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Department of Paediatrics and
Child Health, St James's University Hospital, Leeds LS9 7TF, UK
Correspondence to: Professor Meadow.
Accepted 3 September 1998
AIM
To identify features to help paediatricians
differentiate between natural and unnatural infant deaths.
METHODClinical features of 81 children judged by
criminal and family courts to have been killed by their parents were
studied. Health and social service records, court documents, and
records from meetings with parents, relatives, and social workers were studied.
RESULTSInitially, 42 children had been certified
as dying from sudden infant death syndrome (SIDS), and 29 were given
another cause of natural death. In 24 families, more than one child
died; 58 died before the age of 6 months and most died in the afternoon or evening. Seventy per cent had experienced unexplained illnesses; over half were admitted to hospital within the previous month, and 15 had been discharged within 24 hours of death. The mother, father, or
both were responsible for death in 43, five, and two families,
respectively. Most homes were disadvantagedno regular income,
receiving income supportand mothers smoked. Half the perpetrators had
a history of somatising or factitious disorder. Death was usually by
smothering and 43% of children had bruises, petechiae, or blood on the face.
CONCLUSIONSAlthough certain features are
indicative of unnatural infant death, some are also associated with
SIDS. Despite the recent reduction in numbers of infants dying
suddenly, inadequacies in the assessment of their deaths exist. Until a
thorough postmortem examination is combined with evaluation of the
history and circumstances of death by an experienced paediatrician,
most cases of covert fatal abuse will go undetected. The term SIDS
requires revision or abandonment.
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