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## Complete Summary

#### GUIDELINE TITLE

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](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16818592)

#### 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.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Sudden infant death syndrome (SIDS, also called crib or cot death)

-   Fatal child abuse

#### GUIDELINE CATEGORY

Diagnosis\
Management

#### CLINICAL SPECIALTY

Emergency Medicine\
Pathology\
Pediatrics

#### 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

1.  Complete autopsy (i.e., postmortem examination)

    -   Toxicologic tests

    -   Radiographic skeletal surveys

    -   Metabolic screening

2.  Examination of the death scene, including interviewing of household
    members

3.  Exclusion of other causes of death

4.  Consultation with medical specialists by medical examiner and
    coroner

5.  Medical history, prior to and at the time of death

6.  Supportive, unbiased, non-accusatory approach to parents

7.  Case review

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### 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

### RECOMMENDATIONS

#### 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

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=9477)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting each recommendation is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### 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

#### 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.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

End of Life Care

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### 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](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16818592)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2001 Feb (revised 2006 Jul)

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### 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](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/1/421).

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.

### DISCLAIMER

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Date Modified: 11/3/2008