SIDS Program Manual SIDS & Infant Death Program Manual and Trainer's Guide Trainer's Guide

What is SIDS?


Diagnostic Shift

SIDS programs and researchers have suggested that the recent modest decline in SIDS rates may not only be due to successful public health campaigns, but also changes in classification—or a diagnostic shift. This decline may reflect medical examiners and coroners not assigning a SIDS diagnosis when bedsharing or other risk factors are present. In the past, these same deaths would have been labeled SIDS. Today, they are likely to be diagnosed as undetermined or accidental asphyxia.

Researchers have reviewed international and national data to examine and compare trends. The data appears to support a genuine decline in SIDS deaths although there does appear to be some level of diagnostic shift. Researchers have found while there has been no increase of infant deaths due to aspiration, there has been an increase of suffocation deaths and potentially a very small number of SIDS deaths reclassified as suffocation.94

During the past few years (1999-2001), the decline has not been as significant as the previous years. One explanation for this might be a diagnostic shift. Along with the decrease in SIDS diagnosis, there has been an increase in the “undetermined” diagnosis. The failure of the total postneonatal death rate to fall from 1999 to 2001 also suggests that some deaths are being reclassified to other causes.95

Chart 1.4 : SIDS and Undetermined Diagnosis

Chart 1.4 : SIDS and Undetermined Diagnosis