Table 3 Studies (case–control, cross-sectional and case series) linking nasal bleeding in infancy with deliberate suffocation
Authors (year)Type of studyCountryNo patientsComments
Southall et al (1997)8Case–control study of ALTEsUK30 patients with deliberate suffocation. 46 controls with medical causes9 of suffocation patients had nasal bleeding compared to 0 controls. This was significant at the p<0.001 level
Becroft et al (2001)9Cross-sectional study of nasal bleeding associated with SIDSNZ365 SIDS cases whose parents were interviewed60 (15%) had nasal haemorrhage. Authors conclude that smothering is a possible common factor, although is unlikely to be the cause in most cases presenting as SIDS
Becroft and Lockett (1997)10Case series of children cared for by two women who had been convicted in court of murder and manslaughterNZ2 pairs of siblings and 10 other children under the same careBleeding from mouth or nose was observed during 6 of 10 previous ALTEs suffered by these children and 3 unrelated infants in the same care. The authors say that “external hemorrhage is well described in imposed infant suffocation”
Meadow (1999)11Personal cases series of infant deathsUK81 cases27 had bleeding around the face
Krous et al (2001)12Case series of sudden infant deathUSA406 cases28 (7%) had nasal or oral bleeding. 14 were considered by the authors to be probably due to CPR. The authors state that the other 14 cases included 10 SIDS, two accidental suffocations and two were undetermined
Truman and Ayoub (2002)13Case series of children who had recurrent ALTEsUSA138 cases12 patients had facial bleeding
  • ALTE, apparent life threatening event; CPR, cardiopulmonary resuscitation; SIDS, sudden infant death syndrome.