General Practictitioners

The Role of the General Practitioner

The role of the General Practitioner in relation to sudden infant death is twofold. Firstly, every GP is a vital resource in the education of families about risk factors for SIDS.

Resources are freely available through SIDS New Zealand: a brochure for parents about SIDS risk factors and for health professionals a booklet reviewing the latest scientific evidence for risk factors. There is also a wide range of bereavement literature available.

Secondly, the role of the General Practitioner has been shown to be very significant for the recovery of affected families. Parents appreciate prompt and well informed professional support and explanation in addition to sympathy and support from family and friends. Usually a bond already exists with the family which combined with the medical expertise of the GP places him/her in a commanding position as a long term support person. Yet difficulties may intrude in this relationship.

i. The doctor's own feelings of disbelief, shock and distress. Doctors are not immune from the disturbing range of emotions that envelop everyone involved with sudden infant death.

ii. Doctors may feel an unaccustomed sense of helplessness in a situation which does not lend itself to the normal range of medical interventions. This may be accompanied by a sense of failure that nothing can be done.

iii. The sense that perhaps something was missed can create feelings of guilt for the GP not unlike those which the parents themselves are experiencing.

Grief usually gives rise to anger and this emotion may well be directed towards the doctor on occasions – an uncomfortable experience especially if taken personally! Yet anger is actually often part of the deeper question... "Why?"

Appropriate Interventions

While it is relatively rare for the GP to be called to attend a sudden infant death, familiarity with the recommended emergency response will prepare the GP to respond appropriately at whichever point they intervene. In the immediate event:

BE there.... Attend the home as soon as possible. Your presence as a competent compassionate professional is significant.
Decide if attempted resuscitation is necessary.
Certification of the death by a medical practitioner is a requirement by law.
Give accurate information about SIDS.
Advise that the police will visit. This is a requirement of law and not related to any imputation of guilt on the part of the parents.
Explain the duty of the Coroner and need for an autopsy to confirm the death was not preventable.
Allow parents adequate time to hold their baby and say goodbye. They may wish to accompany their baby to the place of autopsy.
Avoid unnecessary sedation. This tends to delay the normal grief process and the necessary expression of feelings. Parents may regret at a later point their inability to be fully involved. Short acting hypnotics to assist sleep may at times be appropriate.
Advice on lactation suppression. La Leche League New Zealand may be helpful.
Inform parents about SIDS New Zealand and the support network available. GPs are encouraged to make contact with SIDS New Zealand as soon as possible to work with them in assisting the family.
Take note of siblings especially surviving babies of a multiple birth. These infants are at increased risk of morbidity/mortality in the first 24 hours and should be closely monitored until illnesses such as infections and malformations have been eliminated as a cause of death. If a diagnosis of SIDS is made, the risk to a surviving twin is very low, similar to that for any subsequent sibling.
Ensure a relative or close friend is near for immediate support in the next day or two and offer an explanation to this person as well.
Above all assist the parents to make their own decisions and choices at each of the stages outlined.

Autopsy Procedure

The following is intended as a guide to the autopsy procedure which may vary between areas. For more specific information refer to your local Coroners Office.

Infants are usually transported for autopsy by the government contractor following police arrangements. Every attempt is made to perform the autopsy as quickly as possible.
As soon as a preliminary result is available the pathologist notifies the Coroner and a report is prepared.
These results are communicated to the parents as soon as possible.
The GP may discuss the preliminary results with the pathologist to determine any particular details which may be relevant to parents should they require more information.
The GP may discuss the preliminary results with the pathologist to determine any particular details which may be relevant to parents should they require more information. In some region the pathologist is also available to address parents' concerns.
Final results are usually available from the Coroner within twelve weeks when toxicology, microbiology and histopathology tests are completed.
Handprints, footprints, a lock of hair may be taken by the funeral director or the pathologist after the autopsy. Parents are usually pleased to have these lasting memories of their baby and should be made aware of these options.

Follow Up

In the coming months the family will appreciate your ongoing support and assistance.

i. Final results

The final autopsy results will raise further questions for the parents about the exact manner of death and the possibility that it may have been preventable. Many will want to discuss the detail of the report with a medical practitioner. The GP is well placed to interpret the autopsy findings and explain the implications of the various investigations.

Consultation with the relevant pathologist to determine any particular details relevant to the parents is advisable. Parents will benefit from the opportunity to talk through with their GP their doubts and fears about the cause of their baby's death.

ii. Illness

Severe stress can result in illness and even proneness to accidents. Related visits to the surgery provide an opportunity for the GP to express ongoing concern and support for the family as they come to terms with their loss. Always enquire about how they are going, acknowledging the difficulty of the process. Advice about the grief process will be helpful. As the months progress the GP can gauge whether a family member may require professional help in dealing with the loss. Fathers are as vulnerable as mothers during this period and the needs of siblings ought not to be overlooked.

iii. Subsequent Children

Ambivalent feelings around the question of having another baby are common. Parents will be more anxious about a new pregnancy and extra supervision and monitoring may be advisable. Likewise parents' anxieties for their newborn will be considerable. Discuss the advantages and disadvantages of home monitoring. Take parents seriously should they present with health concerns for their new baby. In the case of a SIDS death, parents need to be reassured that older surviving children are not at risk of SIDS. For subsequent children the risk is very low especially if the 'reducing the risk' factors are implemented.

Conclusion

Everyone involved with a sudden infant death is profoundly affected by the confusion of emotions that is evoked. Reactions differ and it is important to find ways of dealing with and expressing your own feelings. SIDS New Zealand are available to assist anyone who is affected by the event of a sudden infant death.