September 10 1999
Many cot-death babies 'killed by parents'BY IAN MURRAY, MEDICAL CORRESPONDENT
UP TO 40 per cent of babies registered as "cot deaths" may have been killed by their parents or another adult, according to a leading paediatric pathologist.
Michael Green, from Sheffield University's Department of Forensic Pathology, makes the claim in the British Medical Journal today. He says it could be time to end the use of "sudden infant death" on death certificates and substitute "not ascertained" instead.
"Child homicide, especially by the mother, is by nature very difficult to detect," Dr Green writes. "We can only hazard guesses at its incidence. Nor should we direct our suspicions solely to the mother."
He quotes a recent study which says the number of cases where adult harm led to or contributed to death is more likely to be double the 50 cases notified to the Office of National Statistics. "I am inclined to agree," he says.
"Many paediatric pathologists and forensic pathologists say that parental or adult intervention may have occurred in 20 to 40 per cent of the cases of so-called sudden infant death syndrome with which they are involved."
After sudden infant death syndrome was accepted in 1971, he says, the number of babies recorded as dying of this cause stayed at about 1,000 a year until the "back to sleep" campaign in the early 1990s. Since then, the figure has fallen to less than 400 a year.
"If we assume that the numbers of adults who harm their children have remained fairly constant over the years, then in the relatively low number of baby deaths currently occurring, the proportion of 'suspicious' cases is increased accordingly," Dr Green says.
"It follows that all of us involved in such deaths should approach them with suspicion, albeit cautiously expressed. The advice given in a recent Canadian investigative protocol to 'Think Dirty', although a little graphically phrased for my liking, sums it up."
Dr Green recently published evidence from his department showing that in babies where there was an unusual amount of bleeding in the lungs there was often a history of parental abuse, suggesting that the baby might have been suffocated.
He urges pathologists who are looking into suspected sudden death syndrome cases to take a careful look at the family history, adding that he never gives sudden death syndrome as a cause of death if the history reveals the baby was at risk of physical abuse.
In an accompanying article, the Countess of Limerick, vice-chairman of the Foundation for the Study of Infant Deaths, argues that most sudden unexpected deaths are natural and there is therefore no case for abandoning the term "sudden infant death syndrome".
She cites a recent survey of baby deaths in three English regions between 1993 and 1996 which concluded that maltreatment was responsible for only 22 of 346 cases (6 per cent) with a secondary cause involved in a further 28 cases (8 per cent). "At least 86 per cent of the sudden infant death cases did not arouse any degree of suspicion, even when the national rate for sudden infant death syndrome had fallen to 0.6 per 1,000 live births."
Copyright 1999, Times Newspapers Ltd.