Medical Hypotheses I
Medical HjQolhues (1991) 36.183-184 @Imngmmomup~IKLtd1991
Sudden Infant Death Syndrome -
A Valid Diagnosis?
D. A. SMITH Department of Emergency Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, Texas 79905, USA (Reprint requests to DAS)
The Sudden Infant Death Syndrome diagnosis?
The Sudden Infant Death Syndrome is defined as ‘The sudden and unexpected death of any infant or young child, which is unexplained by history and in which a thorough post-mortem examination fails to demonstrate an adequate explanation of the cause of death’( 1). This definition is widely quoted in the literature and is used for studies of epidemiology, autopsy specimens and retrospective analysis. Essentially everything that is known about SIDS is derived from research that use these criteria or similar ones. The word syndrome is from the Greek syn which means together and dromos which means running. Literally, syndrome means ‘a running together’. In medicine, a syndrome is ‘a number of symptoms occurring together and characterizing a specific disease’ (2). Implicit in this is the assumption that there is a unique unifying etiology for at least the majority of cases. This may be a chromosomal abnormality, such as Down’s syndrome, a virus such as AIDS, or even a mechanism of injury i.e., the battered child syndrome. SIDS is a phenomenon that seems to manifest itself in a pattern that is characteristic enough to suggest that most cases arise from a single etiology (3). However, many authors, especially recently, are of the opinion that SIDS has a multifactorial etiology (4). This, if held true for SIDS, conflicts with the assumption that a syndrome represents a disease process that arises
from a single etiology. The scientific justification for a narrow classification of SIDS and ICDM-9 code then becomes no longer tenable. Discussions such as the foregoing regarding the validity of the diagnosis of SIDS usually are discussed in the context of statements estimating the frequency with which cases of child abuse are misdiagnosed as SIDS (5, 6). This unfortunate happenstance does occur (7,8,9), but estimates of its frequency vary from the widely held opinion that such events are quite rare to statements that most cases of SIDS are the result of subtle forms of child abuse (10, 11). People find the suggestion that parents sometimes kill their own offspring offensive and difficult to deal with. There is also a great deal of bias in the medical literature against this thought for humanitarian reasons. If child abuse is rare then the humanitarian viewpoint would certainly be that one should not make an issue of whether the diagnosis of SIDS is scientifically based. If child abuse is not uncommon in cases determined to bc SIDS then the diagnosis of ‘nothing found at autopsy’ (12) may not be humanitarian and indeed a hoax (13). Given the absence of positive evidence indicating the cause of death and faced only with an infant that is suddenly dead, can we really state with confidence that we know of what the infant died? Who are we protecting? Who are we trying to help? More to the point, who are we kidding?
Date received 14 January 1991 Date accepted 24 April 1991
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Meadow R. Sudden infant death and suffocation (letter). Br Med J 299: 179, 1989. Cashell AW. Homicide as a cause of the sudden infant death syndrane. Am J Forensic Med Path01 8: 25U. 1987. Diiaio VJ. SIDS or murder? (letter) Pediatrics 81: 747, 1988. Meadow R. Sudden infant death and suffocation. Lancet 299: 455. 1989. Asch SW. Crib deaths: their possible relation to postpartum depression and infanticide.. Mt Sinai J Med 35: 214-220.1968. Cot death: the unfounded lurking suspicion (Editorial). Lancet: 1137, 1984. Bmery JL Welfare of families of children found unexpectedly dead (‘Cot Deaths’). Br Med J 1: 612-5, 1972. ‘&ler JW. Sudden infant death and chronic infant disorders: the N.E.S.T. model versus the lethal cot-death syndrome hoax. Med Hypotheses 30: 271-5, 1989.