A 21-day-old infant’s death was recorded as an open verdict after the State Coroner said on Thursday (28 October) that he could have possibly suffocated while being carried in his confinement nanny’s arms.

While there was no evidence of suffocation at an autopsy, a forensic pathologist from the Health Sciences Authority was unable to exclude it as a possible cause of death due to circumstantial evidence.

His cause of death was therefore certified as “unascertained”, and sudden infant death syndrome and asphyxia cannot be ruled out.

Noting this, former State Coroner Kamala Ponnampalam said, “While the circumstances surrounding (the baby’s) demise are inconclusive, the evidence led does not suggest foul play. However, as (his) cause of death remains unascertained, I am constrained to record an open verdict.”

The 57-year-old nanny had been carrying the baby in her arms until she fell asleep while seated on her bed and leaning against the wall behind her in the wee hours of 19 November last year. The mother found her son’s face against the nanny’s chest.

The nanny later woke up and placed him in a baby cot before leaving the room. But when the mother checked on the baby later, she found him unresponsive. They brought the baby to KK Women’s and Children’s Hospital and he was pronounced dead at 5.18am.

‘Poor sleep practices’

Delivering her verdict, Ponnampalam noted that this was yet another case of “poor sleep practices” which may have led to infant death. “The cases before this court have shown that an infant who falls asleep in a prone position is more likely to fall victim to accidental suffocation.”

She added that parents and caregivers must bear in mind that fatigue can set in as they care for the infant through the night, which risks the baby falling asleep in an unsafe sleep position when the caregiver dozes off even briefly.

In cases where the baby is unable to settle, caregivers must adopt other strategies or hand over to another adult than risk baby falling asleep prone, said Ponnampalam.

The baby was born at full term on 29 October 2020 and discharged well on 2 November.

His parents engaged a nanny, who had no formal training as a confinement nanny and gained experience through caring for her younger siblings and previous jobs with children. She was recommended by the baby’s father’s friend, who had engaged her, yAhoo reports.

Her duties included feeing, bathing and caring for the baby while cooking confinement food for his mother, as well as washing the baby paraphernalia. She occupied and slept in the same room as the baby on the second floor of the residence, on a bed adjacent to his cot.

The baby was fed a combination of breast milk and formula milk in two to three hour intervals. He was observed to spit up after each feed and developed a hoarse voice. He was diagnosed by a paediatrician to have gastroesophageal reflux causing transient laryngitis, but that his voice would recover in a week or two.

Day of the incident

A portable camera with a recording function and which streamed live footage had been placed on the bay window ledge. The camera recorded faint sounds seemingly from Liam around 2am on 19 November last year, with intermittent snoring sounds.

At about 1am, the baby was bottle fed by the nanny. After feeding, he was making sounds of discomfort through the night and was carried by her several times. She carried him in different positions in an attempt to get him to fall asleep.

She alternated between two positions – carrying the infant against her chest or shoulder area, while placing one hand on his neck or back and another hand at his bottom, or carrying him horizontally in her arms.

She sat with her back against a pillow which was on the wall behind her bed. She testified that while she did fall asleep with the infant in her arms, she could not sleep soundly as the baby kept moving in her arms, she testified. She alternated her carrying position and checked on him periodically.

At about 4am, she woke up when she heard the room door opening and saw the mother, who asked why the breast pump accessories had not been washed. The mother noted that her son’s face was against a yellow cloth that had been placed on the nanny’s chest. The nanny recalled that the infant was lying on her chest with the right side of his face against her right chest or shoulder.

‘Baby wake up’

The nanny then left the room to wash the items after placing the baby in the cot. The mother approached her son and saw that the left side of his face appeared darker. She touched the baby but failed to get movement. She then transferred him to the nanny’s bed and called to him, to no avail.

When the nanny returned to the bedroom, she heard the mother saying “baby wake up”. The mother said she could not wake him and that he was not breathing. The nanny noticed milk discharge and blood at his mouth. He was then conveyed to hospital and later pronounced dead.

The mother testified that during her employment with the family, the nanny did not raise any unhappiness and there were no disputes between parties. She did not think the nanny would intentionally harm the baby, but might have been negligent.

“(The mother) added that she had previously informed (her) not to carry (the baby) on her chest for prolonged periods due to the risk of suffocation. She had also informed (the nanny) not to put (the baby) in an inclined position after feeding due to his acid reflux issues. (The mother) stated her belief that (the nanny) appeared to ignore her concerns as she was an experienced nanny,” said Ponnampalam.