1. SIDS Training for Mortuary Professionals

2. Needs SIDS education to be provided to
all persons who may interact with parents
and caregivers following a SIDS death.
(SB1068, passed in 1989)

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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 live births
Happens most often between two and four months of age
Happens most often in winter

9. SIDS is Not Caused by: Suffocation Vomiting or choking Child abuse
Disease or illness
Immunizations

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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

16. Multifactorial SIDS Theory
Infant’s Physiologic Responses
SIDS
Development
Environment

17. Infant’s Physiologic Responses
Oxygen reduced, carbon dioxide increased
Arousal response deficit
Subtle brainstem dysfunction
Slow development

18. 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.

19. Environmental Factors
Sleep position
Smoking
Temperature
Bedding
Swaddling
Season
Minor respiratory symptoms
Drug use
Poverty
Limited prenatal care

20. 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.

21. 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

22. 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

23. 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

24. 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

25. When a Baby Dies Parents Family Professionals providing care
It is stressful for everyone:
Parents
Family
Professionals providing care

26. At the Initial Encounter Tell the Parents
Who you are
That you know
That you care

27. Remember
What you can do
What you cannot do

28. You Can Make a Positive Difference for the Parents
Parents vividly remember
the first moments after they
are told the baby died

29. 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

30. 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

31. What You Cannot Do
Take away the pain
Bring the baby back

32. 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

33. Preparing Yourself Experience fully your own losses.
Otherwise, the losses of others will
become a mirror of your own.

34. 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

35. 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

36. 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

37. Resources Local Health Department
_________________________ Local Bereavement Support Group
_________________________ California SIDS Program
SIDS (7437)

38. 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
SIDS (7437) •