Editor’s Note: Dr. Julie Evans (she/her) is a resident physician in pediatrics at the University of Virginia. She is interested in general pediatrics and global health. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Sudden unexpected infant death (SUID) is the fear of every parent and something pediatricians try to prevent through education. Unfortunately, SUID occurs, with sudden infant death syndrome (SIDS) being the largest proportion of these tragedies.
When an infant dies suddenly and unexpectedly, an autopsy and death scene investigation (DSI) are required. The DSI includes a voluntary reenactment, using a doll, to rule out other causes of death.
Dr. Pål Kristensen and colleagues from the University of Bergen (Norway), University of Oslo, and Harvard Medical School looked into how parents experience this reenactment in their article entitled, “Bereaved Parents’ Perceptions of the Doll Reenactment After Sudden Unexpected Infant Deaths,” which is being early released this week in Pediatrics (10.1542/peds.2024-066731).
This study was conducted in Norway, where forensic professionals complete the DSI, including voluntary doll reenactment. During reenactment, which occurs at the place of death, parents are presented with a doll and asked to demonstrate for investigators their infant’s last observed sleeping position and environment. Although one might expect that this would be distressing to parents who are actively grieving the loss of their child, parent reactions have never been explicitly studied until now.
The authors studied 30 of the 42 DSIs in Norway from 2013 to 2016, involving 45 total parents. A questionnaire and semi-structured interview were completed to collect sociodemographic information, identify which parent found their deceased infant, and to gauge overall reaction to the reenactment.
The authors found that:
- Mothers were more likely than fathers to have found their deceased infant.
- 44% of parents reported moderate to severe distress during reenactment.
- Distress during reenactment and having unwanted, involuntary memories of finding their child lifeless were associated with higher distress at the time of interview, both with investigators and researchers.
Results from semi-structured interviews with parents fell into 4 overarching themes:
- The nature of consent (consent process did not reflect what would happen during the doll reenactment, feeling like they could not change their minds about participation, etc.)
- Parents’ perceptions of the doll (negative and positive)
- The ordeal of the doll reenactment (anticipation, feeling numb, some feeling that it was not so bad, as the worst had already happened)
- Benefits of the doll reenactment (closure, understanding of the other parent’s distress)
Parents agree to participate in the doll reenactment of their infant’s death for many complicated reasons and react in a variety of ways. While this study did not have the statistical power to make any cause and effect associations, it was able to generate many hypotheses about how to improve the doll reenactment for parents overall.
After an infant dies suddenly and unexpectedly, many legal and necessary procedures can be traumatic, but also therapeutic. This and similar research can certainly help push us toward the therapeutic.
