Child abuse and sudden infant death syndrome

Ann Botash reviews the current literature regarding the association of retinal hemorrhage and subarachnoid bleeds in infants who have suffered head trauma. Particular emphasis is placed on differentiating these findings from those in children who suffer other forms of trauma, especially cardiopulmonary resuscitation. The office practitioner needs appropriate skills in performing careful retinal examination and when to refer patients to an ophthalmologist for specific evaluation. The current literature on sudden infant death syndrome is reviewed in this section by Steven Blatt and Victoria Meguid. Specific studies about sleep position are analyzed and the rationale for the "back to sleep" movement is explained from a physiologic standpoint. The impact of maternal smoking and poor prenatal care is also reviewed in the form of a number of epidemiologic studies. It is important for the clinician to recognize that there is often a fine line differentiating sudden infant death syndrome and infanticide. The pediatrician needs to be aware of the importance of careful investigation of death scenes to insure that we are not missing other causes of death in those patients who are labeled as having died of sudden infant death syndrome.