Intended for healthcare professionals

Feature Sudden infant death

Does cot death still exist?

BMJ 2008; 336 doi: (Published 07 February 2008) Cite this as: BMJ 2008;336:302
  1. Jonathan Gornall, freelance journalist
  1. 1London
  1. Jgornall{at}

    With leading researchers saying smoking and other modifiable factors account for most sudden infant deaths, Jonathan Gornall asks whether it is time to put the diagnosis to bed

    There are no cases of sudden infant death syndrome (SIDS) in Vanderburgh County, Indiana. “I simply don’t believe in SIDS deaths,” says chief deputy coroner Annie Groves. “If you do a complete investigation, you will find a cause of death.”

    Coroner Groves’s confidence may sit uncomfortably with many professionals in the United Kingdom, where even the use of the word “unascertained” in unexplained infant deaths is frowned upon because it carries “implications that the death may have been the result of neglect or abuse.”1 But in America she is not alone in her certainty.

    The Vanderburgh experience is one of many highlighted by a review of 40 000 infant deaths between 1992 and 2004 that concludes the quality of investigations carried out into sudden infant deaths in America “varies irrationally.”2

    The nationwide review, conducted by the Scripps Howard News Service, found that the protocol for the investigation of sudden unexpected deaths in infancy launched by the Centers for Disease Control and Prevention in 2006 was mandatory in only seven states. In those areas where the protocol was applied, far fewer deaths were ascribed to SIDS and medical examiners and coroners were more willing to conclude that inappropriate parenting was the cause of sudden unexpected deaths in infancy.

    Centers for Disease Control and Prevention protocol for sudden unexpected infant deaths

    In March 2006 the CDC released an eight page questionnaire based reporting form designed to elicit essential basic information in the investigation of all sudden unexpected infant deaths (

    The form is designed to be used by whoever interviews the witness (coroner, death scene investigator, police officer, or medical examiner). It includes 79 questions divided into five categories:

    • Witness interview

    • Infant medical history …

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