Parental understanding and self-blame following sudden infant death: a mixed-methods study of bereaved parents' and professionals' experiences

The psychological consequences of Sudden Infant Death Syndrome (SIDS) for the family system: A systematic review

The Sudden Infant Death Syndrome (SIDS) is a tragic and difficult experience for families. It involves not only the death of the baby but also the loss of a future as a parent, sibling or grandparent. The subsequent grief is multifaceted and each family member has different needs and resources. Through a systematic review of literature, we identified 24 studies between 1982 and 2021: they dealt with individual, family and couple experience when a SIDS occurs; in addition, some studies compared perinatal loss and neonatal loss with SIDS loss. Our results point out the need for an intervention that focuses on the needs of each family member and tailored around the specifics of SIDS loss rather than general grief.

Sudden Unexpected Death in Infancy [SUDI]: What the clinician, pathologist, coroner and researchers want to know

The loss of an apparently healthy infant is confronting for any family, puzzling for a clinician and challenging for the pathologist charged with the task of demonstrating a cause for death. The term "cot death" evolved to "sudden infant death syndrome" [SIDS] and now "sudden unexpected death in infancy [SUDI]" as the epidemiology and pathology of infant death changed. Community interventions were successful in changing sleep practices for young babies. The current research focus is on understanding genetic predispositions to unexpected death in early childhood. Whilst much has been achieved in reducing the infant mortality rate from SUDI by between 50%, and 80% in some countries, over the last 30 years, there remain challenges for improving rates of accurate diagnosis and reaching out to more vulnerable families with clearly modifiable risk factors for SUDI. These challenges directly involve the clinician through taking a systematic and detailed history and better standardised death scene evaluations with specifically accredited assessors. Better knowledge regarding circumstances of SUDI cases will help Coroners and researchers provide answers for grieving families now, and in the future contribute to further reductions in the rate of SUDI in communities across the world.

Understanding and change - Parents' perspectives of their self-poisoning children: A phenomenological study

PURPOSE

This study aimed to describe the experiences of parents of self-poisoning in Wenzhou, China.

BACKGROUND

Self-poisoning by a child results in severe trauma, placing parents at great risk for psychological and physical problems. However, few studies have examined the experiences of parents following the attempted suicide of their child through self-poisoning, limiting the ability to guide effective services through empirical research.

METHODS

The study adopted a qualitative design and 11 parents whose children harmed themselves through self-poisoning were included. Semi-structure, face-to-face interviews were conducted and Colaizzi's analysis method was followed.

RESULTS

Colaizzi's method identified three key themes: against expectations, sense of guilt, and self-growth.

CONCLUSIONS

The findings highlight the need to understand experiences of parents with self-poisoning children. Nursing staff play an important role in creating a pathway to connect parents with their children. There is a need to include the voices of parents so as to not only care for self-poisoning children but also understand their suicidal behavior.

Bereaved parents’ experiences of being informed about autopsy findings after the sudden and unexpected loss of an infant or small child

Background: Following the sudden and unexpected loss of an infant or small child, the police usually request a forensic autopsy. National guidelines exist for how the autopsy report should be made available for the bereaved parents, but there is limited knowledge whether the guidelines are followed. This study aims to explore bereaved parents’ experiences of being informed about autopsy findings.

Methodology: As part of in-depth follow-up interviews at 13 months post-loss, 24 couples were asked how they experienced being informed about autopsy findings. Participants’ responses underwent thematic analysis.

Results: The results show that the waiting period before the autopsy report was made available was a burden for many parents, particularly those who experienced a delay in the process. Two main themes related to parents’ experiences of being informed when the report was available: ‘informed in a supportive and caring way’ and ‘difficult or negative experiences’.

Conclusion: Several factors are described that help parents cope with being informed about autopsy findings, such as: being informed according to the given timeframe by competent health personnel, face-to-face meetings at the hospital, being able to ask questions and routine follow-up contact. These factors are mostly described in the national guidelines. This study shows that when guidelines were followed, the majority of parents were satisfied with how they were informed. Unfortunately, some parents had negative experiences. Regular training and continuing education for health personnel are recommended.

Cerebellar heterotopia of infancy in sudden infant death syndrome: an observational neuropathological study of four cases

Sudden infant death syndrome (SIDS) is the sudden unexpected death of an infant < 1 year of age that remains unexplained after comprehensive workup including complete autopsy and investigation of the circumstances of death. The triple risk hypothesis posits that SIDS results as a combination of both intrinsic and extrinsic factors on the background of a predisposing vulnerability. Neuropathological examination in the past has focussed mainly on the brainstem as the major player in respiratory control, where subtle findings have been linked to the chain of events leading to death in SIDS. The cerebellum has received less attention, probably due to an assumed negligible role in central cardiorespiratory control. We report four cases of SIDS in which neuropathological investigation revealed cerebellar heterotopia of infancy, a distinct malformation of the cerebellum, and discuss the potential impact of this condition on the aetiology and pathogenesis of SIDS.

Persistent depressive and grief symptoms for up to 10 years following perinatal loss: Involvement of negative cognitions

BACKGROUND

Perinatal loss is known to be associated with a heightened risk of mental health complications. However, the psychological mechanisms underlying the perinatal grief process are less well documented. We hypothesized that negative cognitions are associated with post-perinatal loss symptomatology, and vary according to whether the death occurs before or after birth.

METHODS

We adopted a cross-sectional design to assess demographics, variables related to the death, five types of negative cognitions (about the self, world, life, future, and self-blame), prolonged grief, and depressive symptoms. The sample included 98 perinatally bereaved mothers with a mean age of 33.9 years.

RESULTS

When we controlled for demographics and variables related to the death, hierarchical linear regression showed that maladaptive cognitions about life, the future and the world were associated with prolonged grief symptoms, whereas only maladaptive cognitions about the world were associated with depressive symptoms. Significant interaction effects confirmed that cognitions about the world were associated with increased depressive symptoms when the death occurred after the birth, and cognitions about life when it occurred before the birth.

LIMITATIONS

The cross-sectional design precluded causal conclusions. However, the sample size was relatively representative and limited to perinatally bereaved mothers.

CONCLUSIONS

Different negative cognitions are involved in persistent depressive versus grief symptoms following perinatal loss, and vary depending on the type of loss. These results will serve to enhance perinatal grief interventions.

The Grief of Mothers After the Sudden Unexpected Death of Their Infants

: media-1vid110.1542/5741323271001PEDS-VA_2017-3651Video Abstract BACKGROUND: The loss of a child is associated with elevated grief severity, and sudden infant death syndrome (SIDS) is the leading cause of postneonatal mortality in the United States. The diagnosis of prolonged grief disorder (PGD) has gained broader acceptance and use. Little is known about PGD in mothers after SIDS.

METHODS

Between May 2013 and July 2016, we assessed 49 SIDS-bereaved mothers living in informal settlements near Cape Town, South Africa, and on the Pine Ridge Indian Reservation and 359 SIDS-bereaved mothers affiliated with SIDS parent-support organizations in the United States, United Kingdom, Australia, New Zealand, and the Netherlands. We examined PGD symptom severity and diagnostic prevalence rates between the samples and other significant grief indicators during the period 2 to 48 months after the deaths of their infants.

RESULTS

Extremely high, persistent, and similar rates of PGD were found in both samples at every time interval. The prevalence of PGD was 50.0% in either sample (mean months from loss: 20.5 vs 24.9). Daily, intrusive emotional pain or yearning was found in 68.1% of subjects; yearning was significantly associated with emotional pain (P < .0001). Role confusion and anger were the most prevalent symptoms, reported by the majority at every time interval. Rates of role confusion, anger, and diminished trust in others remained constant. Acceptance was less prevalent than other grief indicators at every interval.

CONCLUSIONS

Severe symptoms and heightened risk for PGD was seen in mothers after their infants died of SIDS, with discernible symptom profiles. Given their involvement with families after SIDS, pediatricians may have a unique role in identifying this problem and helping address its consequences.