SIDS Trainingfor

Mortuary Professionals

Needs

SIDS education to be provided to

all persons who may interact with parents

and caregivers following a SIDS death.

(SB1068, passed in 1989)

Needs

Education may be offered

• As an awareness training and/or

• In the form of current educational materials on SIDS issues

(SB1068, passed in 1989)

Objectives• Define a SIDS death• Describe a typical SIDS baby• Identify the role of the coroner and the

public health nurse in a SIDS event• List four signs of grief• List two ways to provide support to

parents after a SIDS death• List two things to keep in mind when

discussing a SIDS death with children

Definition ofSudden Infant Death Syndrome (SIDS)

• The sudden and unexpected death of an apparently healthy infant usually under one year of age which remains unexplained after a:• complete medical history• death scene investigation• postmortem examination

SIDS is a Diagnosis of Exclusion

What We Know

• The cause(s) of SIDS remain unknown

• SIDS cannot be predicted or prevented

• No one is to blame for a SIDS death• Not parents• Not caregivers• Not emergency personnel or other health

care providers

What Happens

• Baby is usually healthy or may have had sniffles or cold

• Baby is put down for nap or night

• Found dead minutes to hours later

• No sign of struggle or distress

SIDS can happen in any family

Facts about SIDS

• The leading cause of death in infants between one month and one year of age in the U.S.

• Happens in about one of every 1000 live births

• Happens most often between two and four months of age

• Happens most often in winter

SIDS is Not Caused by:

• Suffocation

• Vomiting or choking

• Child abuse

• Disease or illness

• Immunizations

Physical appearance of SIDS infant

• Exhibits no external signs of injury• Exhibits a “natural” appearance of a dead baby:

• Lividity—settling of blood, frothy drainage from nose/mouth

• Small marks, e.g., diaper rash may look more severe

• Cooling/rigor mortis—takes place quickly in infants, in as little as three hours

Difference Between SIDS and Child Abuse

Difference Between SIDS and Child Abuse

Physical appearance of SIDS infant • Infant appears to be well developed

• Other siblings seem normal and healthy

May initially suspect SIDS:

Some of the characteristics previously noted plus parents report that the infant was well and healthy when put to sleep (last time seen alive)

Difference Between SIDS and Child Abuse

Distinguishable and visible signs of injury in infants less than one year of age• Broken bone(s)• Head trauma e.g., black eyes• Bruises• Scars• Burns• Welts• Cuts• Wounds

Difference Between SIDS and Child Abuse

Signs of Child Abuse• May be obviously wasted away—malnourished

• Other siblings may show patterns of injuries commonly seen in child abuse and neglect

May initially suspect child abuse/neglect:

Some of the characteristics previously noted plus parents’ story does not “sound right” or cannot account for all injuries on the infant

Maternal Risk Factors

• Young—less than 19 years of age

• Tobacco use doubles the risk of SIDS

• Substance use is associated with increased risk

• Limited or late prenatal care

• Short intervals between pregnancies

Infant Risk Factors for SIDS

• Male gender

• Infant age

• Low birth weight

• Multiple births

• Premature birth

Babies can die of SIDS without having risk factors

Multifactorial SIDS Theory

Infant’sPhysiologicResponses

Development Environment

SIDS

Infant’s Physiologic Responses

• Oxygen reduced, carbon dioxide increased

• Arousal response deficit

• Subtle brainstem dysfunction

• Slow development

Development—age vulnerability

• 2-4 months—75%

• 4-6 months—15%

• Respiratory system is unstable in all infants

• May take less of an environmental stress to trigger SIDS at this age.

Environmental Factors

• Sleep position• Smoking• Temperature• Bedding• Swaddling• Season• Minor respiratory symptoms• Drug use• Poverty• Limited prenatal care

9 Ways to Reduce the Risk of SIDS1. Always place a baby on his/her Back to Sleep,

even for naps.

2. Never allow smoking around a baby.

3. Place a baby on a firm, flat surface to sleep.

4. Remove all soft things such as loose bedding, pillows, and stuffed toys from the sleep area.

5. Never place a baby on a sofa, waterbed, soft chair, pillowor bean bag.

6. Take special precautions when a baby is in bed with you.

7. Make sure a baby doesn’t get too hot.

8. Keep baby’s face and head uncovered during sleep.

9. Share this information with everyone who cares for a baby.

When SIDS Happens

• Baby found not breathing

• Call is made to 911

• EMS, fire or police respond

• Decision is made about CPR and transport

• Baby is pronounced dead

• Coroner goes to the death scene, home or hospital

Coroner’s Responsibilities

• Investigate death scene

• Obtain complete medical history

• Have autopsy performed

• Contact county health department

• Notify parents of apparent cause of death

• Inform California SIDS Program

• Sign death certificate

Local Health Department Responsibilities

• Contact family/childcare provider within three working days

• Services to be provided:• Assess family, childcare provider/foster

parent or both • Crisis intervention and counseling • Referral to community services• Follow-up care to assess progress

• Submit report of contact to the California SIDS Program

A SIDS Death is Different From Any Other Death Within a Family

• Babies are not supposed to die. The family expected that the baby would grow up and outlive them.

• The death is sudden. The family had no reason to expect that the baby would die.

• The death is incomprehensible. The designation of SIDS tells the family that no medical explanation for their baby’s death was found.

Each of these factors will have an influence on the family member’s grief

When a Baby Dies

It is stressful for everyone:

• Parents

• Family

• Professionals providing care

At the Initial Encounter Tell the Parents

• Who you are

• That you know

• That you care

Remember

• What you can do

• What you cannot do

You Can Make a Positive Difference for the Parents

Parents vividly remember

the first moments after they

are told the baby died

You Can Convey Caring

Give permission to grieve:

• Acknowledge their loss• Accept expressions of grief• Express your own griefOffer continued support:

• Provide information• Link the family with other parents• Develop a follow-up plan

How to Convey Caring

• Be there to listen

• Allow expressions of grief

• Encourage the family to talk about the baby

• Give special attention to the baby’s brothers and sisters

• Help identify family and friends who may help

What You Cannot Do

• Take away the pain

• Bring the baby back

Things that Hurt• Saying you know how they feel• Saying You ought to...• Not using the baby’s name• Offering platitudes• Saying they have other children or can

have more children later• Suggesting that the baby did not have

good care• Being suspicious and judgmental

Preparing Yourself

Experience fully your own losses.

Otherwise, the losses of others will

become a mirror of your own.

The Tasks of Grieving

• Accepting the reality of the loss

• Experiencing the pain of grief

• Adjusting to a life without the baby

• Moving on

—Dr. J. W. Worden

Professional Reaction

Signs and Symptoms of Critical Incident Stress• Recurring dreams• Anger • Physical illness• Depression• Changes in eating and sleeping patterns• Mood changes• Inability to concentrate• Withdrawal

Stress Relief

• Limit overtime hours• Exercise• Plan leisure time• Get adequate rest• Eat a balanced diet• Write down what bothers you• Get professional, religious, or peer counseling• Talk about what happened

Resources

Local Health Department

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Local Bereavement Support Group

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California SIDS Program

800-369-SIDS (7437)

California SIDS Program

This PowerPoint presentation is copyrighted, but may be reproduced without permission. We request that proper credit be given to: California Department of Health Services/

California SIDS Program

Produced by the California SIDS Program under funding by the California Department of Health Services, Maternal, Child and Adolescent Health Branch © 2005

California Sudden Infant Death Syndrome Program800-369-SIDS (7437) • www.californiasids.com