SINGAPORE - A four-year-old boy found dead at his Toa Payoh home died primarily of infantile epilepsy but may also have accidentally taken a medicine not meant for him.
State Coroner Marvin Bay returned an open verdict on Muhammad Irfan Salam's death on Friday. He said it remains an "enigma" why nitrazepam - a type of sleeping pill - was found in his body, though he ruled out foul play.
Irfan was diagnosed with infantile epilepsy with global developmental delay at three months old. He lived with his father Salam Mohammed, 42, in Toa Payoh and his parents were undergoing a divorce at the time of his death last April.
Mr Salam found Irfan motionless and his body cold when he tried to wake him.
Paramedics pronounced Irfan dead about half an hour later.
Forensic pathologist Dr Marian Wang from the Health Sciences Authority certified the cause of death as infantile epilepsy, but could not "conclusively exclude the possibility of adverse mixed drug interaction" as Irfan was found to have taken another medication besides his prescribed ones.
His blood and urine samples showed traces of nitrazepam, which was not prescribed to him as part of his seizure medications, she noted. If they were taken together with his prescribed medications without medical supervision, it could have caused death.
Investigations also showed that foil packaging containing a powdery substance and tablets found in the kitchen dustbin tested positive for the presence of nitrazepam.
Coroner Marvin Bay said on Friday that the pills had bite marks, and it was unlikely that an adult would consume tablets in such a manner.
"But it is not surprising for a child (to do so), especially one engaged in exploratory play," he said. "Irfan was conditioned to take food and drinks from the refrigerator and also to throw away things in the kitchen dustbin."
On the night before his death, his father had left him alone at home for almost two hours when he went out to meet a friend, Coroner Bay noted.
Irfan also had other "risk factors" including recurrent attacks of seizures, his young age, neurological impairment and learning disabilities, which made him "prone to sudden, unexpected death", he added.