Pathologist calls for thorough scrutiny of sudden child death


Many deaths due to ignorance and stupidity were wrongly diagnosed as Sudden Infant Death Syndrome, according to a leading US forensic pathologist. Dr L.J. Dragovic, medical examiner in Oakland County, Michigan, which has one of the highest per-capita incomes in the world, told an international conference on legal medicine in Dublin that the scene should be examined in all cases of sudden death of infants and children.

He blamed what he described as the SIDS lobby for pressure on police doctors to record all infant deaths as SIDS deaths, in order to support the lobbying and research organisations around SIDS.

"The problem in our country is that once you establish federal funding and corporate groups these people directly depend on corporate growth and the corporate establishment. If a person is perceived as a threat they will be victimised.

"They have been carrying out research for 30 years with very little to show for it."

He stressed that he, like the SIDS lobbyists, wanted to see no more unexplained infant deaths. "But I believe that everything that can be explained should be explained, and people taught how to avoid preventable deaths."

A lot of infant deaths were due to "positional asphyxia", where the child smothered, he said.

He gave the example of a 2 1/2-month-old baby whose parents returned late from a party, where they had been drinking. The baby was crying, the father put him on his chest and both fell asleep. In the morning the father found the baby in his armpit. He had been asphyxiated and compressed in that position.

A study Dr Dragovic conducted of 38 unexplained deaths among infants and young children revealed a case where the child died in a poorly-inflated waterbed it shared with intoxicated parents; an eight-month-old baby overlain by a four-year-old sibling; and a three-year-old boy sleeping on a sofa with his 300lb father, who had been drinking, and who squashed the boy to death.

In another case, a child died when his head became stuck in the bars of a cot which had been assembled wrongly.

"I cannot say that human stupidity is not a major factor [in these deaths]," he said. "Sometimes alcohol and drugs are involved, and then there is a combination of the three."

In Oakland County the police and medical examiners have drawn up a scene-investigation protocol to attempt to unify and standardise their approach to investigating the scene.

He said he was not saying that parents should not sleep with their children. "We have seven children and they all slept with us at a given time. But we were never drunk," he said.

He acknowledged that some sudden infant deaths were not due to asphyxia and were apparently inexplicable. But he preferred the use of the term "undetermined", and the continued pursuit of explanations. He advocated constant contact with small babies, especially for the first 12 to 18 months, and particular attention to the possible role of older siblings and pets in sudden infant deaths.

Dr Mitra Kalelkar, a medical examiner from Chicago, supported his view on the importance of examining the scene in all cases of unexplained infant death.

She warned particularly of the dangers to babies of being overlain when they slept with their parents.