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Comment by emodendroket | Hacker News Reader

Since having a kid and reading a lot I've been bothered by how clearly a lot of what is labeled as "SIDS" is pretty clearly accidental suffocation. The conclusion is impossible to escape when you begin reading about measures that have "reduced SIDS." Yet I also wonder if continuing to observe this social fiction is just a way of keeping overzealous prosecutors and other crusaders from locking up and treating as depraved murderers grieving families for accidental deaths.

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A tiny selection of the relevant literature:

[1] https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1099-0...

[2] https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1440-1754....

[3] https://link.springer.com/article/10.1007/s12024-014-9600-5

[4] https://publications.aap.org/pediatrics/article/143/5/e20183...

These do bolster my point but it becomes more striking in resources intended for parents where one minute they’re telling you the mechanism of SIDS is poorly understood and the next they’re giving you advice that is clearly about removing suffocation risks from the sleeping environment. Though there is similarly strange advice about “preventing shaken baby syndrome” which turns out to be just anger management tips. I guess the sensitive nature of the topic makes frank discussion difficult.

Not an expert but it seems to me you'd be making the same kind of error that the article denounces: attaching equal value to direct evidence on the one hand and inference to the best explanation on the other. If a physician does not observe tell-tale signs of suffocation in an infant, then it is not their role to say "Well, statistically speaking, or logically speaking, pretty good chance it's accidental suffocation isn't it? I'll jot this down as Accidental Suffocation Syndrome" or alternatively "I know in my heart that this is accidental suffocation but let's just call it SIDS for the benefit of the parents" but rather they should simply conclude "there's not enough evidence, therefore this death remains unexplained".

Some measures that reportedly reduce “SIDS” include assembling the crib properly and not putting soft objects that could smother the baby in the crib. Risk factors include lower parental educational attainment. You tell me if I’m being unreasonable attributing a death from the crib collapsing to suffocation and not a mysterious, poorly understood disease. When a baby dies in the crib it is rare for much investigation to be done that would conclusively suggest suffocation and it is usually just labeled SIDS.

I mean, I don't mind, you can attribute whatever to whatever and yeah, a crib full of plush toys doesn't seem like such a smart idea... but the question is what a doctor should do, how we want them to behave in the face of limited evidence.

SIDS is intended as a diagnosis of last resort but is often used with little digging so it's not really any different than the case this article discusses, except with the opposite result. I never demanded that doctors start doing something different but I think it's pretty obvious we're just collectively leaving some stones unturned here.

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