Abstract â–¡ 122

Poverty, post-natal depression and child abuse are all risk factors for sudden infant death. An unknown proportion of these deaths is due to intentional suffocation. Pointers to such cases include previous cyanotic episodes or unusual hospital admissions, the findings of facial petechiae or blood around the mouth or nose, a parent with a factitious illness or personality disorder, and a previously sibling who has died suddenly and unexpectedly. Use of child death review teams, or confidential multi-agency enquiries will best ensure these historical details are collated and made available to professionals who have continuing responsibility for the welfare of living children within the family.

Some cases of sudden infant death syndrome have ben found to be due to infanticide when a subsequent sibling has presented with serious child abuse, and the previous death is reinvestigated. Such cases highlight the difficulties in relating post-mortem findings to mechanisms of death. The minor findings in cases of sudden and unexpected death do not allow distinction to be made between natural and unnatural causes. More problematic for the pathologist is the situation when evidence of minor injury or neglect is found which cannot be considered to have caused the infant's sudden death, but may give rise to concerns regarding child care. The label 'sudden infant death syndrome' can be unhelpful because it is often assumed to be synonymous with death due to natural causes. Sudden, unexpected and unexplained infant deaths should be certified as 'undetermined' or 'unexplained' rather than given a label which can give false reassurance to health and social service professionals.