SIDS Training for 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 As an awareness training and/or 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 of Sudden 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

SIDS can happen in any family 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

Difference Between SIDS and Child Abuse 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 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’s Physiologic Responses SIDS Development Environment

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 SIDS 1. 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, pillow or 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 Parents Family Professionals providing care 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 Acknowledge their loss Give permission to grieve: Acknowledge their loss Accept expressions of grief Express your own grief Offer 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 _________________________ Local Bereavement Support Group _________________________ 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 Program 800-369-SIDS (7437) • www.californiasids.com