Fatal Child Abuse and Sudden Infant Death Syndrome: A Critical Diagnostic Decision

Abstract

Distinguishing between an unexpected infant death due to sudden infant death syndrome (SIDS) and one due to fatal child abuse challenges pediatricians, family physicians, pathologists, and child protection agencies. If child abuse is suspected, the physician must fuffill mandated legal obligations to report the case to the appropriate authorities. Coroners, medical examiners, and pathologists have the added responsibility of rendering a medicolegal opinion as to the cause and manner of death. Child protection agencies need to ensure that other children in the home are not at risk. Law enforcement personnel and prosecutors need to proceed if the law has been broken. All agree that the state of our knowledge in this area is incomplete and ambiguity exists in some cases. For everyone concerned, it is necessary and desirable, within the limits of our capability, to know the cause and manner of an infant death. This process requires application of current knowledge, a desire to know the reasons for the deaths, the resources necessary to conduct essential procedures, and the sensitivity and wisdom to perform the task without causing distress to innocent family members.

The history relevant to this decision is a relatively short one. In the first half of this century, searching for the reasons infants die was the lonely province of a few clinicians, researchers, and pathologists who examined the retrospective traces of infant deaths. Bergman¹ recounts the slow progression of knowledge about sudden unexpected infant death in the pathologists' laboratories and morgues where Werne and Garrow² and then Adelson and Kinney³ proposed etiologies for "crib death" other than suffocation.