An evidence-based guide to the investigation of sudden unexpected death in infancy

Garstang, Joanna; Ellis, Catherine; Sidebotham, Peter

doi:10.1007/s12024-015-9680-x

Cited by 24 publications

(20 citation statements)

References 19 publications

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“…Similarly, we found research which focused on what bereaved parents want from professionals (including police) after the sudden death of their child (e.g. Garstang et al 2014 3 ; Garstang et al 2015). But to restate the point, we did not find anything that mentioned the cognitive and emotional stressors likely to be experienced by police investigators of child homicide (and suspicious child death).…”

Section: Investigating Suspicious Child Deathmentioning

confidence: 63%

Dealing with the Unthinkable: a Study of the Cognitive and Emotional Stress of Adult and Child Homicide Investigations on Police Investigators

Roach

Cartwright

Sharratt

2016

J Police Crim Psych

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Although the death of a child is without doubt one of the most distressing events imaginable, when it occurs in suspicious circumstances, such as at the hand of a parent or close family member, its effects are often more acute and incomprehensible. This paper presents an exploratory study comparing the cognitive and emotional stressors experienced by police when investigating child and adult homicides. The results of an online survey questionnaire with 99 experienced UK police investigators are presented, with key differences found in the cognitive and emotional stress experienced depending on whether the victim is a child or an adult, key differences and similarities identified in the ways investigators deal and cope with adult and child homicide cases, with a tentative discussion of the implications for the well-being and training of police investigators provided.

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Section: Investigating Suspicious Child Deathmentioning

confidence: 63%

Dealing with the Unthinkable: a Study of the Cognitive and Emotional Stress of Adult and Child Homicide Investigations on Police Investigators

Roach

Cartwright

Sharratt

2016

J Police Crim Psych

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“…As SUDI is a rare event, many pediatricians manage cases very infrequently limiting their ability to build up expertise. A systematic review of SUDI investigation found that death scene examination is most effective when done by professionals with specialist training who perform these regularly [23]. We should therefore consider whether SUDI investigation should become a specialist pediatric service commissioned on a regional basis similar to the provision of pediatric post-mortem examinations.…”

Section: Discussionmentioning

confidence: 99%

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

Garstang

Ellis

Griffiths

et al. 2016

Forensic Sci Med Pathol

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BackgroundA comprehensive Child Death Review (CDR) program was introduced in England and Wales in 2008 but as yet data have only been analysed at a local level, limiting the learning from deaths. The aim of this study is to describe the profile of causes and risk factors for Sudden Unexpected Death in Infancy (SUDI) as determined by the new CDR program. MethodsThis was a descriptive outcome study using data from Child Death Overview Panel (CDOP) Form C for SUDI cases dying during 2010-2 in the West Midlands region of England. The main outcome measures were: cause of death, risk factors and potential preventability of death, and determination of deaths probably due to unintentional asphyxia. ResultsData were obtained for 65/70 (93%) SUDI cases. 20/65 (31%) deaths were initially categorised as due to medical causes; 21/65 (32%) as SIDS, and 24/65 (37%) as undetermined. Reanalysis suggested that 2/21 SIDS and 7/24 undetermined deaths were probably due to unintentional asphyxia, with 6 of these involving co-sleeping and excessive parental alcohol consumption. Deaths classified as 'undetermined' had significantly higher total family and environmental risk factor scores (mean 2.6, 95% CI 2.0-3.3) compared to those classified as SIDS (mean 1.6, 95% CI 1.2-1.9), or medical causes for death (mean 1.1, 95% CI 0.8-1.3). 9/20 (47%) of medical deaths, 19/21 (90%) SIDS and 23/24 (96%) undetermined deaths were considered to be potentially preventable. There were inadequacies in medical provision identified in 5/20 (25%) of medically explained deaths. ConclusionsThe CDR program results in detailed information about risk factors for SUDI cases but failed to recognise deaths probably due to unintentional asphyxia. The misclassification of probable unintentional asphyxial deaths and SIDS as 'undetermined deaths' is likely to limit learning from these deaths and inhibit prevention strategies. Many SUDI occurred in families with mental illness, substance misuse and chaotic lifestyles and most in unsafe sleep-environments. This knowledge could be used to better target safe sleep advice for vulnerable families and prevent SUDI in the future. Key Words Key pointsThe CDR program provides valuable information on the profile of causes and risk factors for SUDI but is currently not recognising deaths from unintentional asphyxia and often not classifying unexplained infant deaths as SIDS.Most SUDI still occur in hazardous sleep environments despite public health campaigns.Poor parenting, particularly the combination of excess parental alcohol consumption and cosleeping, was a factor in many unexplained SUDI deaths.Research is needed to help target safe-sleep information better at high risk families.Difficulties with health care service provision may have contributed to some medically explained deaths.

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“…SIDS classification spurred the development of diverse approaches to determine the cause of death in order to exclude deaths due to accidental or non-accidental injuries, suffocation and strangulation, or medical causes (2, 3). Despite the publication of ~11,000 SIDS-related articles (4), of which over 100 SIDS studies appearing in Medical Hypotheses , biomarkers are still unavailable (5) and SIDS remains the leading cause of death for infants between 1 month and 1 year in western countries (accounting for ~2,700 deaths per year in 2010 in USA) (6).…”

Section: Introductionmentioning

confidence: 99%

A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

Elhaik

2016

Front. Neurol.

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Sudden infant death syndrome (SIDS) is the leading cause of death among USA infants under 1 year of age accounting for ~2,700 deaths per year. Although formally SIDS dates back at least 2,000 years and was even mentioned in the Hebrew Bible (Kings 3:19), its etiology remains unexplained prompting the CDC to initiate a sudden unexpected infant death case registry in 2010. Due to their total dependence, the ability of the infant to allostatically regulate stressors and stress responses shaped by genetic and environmental factors is severely constrained. We propose that SIDS is the result of cumulative painful, stressful, or traumatic exposures that begin in utero and tax neonatal regulatory systems incompatible with allostasis. We also identify several putative biochemical mechanisms involved in SIDS. We argue that the important characteristics of SIDS, namely male predominance (60:40), the significantly different SIDS rate among USA Hispanics (80% lower) compared to whites, 50% of cases occurring between 7.6 and 17.6 weeks after birth with only 10% after 24.7 weeks, and seasonal variation with most cases occurring during winter, are all associated with common environmental stressors, such as neonatal circumcision and seasonal illnesses. We predict that neonatal circumcision is associated with hypersensitivity to pain and decreased heart rate variability, which increase the risk for SIDS. We also predict that neonatal male circumcision will account for the SIDS gender bias and that groups that practice high male circumcision rates, such as USA whites, will have higher SIDS rates compared to groups with lower circumcision rates. SIDS rates will also be higher in USA states where Medicaid covers circumcision and lower among people that do not practice neonatal circumcision and/or cannot afford to pay for circumcision. We last predict that winter-born premature infants who are circumcised will be at higher risk of SIDS compared to infants who experienced fewer nociceptive exposures. All these predictions are testable experimentally using animal models or cohort studies in humans. Our hypothesis provides new insights into novel risk factors for SIDS that can reduce its risk by modifying current infant care practices to reduce nociceptive exposures.

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An evidence-based guide to the investigation of sudden unexpected death in infancy

Cited by 24 publications

References 19 publications

Dealing with the Unthinkable: a Study of the Cognitive and Emotional Stress of Adult and Child Homicide Investigations on Police Investigators

Dealing with the Unthinkable: a Study of the Cognitive and Emotional Stress of Adult and Child Homicide Investigations on Police Investigators

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy

A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

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