SUIDI Reporting Form: A Guide for Investigators

The SUIDI Reporting Form is a guide for novice and veteran investigators of infant deaths. The form is designed to ensure that all information is collected in a consistent, sensitive manner. The form is designed as a questionnaire. You can read the questions to the person you are interviewing. Most questions can be answered by placing an "x" in the corresponding box or filling in the blank. The eight-page form is divided into nine sections. For more information, contact us.

Download the SUIDI Reporting Form (1.31MB) Download the How to Use the SUIDI Reporting Form (227KB) Download the SUIDI Additional Investigative Forms

1. Investigation Data
   This section is filled out first by the person (e.g., coroner, death scene investigator, law enforcement official, medical examiner) who interviews the witness.

• Primary residence. Address where the infant was living when he or she died.
• Incident address. Address where the infant died or where the final injury occurred.
• Witness. Person who knows some or all of the circumstances surrounding the infant’s death. This may be the person who 1) last placed the infant in or near the area where he or she was found not breathing or breathing with distress, 2) last observed the infant alive, or 3) found the infant not breathing or breathing with distress.

2. Witness Interview
   This section is filled out by the person who interviews the witness.

• Usual caregiver. The person who took care of the infant more than 50% of the time.
• Last placed. The last time the infant was put down to sleep or rest (e.g., in a crib).
• Last known alive (LKA). The last time the infant was observed alive (e.g., time when a parent heard the infant cry).
• Found. The act of finding the infant not breathing or breathing with distress.
• Positional support. Item such as a wedge or pillow used to keep an infant on their side or back while sleeping.
• Wedging. Being caught in a narrow space that causes interference with chest wall movements and normal breathing (e.g., infant wedged between mattress and bed frame).

3. Infant’s Medical History
   This section is filled out by the person investigating the infant’s death. This information may be obtained from the infant’s health care provider, medical record, or caregiver.

• Metabolic disorder. A disease that affects a person’s ability to use or metabolize food (e.g., Medium chain acyl-CoA dehydrogenase (MCAD) deficiency).
• Birth defect. A physical or functional abnormality that the infant had at birth (e.g., spina bifida, congenital heart defect, Down syndrome)
• Newborn screen. Tests done at birth to detect certain metabolic disorders.

4. Infant Dietary History
   This section is filled out by the person investigating the infant’s death. The information should be obtained from the person who last fed the infant. If that person is not the person who usually fed the infant, also interview the infant’s usual feeder.
    
5. Pregnancy History
   This section is filled out by the person who interviews the biological or birth mother or someone who knows her history well (e.g., her health care provider, partner, or mother).
    
6. Incident Scene Investigation
   This section is filled out by the person investigating the infant’s death.
    
7. Investigation Summary
   Investigators use this section to describe any concerns they have that are not documented in the preceding sections of the form. Investigators may use the checkboxes to indicate when tasks, such as doll reenactment, are completed.
    
8. Investigation Diagrams

   Scene Diagram. The investigator indicates the following on the scene diagram:

   • North direction.
   • Windows and doors.
   • Wall lengths and ceiling height.
   • Location of furniture, including infant’s bed or sleep surface.
   • Location of infant’s body when found.
   • Position of other people or animals found near the infant.
   • Location of heating and cooling devices and other objects in room.

   Body Diagram. The investigator indicates the following on the body diagram:

   • Discoloration around face, nose, or mouth.
   • Secretions (drainage or discharge from anywhere on the body).
   • Skin discoloration (livor mortis).
   • Pressure mark areas (pale areas, blanching).
   • Rash or petechiae (small, red blood spots on skin, on membranes, or in eyes).
   • Marks on body (scratches or bruises).
   • Location of medical devices (e.g., breathing tube, gastrostomy feeding tube).
   • Body temperature.
      
9. Summary for Pathologist
   This section summarizes all the information collected during the witness interview and during the investigation at the incident or death scene. This section should be completed last by the person investigating the infant’s death.

• Asphyxia. Condition of severely deficient supply of oxygen to the body that can rapidly lead to unconsciousness and death (e.g., compression of infant’s chest because he was wedged into a narrow space or had a person lying on him).
• Overlying. Situation in which someone or something is placed on or over the infant.
• Hyperthermia. Life-threatening condition in which the core body temperature is above 40°C (104°F).
• Hypothermia. Life-threatening condition in which the core body temperature falls below 35°C (95°F).

Using the SUIDI Additional Investigative Forms

Additional investigative forms can be used by death scene investigators to collect information about the circumstances surrounding a sudden, unexplained infant death and to document personal contacts and collection of evidence. While these forms can be used in addition to the SUIDI Reporting Form to collect important investigative information, this information is not thought to be essential prior to autopsy.

These forms are designed as a questionnaire. The death scene investigator can read the questions to the person they are interviewing. Most questions can be answered by placing an “x” in the corresponding checkbox or filling in the blank provided. Each of these forms can be used alone, or if desired by the local jurisdiction, they can be used with the SUIDI Reporting Form.

Listed below is the name and purpose of each investigative form and definitions of terms not commonly recognized.

1. Body Diagram PDF 295KB
   This diagram is a larger version of the diagram included in the SUIDI Reporting Form. It can be used in place of the smaller version. The diagram can be used to note bruises, discoloration and other observations such as the following:

• Discoloration around face, nose, or mouth.
• Secretions (drainage or discharge from anywhere on the body).
• Skin discoloration (livor mortis).
• Pressure mark areas (pale areas, blanching).
• Rash or petechiae (small, red blood spots on skin, on membranes, or in eyes).
• Marks on body (scratches or bruises).
• Location of medical devices (e.g., breathing tube, gastrostomy feeding tube).
• Body temperature.

2. EMS Interview PDF 821KB
   The investigator uses this form to gather information from emergency medical service (EMS) personnel who responded to the scene. It can be used to augment the EMS run sheet if the sheet is not available.
3. Hospital Interview PDF 461KB
   The investigator uses this form to gather information from the hospital emergency department personnel who treated the infant. This form can be used to augment the hospital records. The form can be used to interview hospital personnel if the medical records are not available.
4. Immunization Record PDF 228KB
   The investigator uses this form to document all immunizations the infant received since birth. The investigator can get this information from the parent or caregiver’s immunization records or from medical records at the infant’s clinic. To date, there is no evidence supporting an association between immunizations and SIDS.
5. Infant Exposure History   PDF 628KB
   The investigator uses this form to identify all persons who were in contact with the infant in the 24 hours before the infant’s death. This form may be used to document day care contacts or people attending large family or community gatherings.
6. Informant Contact PDF 143KB
   The investigator uses this form to track contact information for each person interviewed.
7. Law Enforcement Interview PDF 842KB
   The investigator uses this form to gather information from law enforcement personnel who responded to the scene. This information can be collected from interviews with law enforcement personnel and by reviewing law enforcement reports.
8. Materials Collection Log PDF 223KB
   The investigator uses this form to keep a detailed, descriptive list of all items recovered from the incident or death scene.
9. Nonprofessional Responder Interview PDF 133KB
   The investigator uses this form to gather information from the first nonprofessional (e.g., caregiver, neighbor) who responded to the infant at the scene.
10. Parental Information PDF 97KB
    The investigator uses this form to gather contact information about the infant’s mother, father and/or other primary caregivers.
11. Primary Residence Investigation PDF 784KB
    The investigator uses this form to describe the infant’s primary residence if the incident or death did NOT occur at the primary residence.
12. Scene Diagram PDF 113KB
    The investigator uses this form to diagram multiple scenes or when a larger diagram is needed to document the scene. This form is used to document the immediate area surrounding the infant when the infant was discovered dead, unresponsive, or in distress. The investigator uses the form to record observations, such as the following:

• North direction.
• Windows and doors.
• Wall lengths and ceiling height.
• Location of furniture, including infant’s bed or sleep surface.
• Location of infant’s body when found.
• Position of other people or animals found near the infant.
• Location of heating and cooling devices and other objects in room.

Training Material
The SUIDI training text was developed to help those who investigate infant deaths, and it was used at the SUIDI national training academies.

50-State Summary of SIDS Laws* (The National Conference of State Legislatures)

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Page last reviewed: 6/10/08
Page last modified: 6/10/08
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion