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Association Between Sudden Death in Infancy and Co-Sleeping: A Look at Investigative Methods for Galveston County Medical Examiners Office From 1978–2002

Our retrospective case review from 1978–2002, of infant deaths autopsied under the auspices of the Galveston County Medical Examiner Office, demonstrated a lack of detailed scene investigation, including sleeping circumstances and arrangements, as well as a pattern of ascribing the cause of death to SIDS even when there is evidence of a hazardous sleeping arrangement. During this period, 89/103 pediatric deaths were certified as SIDS and 39/103 of these were co-sleeping, 51/103 were sleeping alone, and 17/103 had no sleeping arrangement indicated. Upon review, there were only 6 cases where the scene visitation was documented. Only 9 cases used an Infant Death Investigation Form (IDIF), and this only started in 1999. The IDIF contains questions regarding the infants’ sleep environment (bedding descriptions, co-sleeping, sleep surface) not used in the standard medical examiner death investigative forms. There has been an upward trend since the late 1990s in the number of scenes visited and detailed descriptions of the scenes, likely due to the increased awareness of hazardous infant sleeping conditions identified by American Academy of Pediatrics and U.S. Consumer Product Safety Commission. The association between co-sleeping and sudden infant death remains controversial among clinicians. We report a high association between these two conditions.