Unexpected death of an infant suffocated in the course of breastfeeding when the mother fell asleep

Medico-Legal Journal, Ahead of Print.
Death following accidental suffocation due to overlaying is often overlooked, and still attributed to Sudden Infant Death Syndrome (SIDS). We report a case of sudden infant death following accidental suffocation due to breast overlaying during breastfeeding. We report the death of a two-month-old male baby, without medical history, who was found lifeless wedged under his mother’s breast. The mother subsequently admitted that she had fallen asleep while breastfeeding and awoke a few minutes later to find him wedged under her breast and not breathing. External examination of the infant’s body revealed right frontal congestion with reddish-purple colour of the right frontal skin corresponding to where the mother’s breast had overlaid his face with bilateral conjunctival petechiae with no signs of external injury. Internal examination revealed congestion with petechiae marks of the internal side of the right frontal scalp, with moderate congestion and few petechiae marks at the level of the lungs. The histopathological examination showed non-specific passive congestion, with no abnormalities. The cause of death was attributed to accidental suffocation following obstruction of external airways by the mother’s breast during breastfeeding. Accidental asphyxia cases require extensive investigation of the circumstances surrounding death, reconstruction of events, and careful documentation of the findings observed at autopsy with full histological examination which may become relevant in a specific case in later stages of the investigation.

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