations of the Interagency Panel on Sudden
Infant Death Syndrome." Morbidity and Mortality
Weekly Report, 1996; 45 (No. RR-10).
Horchler J. (1994). The SIDS Survival
Guide: Information and Comfort for the Grieving Family and
Friends & Professionals Who Seek to Help Them. Hyattsville,
MD: SIDS Educational Services.
National Association of Medical Examiners. "So,
You Want to be a Medical Detective?" http://www.thename.org .
National Institute of Child Health and Human
Development. (June 2001). Targeting Sudden Infant Death
Syndrome (SIDS): A Strategic Plan. Rockville, MD: U.S.
Department of Health and Human Services, National Institutes
of Health.
Valdes-Dapena, M. "The
Postmortem Examination." Pediatric Annals, July
1995; 24(7): 365-372.
Willinger M, James LS, and Catz, C. "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,
September-October 1991; 11(5): 677-84.
This publication was produced by the
National SIDS/Infant Death Resource Center (NSIDRC)
8280 Greensboro Drive
Suite 300
McLean, VA 22102
Phone: (866) 866-7437, (703) 821-8955
E-mail: sids@circlesolutions.com
http://www.sidscenter.org
The NSIDRC is funded under contract to Circle
Solutions, Inc., with the Maternal and Child Health Bureau
(MCHB), Health Resources and Services Administration, U.S.
Department of Health and Human Services. This publication is
not copyrighted; it may be reproduced in whole or in part without
permission. However, in accordance with accepted publishing
standards, it is requested that proper credit be given to the
source(s). The views in this publication do not necessarily
reflect the views of the sponsoring agency.
Health Resources and Services Administration
Maternal and Child Health Bureau
SIDS/Infant Death Program
(301) 443-2115
http://www.hrsa.gov
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