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YOUNGER CHRONIC SICK

Faced with a wealth of epidemiological knowledge, but a paucity of eetiological certainties, there is not much that can be done at present to prevent what (if we extrapolate the South Australian figures in Dr Beal's paper) may amount to hundreds of deaths that are occurring every year in Australia. Where then does the clinician's duty lie? Arrangements to see the parents should be made as soon as possible, the prime aim of this interview being to reassure the parents that this unexpected tragedy was in no way their fault and that accidental suffocation could not possibly have caused their baby's death, nor could they have foreseen or prevented this tragedy. The parents' cooperation should then be sought in searching for any possible cause of death. This will include taking a history from the parents, a post-mortem examination, and virological and bacteriological investigations. A definitive diagnosis in this way should be sought in every case for two reasons. First, it will relieve the parents' own natural guilt feelings that a definitive cause of death has been found and, secondly, it may help to increase our understanding of this little-understood condition. An interview with the parents should be arranged at a later date when the results of all investigations initiated are completed. The parents can then be informed of the cause of death if this has been found, but, more importantly, the parents having recovered from the immediate shock of their unexpected loss will have many questions to ask and many anxieties that need to be relieved.P If the cause of death has been found, this should be explained fully, and, depending on the cause of death, queries about further pregnancies and other siblings can be answered. Explanation will not be so easy in those cases in which no cause of death has been defined. Parents can, however, be reassured that the same tragedy is not significantly more likely to happen to subsequent babies, and that, with our present knowledge, these deaths may be due to an unusual reaction to a relatively minor infection.