Sudden unexpected death in infancy associated with maltreatment: evidence from long term follow up of siblings.

AIMS To identify any association between sudden unexpected death in infancy (SUDI) and maltreatment within local families. METHODS Retrospective enquiry and subsequent follow up of all siblings and later births within the families. Full investigation of the circumstances of all unexpected deaths. SETTING Scarborough and Bridlington Health Districts and Trusts, North and East Yorkshire. SUBJECTS All local families losing a baby from SUDI, 1982-96. Follow up to end of 2000. MAIN OUTCOME MEASURES Court judgements and the objective decisions of legally constituted Social Services Case Conferences to place siblings on the Child Protection Register (CPR), or provide equivalent safeguards. RESULTS Sixty nine families had 72 unexpected deaths; three families had two deaths, with two families raising maltreatment issues. Three families had other children subsequently put on the CPR, all identifiable as likely problems of maltreatment at the time of the single SUDI. In 64/69 families, no child protection issues were formally raised at the time of the SUDI; 41/64 of these families already had 63 children. Four families were lost to follow up after the SUDI; 52/60 of the remaining families have had 93 more children without objective evidence of maltreatment. CONCLUSIONS The association of SUDI and maltreatment within families was at the lower end of previous estimates, 3-10%. Child protection intervention is rarely needed, but investigation and follow up for maltreatment is mandatory where apparent life threatening episodes are reported with a second baby, and after a recurrence of apparent SUDI.