Baby boy possibly suffocated after being placed belly down to sleep: Coroner
SINGAPORE — A two-month-old boy who died after he was placed belly down on a mattress could have suffocated, a coroner’s court ruled, with the State Coroner emphasising safe sleeping habits for babies in her findings.
The baby, aged two months and three weeks, had been placed on his belly with his face turned to the right on a mattress. He was found with face down on the mattress an hour later and his breathing had stopped.
Delivering findings dated 9 October, State Coroner Kamala Ponnampalam said that she was “constrained to record an open verdict” as the cause of the baby’s death could not be ascertained.
Post-mortem findings revealed a well-nourished infant with no abnormalities. There was also no evidence of suffocation. However, suffocation could not be excluded as a possible cause due to the circumstances he was found in.
Before his death on 17 May last year, the baby was bottle fed breast milk by the family’s domestic helper, who then burped him and waited for him to fall asleep. The maid then placed him on a mattress in a prone position, with his head turned to the right. She then left the room, shutting the door behind her.
According to the maid, she turned to her household chores and helped the baby’s two older sisters with showering. As she did not hear the baby cry, she went to take a shower herself before resuming her chores.
When she returned to check on the baby about an hour later, she found him face down on the mattress. She lifted him and saw that his face was pale and he was not breathing. She rushed out of the room and called the baby’s mother on the phone – the mother was out at the time. A while later, the baby’s father returned home to observe milk dripping from his son’s nose.
The boy was taken to the emergency department at Sengkang General Hospital but was pronounced dead at 9.51pm.
While no significant fatal natural diseases were identified, the baby’s lungs were found to be severely congested with blood and fluid. However, a pathologist said that during resuscitation, or when the baby is unconscious, it was not unusual for the bloodstained fluid from the lungs to mix with the regurgitated stomach contents before being expelled through the mouth and nose.
In a further clarification report, the pathologist stated that a prone sleeping position was not likely to cause or contribute to death if there was no circumstantial evidence of someone else sleeping beside the child, or scene evidence indicating that the baby’s nose or mouth was covered by an object.
Possibility that maid was distracted
The baby’s parents gave the view that the domestic helper had been neglectful in looking after the baby, and that this had contributed to his death. Voicing their concerns to the court, the baby’s parents asked why the maid had placed the baby to sleep in his sister’s bedroom rather than his baby cot, why she had fed him breast milk in the evening when he usually took formula milk then, and why the maid only checked on him once and after an hour. They raised the possibility that the helper had been distracted by her mobile phone.
According to the baby’s mother, her son would usually sleep on his belly with his face turned to the side. His neck was strong enough to tilt from left to right and back, said the mother.
The maid said that she put the baby to sleep in his sister’s room as it was nearer to the kitchen and living room so she would be able to hear him if he cried. She also said that she fed him breast milk as he had not slept the whole day and it was still early when she fed him.
She denied using the mobile phone and stated that she had not been distracted by financial issues as these had been resolved by her employers.
Commenting on the case, SC Ponnampalam said, “Once again, we are confronted with unsafe sleeping practices which has possibly led to infant death.”
The SC reiterated advice given by paediatricians on the “ABCs of safe sleep”.
“A – Alone: the infant should not sleep in the same bed as others but not necessarily in a different room. There is always a risk of suffocation from co-sleeping when a larger person rolls over and the infant’s airway becomes blocked.
“B – Back: the infant should always be put to sleep on its back as it has been found to be the safest sleeping position for babies.
“C –Crib: a well-built crib, free of loose bedding, pillows and toys, which could cause entrapment or suffocation.”
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