Introduction
The infant mortality rate is the criterion that largely reflects the quality of healthcare in a particular country and its concern for the population. Pediatric activities aimed at addressing the health problems of young patients are a medical field with individual approaches and practices. Nevertheless, one of the acute problems that, as a rule, does not depend on the level of child healthcare development is sudden infant death syndrome or SIDS. In addition, in forensic medicine, one can often face the term SUID, or sudden unexpected infant death. While both concepts highlight the same problem, they differ in their scope of use since SUID is more commonly applied in a criminological environment while SIDS is rather a medical than forensic term. This work is aimed at revealing the difference between the two aforementioned terms, comparing the principles of investigating infant and adult deaths, identifying the distinctive features of the problem perception in general medical and forensic communities, and determining the reasons for the shift in statistical reporting on unexplained infant deaths from one category to another.
The Terms’ Definitions
Even though ordinary people often refer to SIDS and SUID as equivalent concepts that reflect the same problem, there is a difference between these terms. Maged and Rizzolo (2018) call SIDS “the most common type of SUID,” thereby emphasizing that the latter definition is broader and includes concomitant factors to take into account (p. 25). In other words, SIDS is often referred to as a subspecies of SUID, although the clinical criteria used to assess the setting of such verdicts often coincide.
In making a more precise distinction, one should pay attention to the legal interpretation of both terms. According to Quinn (2013), who studies these definitions, SIDS can be considered the cause of SUID, being a diagnosis of exclusion. This means that such a diagnosis can only be made when a particular infant’s death is thoroughly investigated. This set of activities includes a full autopsy, investigation at the place of death, examination of the child’s medical history, and other procedures. All these activities are aimed at identifying the real causes that have led to the infant’s death. Therefore, SUID can be described as a general term defining a tragic event, while SIDS is one of the diagnoses that specialists make after all the mandatory investigation procedures as the final verdict.
Differences Between Investigating Infant and Adult Deaths
Investigating human deaths is mandatory if the person has not died from a long-term and documented illness under medical supervision. At the same time, despite the obligatory nature of this work, the set of measures aimed at identifying the real causes of infant and adult deaths is different. As Pinneri and Matshes (2017) state, these distinctions are particularly evident in the autopsy technique, and despite the presence or absence of visual trauma, the procedure for a full autopsy of infants does not correspond to that performed with adult deceased. According to the researchers, pediatric forensic pathology is a distinct and recognized subspecialty interest of forensic pathology” (Pinneri & Matshes, 2017, p. 172). One of the main reasons is the distinctive physiology of infants, which, in turn, has led to the fact that infant autopsy specialists worldwide view this work as special. The continuous development of technical equipment allows for a more accurate assessment of the causes of deaths, which simplifies investigations and makes the results of autopsies unambiguous.
In addition to the aforementioned physiological differences, the autopsy of infants is carried out in strict accordance with legal conventions. Cottengim et al. (2019) mention the necessary protocols that standardize this practice and highlight specific operating principles for pediatric coroners, which are not consistent with those for investigating adult deaths. First and foremost, higher reporting is a mandatory principle for ethical reasons. At the same time, despite the existing regulations and standards, Cottengim et al. (2019) argue that, based on a survey of coroners, training for specialists in this field is an important criterion, and 70% of those surveyed confirm the relevance of introducing additional training programs for responsible employees (p. 91). This solution is natural on the way to the development of pediatric forensic pathology and can help better understand the SUID phenomenon and its manifestations.
Distinctive Features of the Problem Perception
The terms SIDS and SUID are reflected not only in a highly specialized environment but also in the civilian sphere. Many cases are made public due to socio-ethical norms and are a natural reaction to such tragedies. However, while analyzing the perception of the problem of unexpected infant death, one can note that it is perceived to be distinctive in different communities. Moreover, these differences are observed not only among medical employees and ordinary citizens but also among professionals involved in investigations of infant deaths.
When comparing perceptions among the population and the medical community, mentioning the role of media resources is necessary. For instance, Ahmed et al. (2018) assess how much the print media has influenced how people view SIDS and what stereotypes and biases have been formed in society. The authors mention newspaper headlines in which publishers, to attract readers’ attention, include harsh and loud statements that do not reflect the real situation but, conversely, increase the panic (Ahmed et al., 2018). A striking example is the case of SIDS among the indigenous Canadian population, despite the great risks of this issue, which is not mentioned in the media because it is not interesting to the public (Ahmed et al., 2018). Since modern media resources largely influence the formation of public opinion, people’s views are dependent on the content that is published. Therefore, despite the understanding of the problem and its possible causes among ordinary people, the perception of unexpected infant mortality is biased and associated with the frequency of mention in the media.
The medical community, being more aware of the aspects of the problem, is not inclined to assess the issues of SIDS and SUID in a biased manner. Moreover, unlike ordinary citizens, healthcare workers have access to accurate data on infant deaths, which makes their perceptions more credible. However, their views may differ from those of coroners and medical examiners who work in the field of pediatric forensic pathology and conduct investigations based not only on clinical data but also on the accompanying factors that influence the existence of SUID. In their work, they use appropriate protocols and standards and, as Shapiro-Mendoza et al. (2017) note, are guided by comprehensive assessment criteria and not just medical records. Therefore, possible differences in views among medical employees and forensic pathology staff regarding SUID and SIDS are often based on the scope of the problem rather than on agreement or disagreement with specific facts and statements.
The analysis of the problem from a deep perspective of death investigations shows that specialists in this profile, as a rule, have a special understanding of the issue under consideration and are guided by distinctive assessment methods. At the same time, research shows that even coroners and medical examiners, who are similar in their direction of work, can perceive unexpected infant mortality distinctively (Shapiro-Mendoza et al., 2017). According to the researchers, “US medical examiners and coroners apply variable practices to classify and investigate SUID, and thus, they certify the same deaths differently” (Shapiro-Mendoza et al., 2017, p. e20170087). This means that experts from the two fields can advance distinctive hypotheses regarding the dynamics of SUID manifestations and the possibilities of prevention. In addition, as Shapiro-Mendoza et al. (2017) argue, coroners and medical examiners evaluate investigative procedures differently, which is due to the nature of their activities and views on the objectivity of assessing the causes of the problem. Thus, distinctions in perception exist not only among ordinary people and medical specialists but also among representatives of forensic pathology.
The shift in Statistical Reporting
In recent years, one can note a shift in statistical reporting on unexpected infant deaths due to several factors. Shapiro-Mendoza et al. (2018) highlight the most significant of them and remark that changes in control policies and diagnostic preferences have revealed valuable evidence of the causes of such tragedies. In 2000, in the United States, the phenomenon of infant suffocation in bed was proposed as one of the common causes of death (Shapiro-Mendoza et al., 2018). This, in turn, was the impetus for a decrease in the frequency of SIDS diagnosis since the identification of the above situation made it possible to exclude the unexpected nature of death, thereby eliminating uncertainty.
Another significant reason that led to the shift in statistical reporting was the changed nature of investigations. Given widespread press coverage, public concerns, and ethical aspects of the issue, forensic pathologists streamlined their working practices. As an example, Shapiro-Mendoza et al. (2018) provide improved scene reconstructions, which enhanced the quality of investigative activities and ensured better resolution of SUID cases. From undetermined status, the causes of infant deaths moved to the proven category, and this was the impetus for improved procedures for the comprehensive identification of risk factors. Thus, through diagnostic advances and streamlined investigations, SUID and SIDS cases were analyzed more successfully, and fewer tragedies remained unresolved due to the lack of clinical data or proof of specific causes.
Conclusion
The comparison of SUID and SIDS as concepts that reflect similar problems but relate to different scales has contributed to identifying the differences between the terms and determining the principles of infant death investigation. Evaluating the perceptual criteria for these issues from a community perspective has demonstrated distinctive approaches to assessment. Revealing the difference in the analysis of unexpected infant deaths by coroners and medical examiners is a significant finding that suggests the need to standardize investigation practices to achieve a higher level of diagnostic approaches. Optimizing individual principles of specialists’ activities, particularly changes in assessment protocols and investigation modes, making it possible to identify additional risk factors, which, in turn, helped shift the status of deaths from undetermined to determined.
References
Ahmed, S., Mitchell, I., & Wolbring, G. (2018). Analysis of sudden infant death syndrome coverage in Canadian newspapers.Journal of Child Health Care, 22(4), 545-562.
Cottengim, C., Parks, S., Rhoda, D., Andrew, T., Nolte, K. B., Fudenberg, J., Sens, M. A., Brustrom, J., Payn, B., & Shapiro-Mendoza, C. K. (2019). Protocols, practices, and needs for investigating sudden unexpected infant deaths.Forensic Science, Medicine and Pathology, 16(1), 91-98.
Maged, M., & Rizzolo, D. (2018). Preventing sudden infant death syndrome and other sleep-related infant deaths.Journal of the American Academy of PAs, 31(11), 25-30.
Pinneri, K., & Matshes, E. W. (2017). Recommendations for the autopsy of an infant who has died suddenly and unexpectedly.Academic Forensic Pathology, 7(2), 171-181.
Quinn, M. (2013). The detective’s guide: Sudden, unexplained infant death investigations. CreateSpace.
Shapiro-Mendoza, C. K., Parks, S. E., Brustrom, J., Andrew, T., Camperlengo, L., Fudenberg, J., Payn, B., & Rhoda, D. (2017). Variations in cause-of-death determination for sudden unexpected infant deaths. Pediatrics, 140(1), e20170087.
Shapiro-Mendoza, C. K., Parks, S., Lambert, A. E., Camperlengo, L., Cottengim, C., & Olson, C. (2018). The epidemiology of sudden infant death syndrome and sudden unexpected infant deaths: Diagnostic shift and other temporal changes. In J. R. Duncan & R. W. Byard (Eds.), SIDS: Sudden infant and early childhood death: The past, the present and the future (pp. 257-282). University of Adelaide Press.