Hazardous infant and early childhood sleeping environments and death scene examination

Infants and young children are at risk of accidental asphyxia from unsafe sleeping environments Specific dangers include wedging/entrapment and positional asphyxia when infants slide into gaps between mattresses and cot sides or between beds and walls. Faulty cot construction may result in defects through which infants may fall and become suspended, or in spaces which entrap the head. Projections on the inside of cots may ensnare clothing causing hanging, as may nearby curtain cords and restraining harnesses. The mouth and nose may be covered by plastic sheeting or by the mattress in partially filled waterbeds. Rocking cradles with excessive angles of tilt may also place infants' heads into positions where breathing is compromised. Finally, external pressure by adults in shared sleeping situations may result in fatal chest compression or airway occlusion. In many of these situations the autopsy findings are entirely nonspecific and do not help in establishing a cause of death. Thus, careful death scene examination with later formal review of findings may be the only way to accurately determine the manner of death.