Maternal Perceptions of Sudden Infant Death Syndrome

The purpose of the present study was to examine the maternal perceptions of the psychosocial sequelae regarding the loss of an infant to sudden infant death syndrome (SIDS) and the effectiveness of the informal and organized sources of support. Seventy-three mothers experiencing a SIDS death within a 3-year period responded to a questionnaire designed to obtain maternal perceptions of the experience. Results indicate that the death of the infant was viewed as a severe life crisis. However, the majority of the mothers reported increased marital supportiveness, increased emotional closeness to surviving children, and a generally satisfactory adjustment. Perceived emotional support was significantly related to the severity of maternal grief reactions. Although the majority of initial grief symptoms subsided, the data indicate that maternal grief reactions may be more extended than would have been predicted from previous literature. A significant number of mothers reported receiving sufficient informational and emotional support. However, one quarter of the respondents indicated that the support was inadequate. Few mothers contacted mental health professionals and, of those that did, their perception was that this contact was of little or no value. Implications for improved support by mental health professionals as well as directions for future research are discussed. Article: The sudden and unexpected death of an apparently healthy and thriving infant represents a tragedy for both the child and the families of the victims. In a recent study examining deaths in infants between the end of the fourth week of life and the end of the first year during a 17year period from 1962 to 1978, sudden infant death syndrome (SIDS) emerged as the leading reported cause of postneonatal mortality (Khoury, Erickson, & Adams, 1984). The toll from this perplexing syndrome is approximately 8000 deaths a year, or one infant in every 350 live births during the first year of life. The peak incidence of death occurs between 2 and 4 months of age. Almost all deaths from SIDS occur during sleep. Medical autopsies reveal that the deaths appear to occur quietly without any evidence of distress. Although some 75 theories have been postulated as to the cause of SIDS, none has accounted for the disease satisfactorily. As with other forms of sudden and unexpected perinatal death, the parents' grief reaction is usually acute (Mandell & Belk, 1977), and they report this event as the most severe personal tragedy and family crisis they have ever experienced (Defrain & Ernst, 1978). Of particular concern is the emotional sequelae of the death of a child due to SIDS for the surviving family members. Parental misunderstanding of the unknown causal factors in SIDS-related deaths may result in extreme guilt, and blame may be focused on the other parent, often resulting in subsequent marital difficulties (Cornwell, Murcombe, & Stevens, 1977). Indeed, the death of an infant appears to affect every aspect of family life (Miles, 1975). The emotional Impact of the infant's death upon parents, particularly mothers, may be particularly devastating. Among the most common grief symptoms experienced by parents who have lost a child to SIDS are the following fears, loss of appetite, inability to sleep, irritability, anger, preoccupation with thinking about the baby, and guilt (Benfield, Leib, & Vollman, 1978, Smialek, 1978). In one study of 32 families, parents required an average of 16 months to regain the level of personal happiness experienced before the infant's death (Defrain & Ernst, 1978). Because of the intense interdependency between mother and Infant during the early postnatal period, mothers, in particular, are at high risk for pathological grief reactions after an infant's death. In one study of 26 mothers who had experienced a perinatal death, 23% were judged to have experienced morbid and prolonged grief reactions 12 to 20 months after the infant's death (Rowe, Clyman, Green, Mikkelsen, & Haight, 1978). Cullberg (1972) found that 19 out of 56 mothers studied 1 to 2 years after the deaths of their newborn infants had developed various psychiatric disorders. Whereas no such empirical data exist regarding the incidence of pathological grief reactions in the fathers of SIDS victims, there are indications that they also experience similar stages of grief (Cornwell et al., 1977). Depending on the child's age, siblings may be burdened with remorse because of a belief that typical childhood sibling fantasies involving the new infant's death may have caused the event (Mandell & Belk, 1977). Parental response to the surviving children may vary and fluctuate between increased emotional distance and nonavailability to intense protectiveness toward the remaining child or children. In addition, the parents' decision to have another child takes on new dimensions after the death of an infant due to SIDS. The subsequent child may be seen as a replacement for the lost infant, a process that has been shown to be associated with delayed resolution of grief and increased psychopathology in mothers (Benfield et al., 1978). An unexplored area of research for families who experience the death of an infant to SIDS is the effectiveness of various sources of support for these families (e.g., spouse, extended family, friends, support groups of other parents experiencing a SIDS death, and a wide variety of medical, psychological, and social support services) (Rowe et al., 1978, Nicholaisen & Williams 1980). The apparent need for empirical research into this area is highlighted by the findings of Rowe et al., (1978) that mothers of SIDS victims never mentioned medical staff as a source of support. Moreover, they were critical of the lack of contact with their physician after their infant's death. The present study was designed to obtain evaluative data on families who had experienced a SIDS death at some time during a 3-year period. Maternal perceptions of family adjustment as well as the perceived effectiveness of various sources of formal and informal support were examined.