Guideline:
Distinguishing sudden infant death syndrome from child abuse fatalities
Bibliographic Source(s)
- American Academy of Pediatrics Hymel KP Committee on Child Abuse and Neglect National Association of Medical Examiners. Distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics 2006 Jul;118(1):421-7. [74 references] PubMed
Guideline Status
This is the current release of the guideline.
All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed revised or retired at or before that time.
Guideline Category
Diagnosis
Management
Intended Users
Advanced Practice Nurses
Allied Health Personnel
Emergency Medical Technicians/Paramedics
Hospitals
Nurses
Other
Physician Assistants
Physicians
Social Workers
Guideline Objective(s)
- To provide professionals with information and suggestions to help avoid stigmatizing families of sudden infant death syndrome victims while allowing accumulation of appropriate evidence in potential cases of death by infanticide
- To address deficiencies and to update recommendations in the 2001 American Academy of Pediatrics policy statement of the same name
Target Population
- Healthy infants younger than one year old who die suddenly and unexpectedly
- Parents of sudden infant death syndrome victims
Interventions and Practices Considered
- Complete autopsy (i.e. postmortem examination)
- Toxicologic tests
- Radiographic skeletal surveys
- Metabolic screening
- Examination of the death scene including interviewing of household members
- Exclusion of other causes of death
- Consultation with medical specialists by medical examiner and coroner
- Medical history prior to and at the time of death
- Supportive unbiased non-accusatory approach to parents
- Case review
Major Outcomes Considered
Not stated
Methods Used to Collect/Select Evidence
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
Not stated
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Not stated
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not stated
Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation
Not stated
Major Recommendations
The following are important conclusions in the evaluation of sudden unexplained infant deaths:
- Accurate history taking by emergency responders and medical personnel at the time of death and immediate transmission of this historical information to the medical examiner or coroner
- Prompt investigation of the scene (Centers for Disease Control and Prevention 1996; Bass Kravath & Glass 1986) at which the infant was found lifeless or unresponsive and careful interviews of household members by knowledgeable individuals with the legal authority and mandate to conduct such investigations
- Appropriate consultations with available medical specialists (e.g. pediatrician pediatric pathologist pediatric radiologist and/or pediatric neuropathologist) by medical examiners and coroners
- Complete autopsy performed by a forensic pathologist within 24 hours of death including examination of all major body cavities including cranial contents microscopic examination of major organs radiographic examination and toxicological and metabolic screening
- Collection of medical history through interviews of caregivers interviews of key medical providers and review of previous medical charts
- Maintenance of an unbiased nonaccusatory approach to parents during the death-review process
- Consideration of intentional asphyxia in cases of unexpected infant death with a history of recurrent cyanosis apnea or apparent life-threatening events (ALTEs) witnessed only by a single caregiver
- Use of accepted diagnostic categories on death certificates as soon as possible after review
- Prompt imparting of information to parents when results indicate Sudden Infant Death Syndrome (SIDS) or accidental or medical causation of death
- Review of collected data by locally based infant death-review teams (Granik Durfee & Wells 1991) with participation of the medical examiner or coroner
Clinical Algorithm(s)
None provided
References Supporting the Recommendations
- Bass M Kravath RE Glass L. Death-scene investigation in sudden infant death. N Engl J Med 1986 Jul 10;315(2):100-5. PubMed
- 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. MMWR Morb Mortal Wkly Rep 1996;45:1-22.
- Granik LA Durfee M Wells SJ. Child death review teams: a manual for design and implementation. Chicago (IL): American Bar Association; 1991.
Type of Evidence supporting the Recommendations
The type of evidence supporting each recommendation is not specifically stated.
Potential Benefits
- An appropriate professional response to a child's sudden death that is compassionate empathetic supportive and nonaccusatory while at the same time results in a thorough investigation
- Accurate reporting of the circumstances surrounding unexpected and unexplained infant death may result in a reduction of associated risk factors (i.e. prone positioning bed sharing passive smoke exposure) through identification and education of new parents
Potential Harms
Not stated
Qualifying Statements
The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations taking into account individual circumstances may be appropriate.
Description of Implementation Strategy
An implementation strategy was not provided.
IOM Care Need
End of Life Care
IOM Domain
Effectiveness
Patient-centeredness
Bibliographic Source(s)
- American Academy of Pediatrics Hymel KP Committee on Child Abuse and Neglect National Association of Medical Examiners. Distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics 2006 Jul;118(1):421-7. [74 references] PubMed
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
American Academy of Pediatrics
Guideline Committee
Committee on Child Abuse and Neglect
Composition of Group that Authored the Guideline
Committee on Child Abuse and Neglect 2004-2005: Robert W. Block MD Chairperson; Roberta Ann Hibbard MD; Carole Jenny MD MBA; Nancy D. Kellogg MD; Betty S. Spivack MD; John Stirling Jr MD; Kent P. Hymel MD Past Committee Member
Liaison Representatives: David L. Corwin MD American Academy of Child and Adolescent Psychiatry; Joanne Klevens MD MPH Centers for Disease Control and Prevention
Staff: Tammy Piazza Hurley
National Association of Medical Examiners: Randy Hanzlick MD; Michael Graham MD; Tracey S. Corey MD
Financial Disclosures/Conflicts of Interest
Not stated
Endorser(s)
National Association of Medical Examiners - Professional Association
Guideline Status
This is the current release of the guideline.
All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed revised or retired at or before that time.
Guideline Availability
Electronic copies: Available from the American Academy of Pediatrics (AAP) Policy Web site.
Print copies: Available from American Academy of Pediatrics 141 Northwest Point Blvd. P.O. Box 927 Elk Grove Village IL 60009-0927.
Availability of Companion Documents
None available
Patient Resources
None available
NGC STATUS
This summary was completed by ECRI on September 17 2001. The information was verified by the guideline developer as of December 5 2001. This summary was updated by ECRI on August 14 2006. The updated information was verified by the guideline developer on September 1 2006.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor American Academy of Pediatrics (AAP) 141 Northwest Point Blvd Elk Grove Village IL 60007.
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