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Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities (RE0036)

AMERICAN ACADEMY OF PEDIATRICS

Committee on Child Abuse and Neglect

(2/6/01)

Dear Friends,

Articles hit the news on February 5, 2001 regarding 'AAP RECOMMENDS ADDITIONAL PROCEDURES IN DETERMINING CAUSE OF SUDDEN INFANT DEATH'. The news refers to a new AAP Policy Statement developed by the AAP Committee on Child Abuse and Neglect, which is concerned with issues relating to physical, sexual, and mental abuse and neglect of children, adolescents, and their families. The Committee develops appropriate policy recommendations for consideration by the Board of Directors and state legislators and serves as a liaison with other organizations concerned with the health and well-being of children and their families. More information follows. We have received many e-mail messages asking for more information. We need to help people separate myth from fact and risk factor from cause. We will post information as it becomes available to us.

Please keep the following in mind:

- When it comes to media coverage of SIDS, we often feel a sense of frustration in being confronted with misleading headlines, announcements of so-called breakthroughs and statements taken out of context.

- Please read the article, "Mass Media's" Role in SIDS Education, at <http://sids-network.org/media.htm>.

The AAP Committee on Child Abuse and Neglect's newest Policy is an update to two previous policies from the same committee:

bullet Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities (February 2001)
bulletInvestigation and Review of Unexpected Infant and Child Deaths (November 1999)
bulletDistinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities (July 1994)

- Read the comments from Dr. Henry Krous, Consultant in Pediatric Pathology for the AAP Committee on Child Abuse and Neglect

- Other recent related information on Day Care Owner Liable In SIDS Death, Abuse vs. SIDS, and dozens of similar topics can be found at:
http://sids-network.org/experts.htm. 

We are currently gathering more information about this specific case and will keep you updated.

Thanks!

Chuck Mihalko
Executive Manager
SIDS Network

Comments from Dr. Henry Krous, Consultant in Pediatric Pathology for the AAP Committee on Child Abuse and Neglect

Date: Tue, 6 Feb 2001

The AAP guidelines have created a storm of controversy, unfortunately much of it could have been avoided.

We (i.e., parents, medical examiners, scene investigators, child maltreatment specialists, etc) all want accurate diagnoses on all babies dying suddenly and unexpectedly.

All agree on essentially all of the guidelines. The one regarding examination of the body by the child maltreatment expert being the exception, I will address that later.

They are recommendations or guidelines, not rules or law,

It is my hope that when the dust settles that the medical examiner/coroners and child maltreatment experts in each jurisdiction will be able, and should, work out a system that accommodates the needs of both sets of medical specialists.

There are two very important and unfortunate controversies:
1. the jurisdictional conflict that is created by the recommendation that a child maltreatment expert examine the body before the medical examiner, and
2. the potential that the publicity surrounding the publication of these guidelines to increase in the public's mind that SIDS parents "got away with murder".

Regarding the first, members of NAME, the National Association of Medical Examiners, are furious about this recommendation, as I knew they would be, and for that reason I HAD STRONGLY RECOMMENDED THAT THE AAP RECOMMENDATIONS be finalized with the input of the NAME executive committee. Unfortunately that did not happen.

Regarding the second, I have been interviewed by the associated press and other newspapers and appeared in two television interviews and I have emphasized that all of us want accurate diagnoses based on thorough review of the medical history, careful investigation of the death scene and comprehensive postmortem examinations, and that all of the evidence indicates that the vast majority of SIDS cases have died of natural causes.

Highly positioned members of NAME will be addressing these guidelines at their meeting in a few weeks and I am sure they will respond to the AAP. It is my hope that this will be settled amicably with the least injury to SIDS parents, but this is going to take a while. There are some very bitter feelings now.

Henry F. Krous, MD
Children's Hospital of San Diego, CA
hkrous@health.ucsd.edu 

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