Sudden infant death syndrome or murder?

Abstract

Differentiating sudden infant death syndrome (SIDS) from suffocation may not be possible based purely on the pathological findings. For this reason there has been some confusion as to the mechanism of death in infants found prone. While prone sleeping increases the risk of SIDS, death is not due to suffocation as a variety of other external and internal factors are involved. Identifying suffocation in infants at autopsy and attempting to determine whether it may have been inflicted or accidental may also not be possible. Other types of death such as those involving drug toxicity and drowning may also have no pathognomonic features at autopsy to help with diagnosis. Established guidelines should therefore be followed for scene examination and autopsy evaluation to maximise the possibility of identifying the range of factors contributing to death. Use of standard definitions of SIDS will also improve diagnostic consistency and enable comparisons to be made between data from different areas. A “triple problem” model is proposed that demonstrates the “gray zone” of cases where it is not possible to determine whether death was due to SIDS, accident or homicide. The number of cases in the gray zone will be inversely proportional to the extent and quality of post-mortem investigations. The authors believe that occult homicides account for only a relatively small percentage of cases that have been labelled ‘SIDS’.