Paediatric Emergencies 371SUDDEN UNEXPECTED DEATH IN INFANCY2 SIDS is defined as the sudden death of any infant under the age of 1 year that
is unexplained by history and in which a thorough post-mortem evaluation
fails to demonstrate an adequate cause of deat h. It is now rare.
3 The cause of SIDS is unknown.
(i) It is more common during winter, with a peak age of 3 months.
(ii) Risk factors include tobacco exposure (before or after birth), sofa
sharing, bed sharing with an intoxicated or smoker parent.
(iii) SIDS babies are more likely to be male, of lower gestational age
at birth, low birth weight, lower APGAR scores, admitted to a
special care baby unit and have congenital abnormalities. Parents
are more likely to be young, solo, have lower incomes, have a
previous child with SIDS, previous stillbirths and higher parity.
(iv) Protective factors include: sleeping supine (on the back), face
uncovered and room sharing in a safe cot.
MANAGEMENT1 Always continue resuscitating in the resuscitation room, if the child is
brought in by ambulance with resuscitation in progress. Call the senior ED
doctor and paediatric team urgent ly (see CPR, p. 339).
2 Examine the child carefully for any signs of trauma or infection, including
evidence of asphyxia or petechiae. Check the temperature.
3 Discuss the necessity for post-mortem blood tests for infection or a drug
screen with the senior doctor. In addition, keep all clothes in a labelled hospi-
tal bag.
4 Check that the parents have full access to the resuscitation area, and encour-
age them to attend the resuscitation room if they want to. Provide a senior
ED staf f member to be wit h t hem at a ll times.
5 The senior doctor should then speak in private to the parents, to talk about
the circumstances of the death and any recent illness in the child.
6 Encourage the parents to see and hold their child in privacy afterwards. They
may derive benefit from the presence of the hospital chaplain and social
worker, and may like a photograph or a lock of the child’s hair.
7 Tell the parents that, because the death is sudden, the coroner (or procurator
fiscal in Scotland) will be informed, and a post mortem may be required.
8 The coroner’s officer or the police will then visit the parents later that day,
and will take further details, possibly even removing the bedding for
examination.
9 Write down and give the parents the details and phone number of the local
SIDS help group (in Australia the SIDS and Kids website [http://www.
sidsandkids.org/] and in the UK the Foundation for the Study of Infant
Deaths [http://www.sids.org.uk/]).