Analysis of sudden infant death syndrome coverage in Canadian newspapers

Abstract

Sudden infant death syndrome (SIDS; also known as crib death) describes the sudden unexpected death of an infant under one year of age, which remains unexplained after a thorough investigation. SIDS is a public health concern. It is the fourth leading cause of infant death in Canada. Newspapers are a major source of health information for the public, shape public perceptions and can direct the discussion around issues. Despite the potential influence of newspapers, no study has examined the portrayal of SIDS in Canadian newspapers over time. The purpose of our study was to gain an understanding of SIDS coverage in Canadian English language newspapers using the Canadian Newsstream database from 1970 to 2015 and the historical database: The Globe and Mail from 1844 to 1977. Generating descriptive quantitative and qualitative data, we noted a decline in SIDS coverage over time. Blame and misdiagnosis were two dominant themes in the coverage of SIDS with many other aspects around SIDS missing; for example, indigenous people, who are at higher risk for SIDS, were rarely mentioned. Our findings suggest problems in the content and frequency of coverage of SIDS that have the potential to shape the public understanding of SIDS.

Keywords

Canadian coverage crib death newspaper analysis sudden infant death syndrome (SIDS)

Sudden infant death has been recognized since ancient times with ‘sudden infant death syndrome’ (SIDS) being the main descriptor since 1968 (Russell-Jones, 1985). SIDS describes the sudden death of an infant under one year of age, whereby the death is unexpected and remains unexplained after a thorough investigation (includes complete autopsy, review of circumstances of death, and clinical history) (Moon and Fu, 2012). Several other terms have been used over time and still are used, such as ‘sudden unexpected death’ and ‘sudden unexpected death in infancy (SUID)’ with little consistency from one country to another (Taylor et al., 2015).

Rates of SIDS have fallen in the United States, between 1993 and 1996 due to safe sleep campaigns and other unknown factors but have since then stalled (Goldstein et al., 2016). From 1999 to 2004 in Canada, a 50% decline in SIDS rates was reported, which in part was attributed to compliance with the back to sleep campaign (Public Health Agency of Canada, 2008). Other factors that have been linked to the decline in SIDS rate include decrease in maternal smoking and increase in breastfeeding (Gilbert et al., 2012).

However, SIDS is still a public health concern as it remains one of the leading causes of death for infants in Western countries (Horne et al., 2015) and the fourth leading cause of infant death in Canada (Gilbert et al., 2012). In Canada, aboriginal infants have the highest rates of SIDS, with risk factors including prenatal exposure to tobacco smoke, inadequate housing due to overcrowding, poverty, and young maternal age (British Columbia Coroners Service, 2009).

What causes SIDS?

SIDS has been the target of academic inquiry, with various issues such as its cause still unresolved. Major ‘modifiable’ risk factors of SIDS have been identified and include exposure to tobacco (pre- and postnatal), prone position, sharing a sleeping surface with an adult and not breastfeeding (Horne et al., 2015). Bed sharing as a risk factor for SIDS has been met with controversy, as it is a common practice in many Western households and around the world (Horne et al., 2015). SIDS is proposed to be multifactorial in origin (Horne et al., 2015). The triple risk model, a conceptual framework proposed for SIDS consists of the following three factors: underlying vulnerability (such as being born preterm), critical developmental period, and exposure to an external stressor (such as prone sleep position) (Horne et al., 2015).

SIDS in media

Mass media, including newspapers, are a major source of health information for the public (Chapman and Lupton, 1996). Even though the Internet has increasing impact, newspapers continue to be an important medium for knowledge dissemination (Slater et al., 2008). Newspapers also have the ability to shape beliefs, public perceptions, and are vital in directing the discussion around social issues (Nord, 1988). Despite the potential influence of newspapers, studies that examined the portrayal of SIDS in newspapers over time are rare. Indeed, we could only find one English language study that focused on the coverage of infant sleeping position and SIDS in three UK newspapers (The Times, Guardian 1985–1991, and The Sun 1988–1991) (Hilliard et al., 2007). Our study is the first to analyze SIDS portrayal in English language Canadian newspapers and one that covers a broader scope (time and content) than the existing study.

Our study adds to the SIDS discourse descriptive, quantitative data from analyzing 300 Canadian English language newspapers and qualitative data from analyzing three Canadian English language newspapers: The Globe and Mail, National Post (the two Canadian newspapers with national reach), and Calgary Herald (local newspaper). Our study answers the question: How is SIDS covered in Canadian newspapers?

Methods

Analytical framework

We used a framing analysis to investigate the coverage of SIDS in Canadian newspapers. Frames provide interpretations of different issues (Vliegenthart and van Zoonen, 2011). In our analysis, we looked at how newspapers framed issues related to SIDS and the implications of such framing. The 2011 report: Sudden Infant Death: A Global Problem, Local Action. Report to Public Health Agency of Canada (Mitchell, 2011) and the 2009 report on sudden infant death in sleep-related circumstances: Safe and Sound: A Five-Year Retrospective (British Columbia Coroners Service, 2009 ) were used as lenses to analyze the newspaper content around SIDS.

Data source

From the Canadian Newsstream (CNS) ProQuest online database, over 300 Canadian newspapers published from 1978 to 2015 were accessed (May 4, 2015; May 17, 2016). The CNS database includes newspapers such as The Globe and Mail, Toronto Star, National Post and provides full online access to articles, columns, editorials, and features (ProQuest, 2017). Within the database, we accessed three Canadian newspapers, two national (The Globe and Mail and National Post) and one local (Calgary Herald) (May 4, May 14, and June 9 2015). The CNS was accessed through the University of Calgary library. Additionally, The Globe and Mail historical ProQuest database was used to access articles from 1844 to 1977 (May 17, 2016).

Data collection

Descriptive quantitative data

Approach 1: We searched the CNS database and The Globe and Mail historical ProQuest database from 1844 to 1977 to collect descriptive quantitative data on four terms for the sudden death of an infant (SIDS, sudden unexpected death in infancy, SUID, and crib death) ( Centers for Disease Control and Prevention, 2017; Health Direct, 2016; SIDS Calgary Society, 2017).

Approach 2: To obtain additional search terms on risks, prevention, and social groups related to SIDS for quantitative analysis, we used the 2011 report: ‘Sudden Infant Death: A Global Problem, Local Action. Report to Public Health Agency of Canada’ to generate search terms (Mitchell, 2011). We also generated terms from reading downloaded articles from the three Canadian newspapers. Search terms that were identified from both sources were also identified using the Word Cruncher function from ATLAS.ti. The Word Cruncher function generates a frequency of every word in a given set of downloaded documents.

Qualitative data

Approach 1: To obtain our sources from the CNS database for qualitative data analysis, we searched for the terms ‘SIDS’ and ‘crib death’ in ‘anywhere’ within The Globe and Mail, National Post, and Calgary Herald (May 4, 2015). Articles from The Globe and Mail (n = 254), National Post (n = 106), and Calgary Herald (n = 183) containing the search terms ‘SIDS’ and ‘crib death’ were downloaded in PDF format and then imported into the software, ATLAS.ti, for thematic qualitative content analysis.

Approach 2: To obtain additional sources for our qualitative data analysis, we searched the Globe and Mail historical ProQuest database from 1844 to 1977 for ‘SIDS’ (n = 12), and ‘crib death’ (n = 29; May 17, 2016) and the articles were downloaded for thematic qualitative content analysis.

Data analysis: To obtain descriptive quantitative data, we searched the CNS database on May 14, June 9, June 29, and July 21, 2015 for the terms identified.

We furthermore generated descriptive quantitative numbers for the frequency of terms in the downloaded articles from The Globe and Mail historical ProQuest database (1844–1977) that contained ‘SIDS’ (n = 12) and ‘crib death’ (n=29; May 17, 2016)

We used the software ATLAS.ti (version 7) to perform a qualitative thematic content analysis of the downloaded newspaper articles from the Globe and Mail, National Post, and Calgary Herald. Coding was semi-deductive as certain themes identified from the quantitative analysis (risk factors and risk reduction) were also searched for in the qualitative analysis. Two authors read the downloaded articles and performed the thematic analysis. Discrepancies of codes and themes generated between the two authors were resolved through discussions.

Limitations

The focus of this study was on Canadian newspapers. Sources such as social media or online only news content (e.g. Canadian Broadcast Corporation) were not the focus and therefore were not included. Furthermore, the focus was on English language newspapers only. Therefore, our results cannot be generalized for media in general, newspapers in Canada, and media including newspapers from other countries. Since our search, the CNS had changed its name from Canadian Newsstand Complete to CNS and also updates its database constantly, which could alter the article counts for certain search terms slightly if they are searched for the same time frame at different dates.

Trustworthiness measures

Credibility/dependability, confirmability, and transferability are trustworthiness measures (Baxter and Jack, 2008; Bryman, 2012; Lincoln and Guba, 1985; Shenton, 2004). To enhance the credibility of this study, two coauthors engaged in peer debriefing on the generation of qualitative and descriptive quantitative data. For instance, the coauthors examined the newspaper articles and discussed discrepancies in codes and themes that were generated from the analysis. An audit trail is important in being transparent within the research process and therefore increasing confirmability. A complete audit trail of the study was kept, which included search terms, newspaper articles, and codes and themes generated on ATLAS.ti. As to transferability (Baxter and Jack, 2008; Bryman, 2012; Lincoln and Guba, 1985; Shenton, 2004), the authors made clear the terms used for the descriptive quantitative search, therefore other researchers may utilize the same search terms to generate their own search.

Results

The results section is divided into sections reflecting major themes of our findings. Within each of these sections, both descriptive quantitative data and then results of the qualitative thematic content analysis are discussed. From our quantitative approach, we obtained frequencies of all terms associated with SIDS such as risk factors, risk reduction, and social groups. Tables 1 and 2 present the terms linked with SIDS and crib death and their frequencies. From our qualitative content analysis of three Canadian newspapers (The Globe and Mail, National Post, and Calgary Herald), the following main themes were identified in relation to ‘SIDS’ and ‘crib death’: coverage of risk factors and risk reduction, social groups, labeling and misdiagnosis of SIDS, and blame.

Table 1.
Potential causes of infant death and risk factors of sudden infant death and crib death mentioned in articles of the CNS database.

Risk factor/potential cause Total number of articles, n = 4257 (%) Total number of articles 1970–1989, n = 259 (%) Total number of articles 1990–1999, n = 1361 (%) Total number of articles 2000–2009, n = 2141 (%) Total number of articles 2010–2015, n = 496 (%)

SID

Apnea 73 (1.7) 23 (8.9) 38 (2.8) 11 (0.5) 1 (0.2)

Bacteria 105 (2.5) 6 (2.3) 24 (1.8) 70 (3.3) 5 (1.0)

Bed sharing 100 (2.3) 0 (0) 20 (1.5) 55 (2.6) 25 (5.0)

Caffeine 18 (.4) 5 (1.9) 7 (.5) 6 (.3) 0 (0)

Flu 10 (.2) 6 (2.3) 4 (.3) 0 (0) 0 (0)

Digoxin 19 (.4) 19 (7.3) 0 (0) 0 (0) 0 (0)

Gene 68 (1.6) 1 (.4) 24 (1.8) 36 (1.7) 6 (1.2)

Homicide 185 (4.3) 13 (5) 82 (6.0) 63 (2.9) 27 (5.4)

Male 108 (2.5) 8 (3.1) 37 (2.7) 46 (2.1) 17 (3.4)

Overheating 101 (2.4) 0 (0) 39 (2.9) 52 (2.4) 10 (2.0)

Pertussis vaccine 14 (.3) 2 (.8) 4 (.3) 7 (.3) 1 (.2)

Phenergan 11 (.3) 11 (4.2) 0 (0) 0 (0) 0 (0)

Paralysis 25 (.6) 7 (2.7) 6 (.4) 12 (.6) 0 (0)

Prone position 28 (.7) 0 (0) 20 (1.5) 5 (.2) 3 (.6)

Premature birth 54 (1.3) 4 (1.5) 8 (.6) 32 (1.5) 10 (2.0)

Smoking 950 (22) 28 (10.8) 226 (17) 601 (28) 95 (19.2)

Suffocation 189 (4.4) 13 (5.0) 64 (4.7) 84 (3.9) 28 (5.6)

Note: CNS: Canadian Newsstream; SIDS: sudden infant death syndrome.

Table 2.
SIDS prevention and/or risk reduction mentioned in articles of the CNS.

Prevention/risk reduction Total number of articles n = 4257 (%) Total number of articles 1970–1989, n = 259 (%) Total number of articles 1990–1999, n = 1361 (%) Total number of articles 2000–2009, n = 2141 (%) Total number of articles 2010–2015, n = 496 (%)

SID

Apnea monitor 10 (.2) 1 (.4) 8 (.6) 1 (.04) 0 (0)

Blood test 27 (.6) 3 (1.2) 5 (.4) 12 (.6) 7 (1.4)

Back to sleep 198 (4.7) 0 (0) 44 (3.2) 124 (5.8) 30 (6.0)

Baby monitor 19 (.4) 0 (0) 2 (.1) 16 (.7) 1 (.2)

Breastfeeding 358 (8.4) 1 (.4) 55 (4.0) 212 (9.9) 92 (19)

Firm surface 10 (.2) 0 (0) 1 (.1) 8 (.4) 1 (.2)

Humidifier 1 (.02) 1 (.4) 0 (0) 0 (0) 0 (0)

Smoke free environment 71 (1.7) 0 (0) 22 (1.6) 36 (1.7) 13 (2.6)

Note: CNS: Canadian Newsstream; SIDS: sudden infant death syndrome.

What is the frequency of different sudden infant death terminology in Canadian newspapers?

From our quantitative approach, four sudden infant death terms were searched within the CNS (SIDS, sudden unexpected death in infancy, SUID, and crib death; Online Supplemental Table S1). ‘SIDS’ and ‘crib death’ were first mentioned in the newspapers covered by the CNS in 1978. ‘Crib death’ was mentioned in The Globe and Mail for the first time in 1964 and ‘SIDS’ in 1973. From 1978 to 2015, the term ‘SIDS’ totaled 4257 article counts in the CNS (which contains over 300 newspapers) and crib death totaled 1134 article counts. These two terms were more frequent (out of the other terms) within Canadian newspapers. Figure 1 demonstrates the trend in ‘SIDS’ coverage from 1844 to 2015. The two other terms ‘sudden unexpected deaths in infancy’ (SUDI) and ‘SUID’ were only mentioned in 10 and 4 articles, respectively.

Figure 1.
Coverage of SID from 1844 to 2015. SID: sudden infant death syndrome.

Coverage of the terms ‘SIDS’ and ‘crib death’

Through a qualitative content analysis of three Canadian newspapers, in majority of the articles, SIDS and crib death were used interchangeably. However, in 11 of 29 articles from The Globe and Mail prior to 1978 (pre-back to sleep campaign), in which only ‘crib death’ is used, the cause of death was attributed to the fault of the crib, and not related to SIDS.

Coverage of risk factors: ‘smoking’, ‘prone position’, ‘bed sharing’, and ‘suffocation’ with SIDS

From the quantitative approach, Table 1 presents the article counts of risk factors that were obtained to gain a sense of the frequency of these risks in relation to SIDS. Smoking is an established risk factor for SIDS. In Canadian newspapers, smoking was first mentioned as a risk factor in 1985 and was the most covered risk factor for SIDS (n = 950). Coverage of smoking was highest from 2000 to 2009 (n = 601).

Through a qualitative content analysis of the articles in ‘The Globe and Mail’, ‘National Post’, and ‘Calgary Herald’, smoking as a risk factor for SIDS was further explored. Maternal smoking or ‘smoking during pregnancy’ (n = 161 articles) was covered more frequently than ‘secondhand smoking’ (n = 9 articles) or ‘parental smoking’ (n = 35 articles). The term ‘triple risk’, a dominant hypothesis in the academic literature was only mentioned in three articles (1985, 2001, and 2014) in the CNS database (one of the articles was from the National Post) (Cutz, 2014).

The prone position, a risk factor for SIDS was mentioned in 28 articles. However, another term used instead of prone position was ‘stomach sleeping’ (n = 35), which revealed more article counts. Other terms used alongside prone position include ‘sleep on stomach’ (André, 2004; Balfour, 2004; Fortney, 2005; Kleiss, 2013; Lowey, 1998; Leong, 2005; Nieman, 2004, 2012; Patricia Anstett, 1992; Reuters, 1991; The Globe and Mail, 1991, 1992a, 1993a, 1993b, 1995a, 2001; Williamson, 2005a, 2005c, 2005f, 2005h), ‘sleeping face down’ (Altman, 1993; Magnan, 2008; Owens, 2003), ‘lying down on its front’ (Reuters, 2000b), ‘sleep on belly’ (The Globe and Mail, 1998a), ‘sleep on tummy’ (Campbell, 1999; The Globe and Mail, 1995b), or ‘tummy down’ (The Globe and Mail, 1992b).

There were 102 articles from 1996 to 2014 for ‘bed sharing’, a controversial risk factor for SIDS. The term ‘co-sleeping’ (n = 94 articles) was found to be used earlier than the term ‘bed sharing’ from 1993 to 2015.

The second most covered risk factor for infant death related to SIDS in Canadian newspapers was ‘suffocation’ (n = 189 articles) (see e.g. The Globe and Mail, 1986a). In Canadian newspapers, suffocation was linked with soft bedding (The Globe and Mail, 1993b), bed sharing (André, 2003; Mickleburgh, 2001; Reuters, 2000a; Sokoloff, 2009), and cluttered bedding (Sherman, 1999), all which are known risk factors for SIDS.

Coverage of vaccines with SIDS

In Canadian newspapers, vaccines combined with SIDS were mentioned in 134 articles, with inconsistency in coverage from 1884 to 2004. Through a qualitative analysis of three Canadian newspapers, pertussis (also called ‘whooping cough’) vaccine was reported as being a cause of SIDS in some articles (Barnes, 1986; Lipovenko, 1984; McFarlane, 1995; Radkewycz, 1987), while other articles reported both concerns about vaccines from parents and rebuttals from pediatric organizations (Kirkey, 2004a, 2004b; Mittelstaedt, 2000). The pertussis vaccine was also portrayed as preventative against SIDS in other articles (André, 2004; Humphreys, 2004; Kirkey, 2001; The Globe and Mail, 2001).

Coverage of prevention and risk reduction of SIDS

From the quantitative analysis, ‘back to sleep’ combined with ‘SIDS’ is mentioned in 198 articles in Canadian newspapers. Pre-back to sleep campaign, from 1970 to 1989, only 10 articles were published about ‘SIDS’ and all were published in The Globe and Mail.

Through a qualitative analysis of individual newspapers, back to sleep is mentioned in seven articles in The Globe and Mail, seven articles in Calgary Herald, and nine articles in National Post. ‘Back to sleep’ is first mentioned in The Globe and Mail in a 1992 article, reporting on research from New Zealand and Australia. However, sleep position being linked to crib deaths was first mentioned in a 1979 article in The Globe and Mail. In Calgary Herald, back to sleep is mentioned later (in 1997), and in National Post, back to sleep is first mentioned in 1999. The year 2000 had the highest number of articles (n = 40) about ‘back to sleep’ in the CNS. Since then, articles about ‘back to sleep’ have declined, with only two articles mentioning ‘SIDS’ and ‘back to sleep’ in 2015.

Breastfeeding, a protective factor for SIDS, has been mentioned in 358 articles in the CNS (from 1978 to 2015). However, in the three papers covered for qualitative analysis, breastfeeding was mentioned in 16 articles in The Globe and Mail, 13 articles in Calgary Herald, and 7 articles in National Post from 1978 to 2015.

From a qualitative analysis of the three Canadian newspapers, apnea monitors were portrayed as preventative from 1973 to 2004 (Andrews, 1998; Clark, 2004; Hollobon, 1983; Kennedy, 1999; National Post, 1999; The Globe and Mail, 1973, 1979c, 1986b, 1993c). Some articles in the National Post, The Globe and Mail, and Calgary Herald do discourage parents from using home monitoring systems to prevent SIDS (Hollobon, 1981; Knight, 1990; National Post, 2001b; Nieman, 2004; The Globe and Mail, 1980). Other products making claims about reducing SIDS have also been mentioned in Canadian newspapers (Jackman, 2001; White, 2015). However, one article from the Calgary Herald (local newspaper) mentions that products cannot claim to prevent SIDS, as no known cause has yet been identified for SIDS (Balfour, 2004).

Coverage of social groups in Canadian newspapers

Using the search terms ‘Aboriginal people’ (n = 15), ‘First Nation’ (n = 22), ‘Indigenous people’ (n = 2), and ‘Inuit’ (n = 24), we found little mention of them (Online Supplemental Table S2). From a qualitative analysis of the articles in the Calgary Herald, only three articles encourage improving health outcomes in aboriginal communities and making children’s health a priority (Calgary Herald, 2013; Mate, 1994; The Canadian Press, 1997). Two articles focused on prevention of SIDS in aboriginal communities (Calgary Herald, 2002; Summerfield, 2000). In The Globe and Mail, one article mentions poor housing conditions for First Nations, impacting infant health (Drews, 2008). Other articles briefly mention aboriginal infants as having a higher risk of SIDS than other infants (Adams, 1999; Calgary Herald, 2000; McGinnis, 2001a, 2001b).

Labeling and misdiagnosis of death in Canadian newspapers

From a qualitative content analysis of three Canadian newspapers, there have been reports on incidences mislabeled as an SIDS death. Articles from 1995 to 2013 in The Globe and Mail have reported on homicides that were mistaken for SIDS at first (Cox, 1983e; Claridge, 1997a, 1997b, 1997c; Gadd, 2000; Makin, 2007a; Malarek, 2002; Matas, 2001; Oliveira, 2008; Rook and Appleby, 2005; The Globe and Mail, 1997, 1998b, 1998c, 1995c), and also in the National Post (Blatchford, 2001a, 2001b; Blatchford, 2013; Bunyan, 1999; Humphreys, 2011; National Post, 2001a; Rook, 2008; Slade, 2012a; Smith, 2011), and Calgary Herald (Anonymous, 2008, ;2010, ;2011; Calgary Herald, 2005, 2006; Forteny, 2011; Jason Van, 2010; Nguyen, 2011; Richards, 2010; Slade, 2011, 2012b, 2012c, 2012d). One article mentions 900 infant deaths that were mistakenly attributed to SIDS and were actually the result of suffocation from soft bedding (National Post, 2000). SIDS has also been misdiagnosed when long QT syndrome was the actual cause of death (André, 2006; Picard, 2005). Usage of the term ‘undetermined’, in place of SIDS, was mentioned in one article (The Globe and Mail, 1979b). Articles from 1980 to 1984 on SIDS (pre-back to sleep campaign) were heavily focused on controversial stories, such as where non-accidental trauma may be involved. Articles in The Globe and Mail have reported on parents receiving two versions on how their infant had died and SIDS being possibly misdiagnosed (Cox, 1982a, 1982b, 1982c, 1982d, 1982e, 1983a, 1983b, 1983c, 1983d, 1983f, 1983g, 1983h, 1984; Kashmeri, 1982; The Globe and Mail, 1980, 1982a, 1982b, 1983a, 1983b, 1984). Misdiagnosis of SIDS has also occurred through misleading use of the terms ‘near miss crib death’ in four articles from 1979 to 1998 (Slade, 1998a, 1998b; The Globe and Mail, 1979a; Zurowski, 1992) or ‘near miss SIDS’ in three articles from 1989 to 2005 (Dohy, 2005; Gilbert, 1989; Nieman, 2001), which are used for living infants.

Coverage of blame with SIDS

Through a qualitative analysis of three Canadian newspapers, ‘blame’ was identified as another theme. Some reporting of SIDS coverage from 1986 to 2002 includes parent’s negligence or poor judgment (Heyman, 2002; Owens, 2000; The Globe and Mail, 1986a) or lack of supervision by caregivers (Fortney, 2005; Williamson, 2005a, 2005b, 2005c, 2005d, 2005e, 2005f, 2005g, 2005h). SIDS reporting from 1998 to 2007 also included coverage of parents criminally charged for the death of their infant (but then later found to be innocent) (Appleby, 2008; Herald News, 1999; Makin, 2007b; Makin et al., 2007; Payne, 2002; Slade, 1998a). Articles in The Globe and Mail, National Post, and Calgary Herald have also mentioned parent’s self-blame and guilt following the death of their infant (Abraham, 2002; Adams, 1999; Braiker, 2005; Calgary Herald, 2003; Peritz, 2006; Slade, 1998b; Svrugla, 2011). One article in Calgary Herald mentions there is no one to blame in a SIDS incident (Haigh, 2005).

Discussion

There is a decline in coverage of SIDS in all CNS newspapers including The Globe and Mail, the National Post, and the Calgary Herald. This is concerning, as SIDS continues to be the fourth leading cause of infant death in Canada (Gilbert et al., 2012a). The 2011 report: Sudden Infant Death: A Global Problem, Local Action. Report to Public Health Agency of Canada states that ‘SIDS needs to stay in the news’ (Mitchell, 2011) and by doing so, public awareness of SIDS can be sustained. However, the coverage of SIDS under the name ‘SIDS’ may be declining. One reason for this decline may be due in part to the change in the labeling of death of infants from SIDS to ‘undetermined’ by medical examiners, as noted by some newspaper articles (Blackwell, 2016; Weeks, 2017) and national SIDS organization (Baby’s Breath, 2016). Decline in coverage of SIDS has an effect on the public perception, as the public may perceive SIDS as being solved.

Headlines of some articles have been found to be misleading and exaggerated such as ‘crib death breakthrough’ in 1981, ‘SIDS solution believe found’ in 1991, and ‘bedding may be deadly’ in 1994 which portray SIDS as being solved and exaggerate risk factors for SIDS. These sensationalized headlines do not accurately portray the research findings. Two letters to the editor (out of three) have addressed how harmful these headings can be (Calgary Herald, 1992; Mitchell and Lloyd-Price, 1992). One letter to the editor has addressed how new research findings reported by the media, as well as the ‘parade of medical theories’, are vague and cause anguish and fear for parents, rather than relief (Calgary Herald, 1992).

Blame and misdiagnosis

Reporting of blame associated with SIDS is harmful, as the death of an infant from SIDS leads to intense parental grief and has been described as one of the most stressful events that adults may experience (Wing et al., 2001). Additionally, newspapers have used misleading terms such as ‘near miss SIDS’, or ‘near crib death’, that apply to living babies. SIDS can only be used when an infant has died. The 1986 National Institutes of Health consensus statement had recommended the abandonment of these labels because it implies a misleading close association between an apparent life-threatening event (ALTE) and SIDS (Patricia King, 1987). However, Canadian newspapers continued to use the label ‘near miss SIDS’ or ‘near miss crib death’ till 2005. The inaccuracy of this label is recognized in a recent recommendation that the descriptor Brief Resolved Unexplained Events now replace ALTE! (Tieder et al., 2016).

Reporting of SIDS prevention

The causal link between apnea and SIDS had been the focus of SIDS research in the 1970s, leading to the use of home monitors through the 1970s and 1980s (Patricia King, 1987). However, studies have confirmed that apnea is not an independent risk factor for SIDS and may only have a small contribution to deaths from SIDS (Keens and Davidson Ward, 1993; Patricia King, 1987). Apnea monitors have proven to be ineffective and not preventative against SIDS (Mitchell, 2009), yet some articles in Canadian newspapers have encouraged the use of monitors from 1973 to 2004 (Andrews, 1998; Clark, 2004; Hollobon, 1983; Kennedy, 1999; National Post, 1999; The Globe and Mail, 1973, 1979c, 1986b, 1993c). The 2011 report: Sudden Infant Death: A Global Problem, Local Action. Report to Public Health Agency of Canada also states that there is lack of evidence of benefit for home monitors; however, they continue to be used (Mitchell, 2011). Additionally, the coverage of vaccines in relation to SIDS from 1984 to 2004 has been inconsistent in Canadian newspapers. Several studies have shown immunization does not increase the risk of SIDS and may even be protective against SIDS (Byard et al., 1995; Essery et al., 1999; Fleming et al., 2001; Jonville-Bera et al., 1995; Mitchell et al., 1995). The inconsistency in the coverage of vaccines is problematic and has the potential to deter parents from immunizing their infants. Studies have also found misinformation on the risk of vaccines with other conditions, including autism, diabetes, asthma, multiple sclerosis, cancer, and AIDS (MacIntyre and Leask, 2003).

The back to sleep campaign is one of the largest preventative campaigns against SIDS and was effective in spreading the message on safe infant sleep practice and in turn, was associated with a reduction in SIDS. However, in 2015, there were only two articles reporting on ‘back to sleep’. The Safe and Sound: A Five-Year Retrospective 2009 report recommends developing a social marketing strategy for sudden infant death and safe sleep to bring back public awareness of the issue (British Columbia Coroners Service, 2009). Reintroducing the back to sleep campaign and other risk factors of SIDS through newspapers and other forms of media could be beneficial in launching another successful campaign. Both the 2009 and 2011 report state, the following as risk factors for SIDS: prone position, side sleeping, maternal smoking, co-sleeping/bed sharing, placental abnormalities, teenage mothers, unsafe sleeping environment (cluttered with pillows, duvets, etc.), among others. Newspapers cover most of these risk factors, except that they do not mention the ‘triple risk model’ or that the risk of SIDS increases in the presence of multiple factors, according to the triple risk hypothesis. Aboriginal infants are also overrepresented in SIDS deaths but underrepresented in Canadian newspapers from the CNS. As Aboriginal infants are disproportionately affected by SIDS, their health must be a priority in Canadian Society. Preventative recommendations mentioned in the document presented by the child death review unit aim to improve the health and well-being of all infants and include prenatal care, public education, education/training of health-care providers, social determinants of health, consumer product safety, and home visiting (British Columbia Coroners Service, 2009). Newspapers can incorporate some of these recommendations when reporting on SIDS prevention and risk reduction, by contributing to public education about SIDS.

Additionally, SIDS organizations and journalists should work together in the reporting of SIDS news. The Lullaby Trust (2017), a SIDS organization in the United Kingdom, recently released media reporting guidelines for SIDS. These guidelines can inform journalists on how to report SIDS news in a sensitive and accurate manner (The Lullaby Trust, 2017). Other SIDS organizations around the world should similarly create their own media reporting guidelines to guide SIDS reporting in their country.

Conclusion

Our findings suggest that Canadian newspapers portray SIDS poorly, undermining public health efforts to decrease SIDS. Readers are not being informed enough about risk factors and risk reduction for SIDS, as well as the higher prevalence of SIDS within the Canadian aboriginal community. Canadian newspapers need to increase and improve the coverage of SIDS, to dispel false understandings of SIDS and to support public health efforts around SIDS. Newspapers have the power to influence and have an impact on its readers. However, to examine the impact and influence of newspaper coverage, it would be interesting to investigate how newspaper coverage of SIDS impacts parents who have lost an infant due to SIDS and also new parents/carers of infants. Future studies could also consider comparing our Canadian newspaper coverage with newspaper coverage in other countries.

Supplemental Material

Supplementary_tables - Analysis of sudden infant death syndrome coverage in Canadian newspapers

Supplementary_tables for Analysis of sudden infant death syndrome coverage in Canadian newspapers by Sadia Ahmed, Ian Mitchell, and Gregor Wolbring in Journal of Child Health Care

Risk factor/potential cause	Total number of articles, n = 4257 (%)	Total number of articles 1970–1989, n = 259 (%)	Total number of articles 1990–1999, n = 1361 (%)	Total number of articles 2000–2009, n = 2141 (%)	Total number of articles 2010–2015, n = 496 (%)
SID
Apnea	73 (1.7)	23 (8.9)	38 (2.8)	11 (0.5)	1 (0.2)
Bacteria	105 (2.5)	6 (2.3)	24 (1.8)	70 (3.3)	5 (1.0)
Bed sharing	100 (2.3)	0 (0)	20 (1.5)	55 (2.6)	25 (5.0)
Caffeine	18 (.4)	5 (1.9)	7 (.5)	6 (.3)	0 (0)
Flu	10 (.2)	6 (2.3)	4 (.3)	0 (0)	0 (0)
Digoxin	19 (.4)	19 (7.3)	0 (0)	0 (0)	0 (0)
Gene	68 (1.6)	1 (.4)	24 (1.8)	36 (1.7)	6 (1.2)
Homicide	185 (4.3)	13 (5)	82 (6.0)	63 (2.9)	27 (5.4)
Male	108 (2.5)	8 (3.1)	37 (2.7)	46 (2.1)	17 (3.4)
Overheating	101 (2.4)	0 (0)	39 (2.9)	52 (2.4)	10 (2.0)
Pertussis vaccine	14 (.3)	2 (.8)	4 (.3)	7 (.3)	1 (.2)
Phenergan	11 (.3)	11 (4.2)	0 (0)	0 (0)	0 (0)
Paralysis	25 (.6)	7 (2.7)	6 (.4)	12 (.6)	0 (0)
Prone position	28 (.7)	0 (0)	20 (1.5)	5 (.2)	3 (.6)
Premature birth	54 (1.3)	4 (1.5)	8 (.6)	32 (1.5)	10 (2.0)
Smoking	950 (22)	28 (10.8)	226 (17)	601 (28)	95 (19.2)
Suffocation	189 (4.4)	13 (5.0)	64 (4.7)	84 (3.9)	28 (5.6)

Prevention/risk reduction	Total number of articles n = 4257 (%)	Total number of articles 1970–1989, n = 259 (%)	Total number of articles 1990–1999, n = 1361 (%)	Total number of articles 2000–2009, n = 2141 (%)	Total number of articles 2010–2015, n = 496 (%)
SID
Apnea monitor	10 (.2)	1 (.4)	8 (.6)	1 (.04)	0 (0)
Blood test	27 (.6)	3 (1.2)	5 (.4)	12 (.6)	7 (1.4)
Back to sleep	198 (4.7)	0 (0)	44 (3.2)	124 (5.8)	30 (6.0)
Baby monitor	19 (.4)	0 (0)	2 (.1)	16 (.7)	1 (.2)
Breastfeeding	358 (8.4)	1 (.4)	55 (4.0)	212 (9.9)	92 (19)
Firm surface	10 (.2)	0 (0)	1 (.1)	8 (.4)	1 (.2)
Humidifier	1 (.02)	1 (.4)	0 (0)	0 (0)	0 (0)
Smoke free environment	71 (1.7)	0 (0)	22 (1.6)	36 (1.7)	13 (2.6)

Footnotes

Authors’ contribution

SA co-designed and conducted the study, drafted the initial manuscript, and approved the final manuscript as submitted. Dr IM co-designed the study, was involved in commenting on various drafts of the document, and approved the final manuscript as submitted. Dr GW co-designed the study, co-analyzed the data, was involved in commenting on various drafts of the document, and approved the final manuscript as submitted.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

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