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SIDS gets blame for death when cause is unknown

Dr. Antoinette Laskey, chair of the State Child Fatality Review Team, told attendees at a first-of-its-kind conference in the state last Wednesday in Corydon that a child’s death should only be classified as Sudden Infant Death Syndrome when all other possibilities are exhausted.
‘It is SIDS when it is nothing else,’ she said.
Laskey, speaking to law enforcement, judicial and other officials from throughout Southeastern Indiana at the Sudden Unexplained Infant Death Investigation Training at Lincoln Hills Christian Church that continued Thursday, said many deaths can look like SIDS but aren’t.
‘Never listen to an ER doctor who says it’s SIDS,’ she said, only a forensic pathologist can make that determination after running a variety of tests, including toxicology and radiology, and talking with somebody at the investigation scene.
The point, Laskey said, is SIDS can look just like smothering, poisoning, abuse or genetic conditions. Both smothering and poisoning may be intentional or unintentional, she said.
While intentional smothering is self-explanatory, unintentional smothering is known as positional asphyxiation and occurs when a child’s airway gets accidentally blocked, either by the position they are laying in or by a foreign object. Intentional poisoning can include when a child is given illegal drugs, over-the-counter medications not meant for children, or prescription medications in the wrong dosage. Unintentional poisoning is when a child takes the medication or is given the medicine by another child.
Laskey encouraged law enforcement, medical and other personnel at a crime scene to gather as much information as possible, explaining the more information she has helps her determine the cause death.
‘So, you’re my eyes and ears at the scene and talking to people I can’t have access to,’ she said.
Laskey also encouraged better communication between agencies, such as police and the Division of Child Services. That will enable more definitive statistics regarding the number of child abuse-related deaths, she said, noting that right now different agencies tend to produce different numbers.
‘It’s because we’re not counting them accurately. We’re not counting them the same way,’ she said.
Laskey detailed the various types of non-SIDS deaths ‘ neglect and abuse ‘ and why they are often missed and assigned as SIDS.
Besides positional asphyxiation and accidental poisoning, neglect can include starvation, untreated medical conditions due to a family’s religious beliefs, drowning and fires.
‘Last winter and the winter before that were especially bad for fire deaths for children in Indiana,’ she said.
Physical abuse can include abusive head trauma (often known as blunt force trauma once death has occurred), abdominal trauma, burns, smothering/strangulation and do-mestic violence crossfire. The latter is when the child is injured during a domestic violence incident typically between the mother and father or her boyfriend.
Talking in detail about abusive head trauma, Laskey said most victims are under the age of 2, with the highest risk between the ages of six weeks and four months, but it can happen at any age. That is why officials need to get away from the term ‘Shaken Baby Syndrome,’ she said.
Laskey added that infants six-weeks to four-months old often don’t sleep well and are colicky, which can be extremely stressful for young parents.
‘This is a recipe for disaster,’ she said.
Babies have large heads in relation to their body and their brain occupies 10 to 15 percent of their total body compared to just two to three percent for adults, Laskey said. In addition, she said, they have weak neck muscles, making it easy for their heads to snap back and forth, which is extremely dangerous since their brains are still developing and take up just a small portion of their skulls.
Laskey warned that not all abusive head trauma cases are the same and can occur from varying amounts of trauma, but none happen from routine handling.
She also said that not all of those cases show evidence of an impact. An example, she said, would be if a baby is thrown onto a mattress.
‘If there was a skull fracture, I can say for sure there was an impact,’ she said. ‘If there was no skull fracture, I cannot promise there was no impact.’
Even if the head doesn’t hit anything, the brain is still being slammed around the inside of the skull when a baby is shaken violently, Laskey said.
Laskey also warned officials to be leery of the excuses people who have abused their child will often give to explain the injuries. These including saying the brother, sister, dog or even the child itself did it, or they suddenly remember some ‘incident’ from a few days before, she said.
Deaths are often categorized as SIDS when they shouldn’t be for several reasons, Laskey said. Reasons they’re misdiagnosed include the caregiver doesn’t tell the doctor the entire story, the caregiver doesn’t know the entire story, or the doctor doesn’t press the issue, not wanting to believe that a family member could be responsible.
While it may be tempting to classify any unexplained medical crisis, such as choking or not breathing, as SIDS, officials should only do so after ruling out all other potential causes, Laskey said.

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