What information should be provided to officials during an investigation of an infant death?

Information to Provide During Official Investigation of Infant Death

You should be prepared to provide a comprehensive account of the infant's sleep environment, medical history, and circumstances surrounding the death, as officials will conduct a thorough case investigation that includes scene investigation, autopsy, and clinical history review to determine the cause of death. 1

Understanding the Investigation Process

The investigation of sudden unexpected infant death (SUID) follows standardized protocols that require multiple sources of information to accurately determine cause of death 1. Officials cannot determine the cause by autopsy alone—they need detailed information from caregivers, scene investigation, and complete medical records 1.

What Officials Are Investigating

• Explained deaths: Those attributed to suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, or trauma 1
• Unexplained deaths (SIDS): Deaths that remain unexplained after complete investigation, assigned only after thorough case review 1
• Approximately 82% of SUID cases are categorized as unexplained, while 18% are explained 2

Critical Information You Will Be Asked to Provide

Sleep Environment Details (Most Important)

Officials will focus extensively on the sleep environment, as 72% of SUID cases occur in unsafe sleep conditions 2:

• Infant's sleep position: Whether placed on back, side, or stomach 1
• Sleep surface: Type of mattress (firm vs. soft), whether crib, adult bed, couch, or armchair 1
• Bedding present: Presence of pillows, blankets, quilts, comforters, or soft toys in sleep area 1
• Bed-sharing: Whether infant was sleeping alone or with parents/siblings 1
• Room-sharing arrangements: Whether infant slept in same room as parents on separate surface 1
• Position when found: Exact position and location where infant was discovered 1

Among explained suffocation deaths, approximately 75% result from airway obstruction attributed to soft bedding 2.

Complete Medical and Prenatal History

Officials will request detailed information about 1, 3:

• Prenatal care: All pregnancy complications, maternal infections, substance use during pregnancy 3
• Birth history: Gestational age at birth, birth weight, mode of delivery, any complications 3, 4
• Infant's health: Any recent illnesses, infections, fever, respiratory symptoms, feeding difficulties 1, 5
• Medications: Any medications or supplements given to infant 3
• Immunization status: Vaccination history and dates 1
• Previous medical visits: Recent pediatric visits, emergency department visits, or hospitalizations 1

Family and Social History

Be prepared to discuss 3, 5:

• Family medical history: Any sudden unexplained deaths in first- or second-degree relatives before age 35 3
• Household composition: Who lives in the home and who had access to the infant 3
• Substance exposure: Tobacco smoke exposure (active or passive), alcohol use, drug use in household 3
• Maternal health: History of depression, anxiety, or other mental health conditions 3

Circumstances Immediately Before Death

Officials will ask detailed questions about 5, 6:

• Last time infant was seen alive: Exact timing and infant's condition 5
• Feeding history: Last feeding time, type (breast or formula), any difficulties 5
• Who discovered the infant: Identity of person who found infant unresponsive 6
• Resuscitation attempts: What actions were taken before emergency services arrived 6
• Timeline of events: Detailed sequence from last seeing infant alive to discovery 5

The Investigation Team and Process

Who Will Be Involved

Multiple professionals will participate in the investigation 1:

• Medical examiner or coroner: Determines official cause of death 1
• Scene investigators: Trained personnel who document death scene 1
• Law enforcement: May be present during initial investigation 1
• Child Fatality Review Team (CFRT): Multidisciplinary team including pediatricians that reviews case 1
• Emergency responders: First responders who arrived at scene 1

What Will Happen

The investigation follows standardized protocols 1, 5:

1. Scene investigation: Trained investigators will document the exact location and circumstances using standardized forms (Sudden Unexpected Infant Death Investigation Reporting Form) 1
2. Comprehensive autopsy: Complete external and internal examination of all organs including brain, radiographs, metabolic testing, and toxicology screening 1
3. Microbiological sampling: Collection of blood, cerebrospinal fluid, respiratory samples, and tissue specimens to rule out infection 1
4. Medical record review: Examination of all prenatal and postnatal medical records 1
5. Caregiver interviews: Detailed interviews with parents and anyone who had contact with infant 1

Important Points to Understand

Diagnostic Coding and Classification

Death certificates use specific International Classification of Diseases (ICD-10) codes 1:

• R95: SIDS (sudden infant death syndrome) - unexplained after complete investigation 1
• R99: Unknown or unspecified cause of mortality 1
• W75: Accidental suffocation and strangulation in bed - when asphyxia terms are reported with bed/crib 1

Variability in Death Certification

Be aware that different medical examiners and coroners have varying diagnostic preferences and levels of training 1:

• Some certifiers rarely use SIDS as a diagnosis 1
• Others will not classify death as suffocation without pathologic markers of asphyxia at autopsy, even with strong scene evidence 1
• This variability affects how your infant's death may be classified 1

Child Fatality Review Team Role

After initial investigation, a multidisciplinary CFRT will review the case 1:

• Reviews are conducted to identify preventable factors and improve community systems 1
• Teams include pediatricians, public health officials, law enforcement, and social services 1
• The goal is prevention of future deaths, not assignment of blame 1
• Where permitted by law, teams may provide feedback to healthcare providers involved in the infant's care 1

How to Prepare for the Audit

Be Honest and Detailed

• Provide complete, truthful information even if you feel it may reflect poorly on your care 5, 6
• Inconsistencies or omissions can complicate the investigation and delay determination of cause 5
• Officials are trained to gather information compassionately while being thorough 6

Gather Documentation

Have available 1:

• All medical records from prenatal care through infant's death 1
• Immunization records 1
• Any photographs of the sleep environment if taken 1
• Names and contact information for all healthcare providers 1

Understand This Is Standard Protocol

Every sudden unexpected infant death requires this level of investigation regardless of suspected cause 1. The thoroughness of the investigation:

• Helps determine accurate cause of death 1
• Identifies preventable factors for public health interventions 1
• Provides data for national surveillance systems 1
• May identify rare genetic or metabolic conditions that affect other family members 1

Common Pitfalls to Avoid

• Do not alter the scene before investigators arrive 1, 5
• Do not withhold information about unsafe sleep practices out of guilt 2
• Do not refuse autopsy - it is essential for determining cause and may be legally required 1
• Do not assume officials are accusing you - standardized investigation is required for all cases 1, 6

Support and Resources

The investigation process is emotionally difficult for families 1. Child Fatality Review Teams recognize this and aim to conduct investigations with sensitivity while gathering necessary information 1. The ultimate goal is preventing future infant deaths through better understanding of risk factors and circumstances 1.