Sudden Infant Death Syndrome

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Sudden Infant Death Syndrome : 

Sudden Infant Death Syndrome Sudden death of infant where thorough postmortem fails to reveal cause

SIDS : 

SIDS Incidence 2 to 3 deaths/1000 live births #1 cause of death 1 week to 1 year 90% occur at 1 month to 6 months Rare in first few weeks of life

SIDS : 

SIDS More common in Winter Males Young mothers Low birth weight infants Multiple birth

SIDS : 

SIDS More common in Lower socioeconomic groups Blacks, Native Americans Maternal drug/cigarette use

SIDS : 

SIDS 50% have history of “cold” in week before death

SIDS : 

SIDS May be due to: Chronic hypoxia Sleep apnea Pharyngeal obstruction during sleep Increased CO2 levels in microenvironment created by infants sleeping in prone position

SIDS : 

SIDS SIDS is NOT External suffocation Result of aspiration Child abuse Hereditary Caused by cow milk allergy

SIDS : 

SIDS Cause unknown Cannot be predicted/prevented Always fatal

SIDS : 

SIDS Assessment Normal nutrition/hydration Fluid in/around mouth nostrils; may be blood-tinged Livor mortis/rigor mortis Rumpled bed clothes “Squashed nose” appearance

SIDS : 

SIDS Management Appropriate care for infant Support for family Crisis intervention for EMS personnel

SIDS : 

SIDS Management Aggressive resuscitation unless signs of irreversible death present Parental reaction Agency policy True SIDS cannot be resuscitated

SIDS : 

SIDS Management Support for parents/siblings Ask for, use infant’s name Calm, authoritative manner Structured information Stress that nothing could have done to prevent event

SIDS : 

SIDS Management Support for parents/siblings Expect grief reactions Act as advocate for family

SIDS : 

SIDS Management Crisis intervention for EMS personnel Acknowledge impact Prepare through training Know your limits Use CISM team if needed

Child Abuse : 

Child Abuse

Child Abuse : 

Child Abuse Abuse Physical, emotional, sexual maltreatment of child resulting from acts of omission or commission by parent, guardian, or other caretaker

Child Abuse : 

Child Abuse Neglect Failure to provide for child’s needs although support sources available

Child Abuse : 

Child Abuse 1,000,000 cases/year 4,000 fatalities 10% of trauma < 3 y.o. seen in ERs All social, economic, religious, ethnic groups

Child Abuse : 

Child Abuse Contributing Factors: Child “Different”: handicapped, hyperactive, precocious Male > Female 2:1 Small enough to be unlikely to retaliate 2/3 < 3 years old

Child Abuse : 

Child Abuse Contributing Factors: Abuser Often abused themselves as children Lonely, unhappy, under stress Lack of understanding of normal child development

Child Abuse : 

Child Abuse Contributing Factors: Lack of Support Spouse often non-supportive Extended family support unavailable

Child Abuse : 

Child Abuse Contributing Factors: Crisis Poverty Job loss Marital conflict Illness producing uncontrollable crying

Indicators of Abuse : 

Indicators of Abuse Multiple or repeated injuries Unusual variety Different stages of healing Unusual locations

Indicators of Abuse : 

Indicators of Abuse Inconsistency of injury with: Reported mechanism History Developmental abilities

Indicators of Abuse : 

Indicators of Abuse History changes on retelling Multiple ER visits, EMS contacts

Indicators of Abuse : 

Indicators of Abuse Inappropriate parental response Prolonged delay in seeking help Parent hostile, indifferent, apathetic Person other then caretaker brings child in

Indicators of Abuse : 

Indicators of Abuse Malnutrition Poor hygiene Inappropriate dress

Indicators of Abuse : 

Indicators of Abuse Child is: Apathetic Unusually stoic Extremely fearful of adults Unusually loving or cooperative

Child Abuse : 

Child Abuse Management Get child out of abusing environment Report suspicious to ER physician Document thoroughly Reporting is mandatory Civil immunity if report in good faith

SIDS vs Child Abuse/Neglect : 

SIDS vs Child Abuse/Neglect SIDS victim No external signs of injury “Normal” post-mortem changes Other siblings appear healthy History of child being well when put to sleep

SIDS vs Child Abuse/Neglect : 

SIDS vs Child Abuse/Neglect Abuse/Neglect Victim Visible signs of injury May appear malnourished Siblings may show signs of abuse, neglect Story is evasive, does not sound right

Pediatric Critical Incident Stress : 

Pediatric Critical Incident Stress

Pediatric CIS : 

Pediatric CIS Death of child Prolonged rescue, especially if child dies Child abuse Mutilation Intense media coverage Identification with victim

Acute CIS Reaction : 

Acute CIS Reaction Physical: Fatigue Nausea Tremors Sweating Chills Dizziness Shock symptoms

Acute CIS Reaction : 

Acute CIS Reaction Cognitive memory loss decision-making difficulty concentration lapses difficulty setting priorities dysnomia dyscalcula

Acute CIS Reaction : 

Acute CIS Reaction Emotional anxiety fear hopelessness grief anger irritability depression

Acute CIS Reaction : 

Acute CIS Reaction 85% occur in first 24 hours 50% last 3 weeks or longer

Pediatric CIS : 

Pediatric CIS Untreated reactions can progress to Post Traumatic Stress Disorder

Pediatric CIS : 

Pediatric CIS During emergency Warn incoming crews Maintain proficiency; confidence reduces stress Get people having reactions off scene Accept limitations Use breathing control

Pediatric CIS : 

Pediatric CIS Following emergency Defuse as early as possible Debriefings within 24 to 72 hours Physical exercise reduces stress Avoid sugar, caffeine It’s OK to cry Take care of spouses/families too