Sudden Infant Death Syndrome Differential Diagnoses

Updated: May 16, 2022
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Kirsten A Bechtel, MD  more...
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Diagnostic Considerations

A clinician untrained in forensic medicine may inadvertently overlook or destroy gross or trace evidence. Furthermore, misinterpretation of physical injuries or other objective evidence may lead to an inaccurate opinion that, if documented on the chart, may pose considerable problems when used in future court proceedings.

Tragic consequences can follow the misattribution of an infant’s death. One example is that of a young African American couple who were criminally charged after a medical examiner indicated that their baby had died of abandonment—even though autopsy findings were consistent with SIDS and there were no signs of abuse or neglect. The couple spent 6 months in jail because they were unable to post bond before the charges were dismissed.

Similarly egregious examples may be found at the other end of the spectrum, as illustrated by the case of Mary Beth Tining. Only when Tining was charged with the smothering death of her adopted daughter was it discovered that 8 of her biologic children had died, their deaths having been attributed to SIDS or other natural causes. A similar case is that of Waneta Hoyt, who was convicted in 1995 of murdering her 5 children between 1965 and 1971, all of whom were described as having succumbed to SIDS.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Aberrant thermoregulation

  • Brain stem tumor

  • Cardiac dysrhythmias

  • Chiari malformation type I

  • Choanal atresia/stenosis

  • Central nervous system immaturity

  • Congenital central hypoventilation syndrome

  • Congenital heart disease

  • Craniofacial abnormalities

  • Disorders of cardiorespiratory control

  • Drowning

  • Drug exposure

  • Fluid and electrolyte imbalance

  • Gastroesophageal reflux

  • Heat injury

  • Hemangioma

  • Lymphangioma

  • Laryngomalacia

  • Mast cell activation

  • Neuromuscular disorders

  • Occult trauma

  • Pharyngeal/retropharyngeal mass

  • Poisoning

  • Respiratory syncytial virus infection

  • Seizures

  • Shaken infant impact syndrome or nonaccidental trauma

  • Suffocation

  • Toxin exposure

  • Tracheobronchial or esophageal foreign bodies

  • Tracheoesophageal fistula

  • Tracheomalacia

  • Upper airway obstruction

  • Vascular malformation

  • Vascular ring

  • Vocal cord paralysis

Differential Diagnoses