Rev. 2004

Sudden, Unexpected Infant Death:

Information for the Emergency 

Medical Technician

As an emergency medical technician (EMT), you are often the first

person on the scene following the discovery of a lifeless infant.

Responding to these calls is especially difficult and emotionally

wrenching—even for the most experienced and well-trained EMT.

Dealing with a sudden infant death presents both professional and

personal challenges for the first responder. While working to hopefully

revive the infant, the EMT may also be faced with consoling the parent or

other caregiver, as well as assessing and recording information about the

death scene. Moreover, infants—especially seemingly healthy infants—

are not supposed to die. It is not surprising that local officials and the

community pay much more attention to the death of a baby than incidents

involving adult fatalities.

This fact sheet provides an overview of the EMT’s role in responding to a

sudden infant death. We also discuss potential grief responses, causes of

sudden infant death, and the differences between sudden infant death

syndrome (SIDS) and child abuse. 

The EMT: Playing a Vital Role

The EMT has three major roles in responding to a sudden, unexpected

infant death:

■ Providing immediate emergency medical care to the baby

■ Observing, assessing, and documenting the scene

■ Offering support and consolation to parents/caregivers.

Caring for the Infant

Depending on local jurisdiction and agency, you may be required to carry

out infant resuscitation based on physical assessment. Some jurisdictions

require resuscitation and transport to the hospital, even when signs of

death are obvious. You, and all members of the emergency medical

services (EMS) response team, should be familiar with local medical

National Sudden

Infant Death

Syndrome/

Infant Death

Resource Center
2

examiner (ME) or coroner policies and follow these

protocols when responding to a call involving an

unexpected infant death.

Once you have determined the infant’s status, calmly

explain to the parent/caregiver what is happening and

what will happen next.

■ Take control of the scene.

■ Stay focused.

■ Try to be as factual as possible.

■ Record actions and the behavior of anyone at the

scene (what the person is doing, not how he/she

seems).

■ Don’t prejudge.

■ Be aware that there may be a language barrier.

■ Respect the differences in how various

racial/ethnic groups react to and deal with a

sudden, unexpected infant death.

■ Offer your condolences to the grieving

parent/caregiver.

Supporting the Parent/Caregiver

Ideally, the first responder team should have enough help

on the scene to explain to parents what is going on and to

comfort them. Express condolences to the

parents/caregivers and be sure to let them know that it is

routine to investigate all sudden deaths. You may need to

seek help from other

family members or

neighbors in

translating what is

happening for nonEnglish speaking

parents or caregivers.

Your skill and

sensitivity will set the

tone for the family’s

and caregiver’s interactions with other officials and

professionals who will subsequently become involved.

But don’t try to control parent/caregiver reactions during

this tragic and trying time. Ask if there is someone, for

example, other family member, neighbor, or member of

the clergy who the parent or caregiver would like you

to contact.

Some locales require the baby to be transported to the

hospital. The parent or caregiver may want to accompany

the baby to the hospital. Depending on your agency and

local procedures, the parent may be allowed to travel in

the ambulance with the infant and the EMTs. If this is not

the practice in your community or agency, see if a friend

or relative can take the parent or caregiver to the hospital.

Observing, Assessing, and Documenting 

the Scene

The ME/coroner likely will not be at the death scene.

Therefore, the ME will rely on documentation from the

EMS team and law enforcement to help determine cause

of death. Although law enforcement officials may conduct

the formal investigation, the first responder team’s

information about the scene is often invaluable.

You should expect that you will need to prepare a report

for the ME on what you saw and heard at the scene of the

baby’s death. Keep in mind that this report is a legal

document. Parents, other family members, and the child

death review team also may review your report.

Therefore, your report should be objective, accurate, and

complete and should follow local protocol.

Collecting Information

At the scene, as you ask questions about the circumstance

of the death and the baby’s health history, you should

obtain key information, including current medication

(take samples to the hospital), and circumstances at the

time of death. Open-ended, precise questions are most

effective, for example:

■ Can you tell me what happened?

■ Where was the baby?

■ Who found the infant?

■ What did you do when you found the baby?

■ Has the infant been moved?

■ What time was the infant last seen alive?

■ How did the infant seem that day?

■ Had the infant recently been sick?

Answers to questions such as these will help you prepare

your formal report, as part of the death scene

investigation. The ME will refer to this information in

determining the cause of death.

Documenting Findings

Recording your observations may be very difficult if you

are attending the baby while supporting parents and

caregivers. Also, depending on your agency and

community, the death scene documentation protocol may

be lengthy.

Sudden Infant Death Syndrome is

the sudden death of an infant

under 1 year of age which remains

unexplained after a thorough case

investigation, including

performance of a complete

autopsy, examination of the death

scene, and review of the clinical

history (Willinger et al., 1991).
3

Grief Responses:

Parents/Caregivers

In responding to a call involving a sudden infant death,

you will likely encounter parents/caregivers who have

intense and traumatic reactions to the infant’s death. It is

important to respect these reactions and feelings. 

First, be aware that not everyone reacts to shock, trauma,

and fear in the same way. When confronted with such a

sudden and traumatic loss, some parents and caregivers

will become angry, even hysterical. Some parents or

caregivers may blame themselves. Others may withdraw,

with no visible response. Others may deny that the infant

is dead. 

It is important that you remain calm and patient. Parents

or caregivers may repeat the same question or questions. 

Try to explain in terms that the parent or caregiver 

can understand. 

Some parents or caregivers ask that the EMS team try to

resuscitate the baby. Other parents or caregivers ask that

resuscitation be terminated. Some parents want to be

alone with the infant. 

Recognize that the parents and family, as well as other

caregivers, may have cultural beliefs, values, and

practices related to death. The baby’s family may have

various rituals that they will want to observe, and that are

part of their religious and cultural background. 

Grief Response: EMTs

There is no doubt that a sudden and

unexpected infant death is especially tragic.

Although experienced in dealing with death

resulting from illness, accidents, or even

homicide, you may be surprised at the depth of

your feelings regarding an infant’s death. 

Even “veteran” EMTs report reacting

emotionally to an infant death. It is not unusual

to feel symptoms of grief and guilt similar to

those of the parents/caregivers. Some first

responders express regret and frustration at

being unable to revive the baby. Other

common reactions include anger, blame,

identification with the parent/caregiver, selfdoubt, sadness, and depression.

It may help to discuss the circumstances

surrounding the death in a critical incident

stress debriefing or support group. These

debriefing sessions

usually are conducted

within 24 to 72 hours

after the death. Many

EMS agencies have

found that debriefing

sessions help confirm that the EMT did everything that he

or she could have done.

Causes of Sudden and Unexpected

Infant Death

SIDS is the most common cause of sudden, unexpected

death among infants between 1 month and 1 year of age.

Ninety percent of SIDS deaths occur under 6 months of

age, with most SIDS deaths happening in babies between

2 and 4 months of age.

Sudden, unexpected death may also be due to injury,

congenital birth defects, infection, or metabolic disorders.

The ME/coroner will determine the cause of death based

on information taken from the death scene investigation,

autopsy, and clinical history.

SIDS is often confused with child abuse. The following

table lists important characteristics that can help the first

responder distinguish between SIDS and child

abuse/neglect.

Grief responses are normal and

usually resolve in time. Don’t walk

away or try to “bury” your

feelings. They will catch up with

you eventually. 

SIDS 

Physical Appearance

No external signs of injury

“Natural” appearance of a deceased baby

■ Lividity—settling of blood, frothy

 drainage from the nose/mouth

■ Small marks (e.g., diaper rash)

 look more severe

■ Cooling/rigor mortis (takes place 

 quickly in infants, about 3 hours)

■ Purple mottled markings on head 

 and facial area, may appear as bruises

Appears to be a well-developed baby

May initially suspect SIDS when all of the 

above are present PLUS parents say that the 

infant was well and healthy when put to sleep 

(last time seen alive). 

Child Abuse/Neglect

Physical Appearance

Distinguishable and visible signs of injury

■ Broken bone(s)

■ Bruises

■ Burns

■ Cuts

■ Head Trauma (e.g., black eye)

■ Scars

■ Welts

■ Wounds

May be obviously malnourished

Other siblings may show patterns of injuries 

commonly seen in child abuse and neglect

May initially suspect child abuse/neglect when 

all of the above appear accurate and parents’ 

story does not account for all injuries on 

the infant.
4

Additional Resources

Sudden Infant Death Syndrome: A Manual for First

Responders and Emergency Room Personnel (1997)

Illinois Department of Public Health 

Springfield, IL

Phone: (217) 557-2931

Training Guide for Training of Emergency 

Personnel (2001) 

California SIDS Program 

Fair Oaks, CA

Phone: (800) 369-7437 or (917) 266-7434

Responding to Sudden Deaths in Infants and Young

Children: Interactive Training Guide for Death

Investigators, Law Enforcement and Emergency Medical

Personnel (2003) 

SIDS Foundation of Washington 

Seattle, WA

Phone: (206) 548-9290

Skills Update for First Responders, Emergency 

Medical Technicians, Paramedics, and Emergency

Department Personnel 

Georgia Division of Public Health 

Sudden Infant Death Syndrome/Other Infant Death

Information and Counseling Center 

Atlanta, GA

Phone: (404) 657-6700

Sudden Infant Death Syndrome: Study Outline 

for EMT’s and Paramedics 

SIDS of Pennsylvania 

Pittsburgh, PA

Phone: (800) 721-7437 

References 

American Academy of Pediatrics, Committee on Child Abuse and

Neglect. “Distinguishing Sudden Infant Death Syndrome from Child

Abuse Fatalities,” Pediatrics February 2001; 107(2): 437–441.

Georgia Emergency Medical Services for Children, Pediatric Life

Support March 2003;

http://www.emsc.org/downloads/pdf/1031gapls.pdf.

Mathews TJ, Menacker F, MacDorman MF. “Infant Mortality Statistics

from the 2001 Period Linked Birth/Infant Death Data Set.” National

Vital Statistics Reports; (52)2. Hyattsville, (MD): National Center for

Health Statistics. September 15, 2003.

National Clearinghouse on Child Abuse and Neglect Information Child

Maltreatment 2001: Summary of Key Findings.

http://www.calib.com/nccanch/pubs/factsheets/canstats.cfm.

Willinger M, James LS, and Catz, C. “Defining the Sudden Infant

Death Syndrome (SIDS): Deliberations of an Expert Panel Convened

by the National Institute of Child Health and Human Development,”

Pediatric Pathology 1991; 11: 677–84.

Additional References

American Academy of Pediatrics, Committee on Child Abuse and

Neglect. “Addendum: Distinguishing Sudden Infant Death Syndrome

from Child Abuse Fatalities,” Pediatrics September 2001; 108(3): 812. 

Association of SIDS and Infant Mortality Programs. The Unexpected

Death of an Infant or Child: Standards for Services to Families.

Minneapolis (MN): Association of SIDS and Infant Mortality

Programs, 2001.

Carolan PL. “Sudden Infant Death Syndrome.” Pediatrics: An On-line

Medical Reference. 1st Edition. St. Petersburg, FL. Emedicine Online

Textbooks. Ed. Steven Altschuler et al., 2001. Emedicine.com, Inc.

http://www.emedicine.com/PED/topic2171.htm.

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.” Morbidity and Mortality Weekly Report 1996; 45

(No. RR-10).

Centers for Disease Control and Prevention. “Variation in Homicide

Risk During Infancy—United States, 1989–1998.” Morbidity and

Mortality Weekly Report 2002; 51(09), 187–9.

This publication was produced by the

National SIDS/Infant Death 

Resource Center (NSIDRC)

2070 Chain Bridge Road

Suite 450

Vienna, VA 22182

Phone: (866) 866-7437, (703) 821-8955

E-mail: sids@circlesolutions.com

www.sidscenter.org

The NSIDRC is funded under contract to Circle Solutions, Inc., with the Maternal and Child

Health Bureau (MCHB), Health Resources and Services Administration, U.S. Department

of Health and Human Services. This publication is not copyrighted; it may be reproduced

in whole or in part without permission. However, in accordance with accepted publishing

standards, it is requested that proper credit be given to the source(s). The views in this

publication do not necessarily reflect the views of the sponsoring agency.

Health Resources and Services Administration

Maternal and Child Health Bureau

SIDS/Infant Death Program

(301) 443-2115

www.hrsa.gov