Child Abuse and Sudden Infant Death

Abstract

In times past, parents were usually blamed when an infant died suddenly and unexpectedly. A more caring attitude evolved with the adoption of the term 'cot death' or 'sudden infant death syndrome' (SIDS). Recent research looking at the factors responsible for SIDS has focused on aspects of child care and parental behaviour.Epidemiological studies confirm that several risk factors associated with child maltreatment are also to be found in many families who experience a sudden infant death. Social deprivation and other well-known associated features linked to maltreatment are correlated with sudden death in infancy. It is suggested that both physical abuse (suffocation is the most usual mechanism proposed) and neglect (failure to thrive, failure to recognize and treat illness) are important mechanisms. Infanticide (filicide) has existed widely over past centuries and its continuation in modern times is reflected in the highest murder rates of all age groups in infancy. However, much fatal abuse and neglect remains hidden, as demonstrated from the results of detailed fatality reviews. The evidence linking child abuse and neglect with sudden unexpected death in infancy is reviewed.KEY WORDS: sudden infant death syndrome; child abuse and neglect; suffocation: infanticide he association of sudden death in infancy and child

The Dark Figure of Infanticide in England and Wales

“…SIDS was introduced as a registerable cause of death in the United Kingdom in 1971. It comprises a subcategory of sudden unexpected deaths in infancy (SUDI) and "ill-defined deaths" (Fleming, Blair, Bacon, & Berry, 2000;Hobbs & Wynne, 1996) and accounts for the largest single category of deaths in England and Wales for infants between the ages of 1 month and 1 year . Statistics from the United States (Anderson & Smith, 2003National Center for Health Statistics, 2004), Canada (Health Canada, 2003;Public Brookman, Nolan / Dark Figure of Infanticide 879 Health Agency of Canada, 1998Canada, , 1999, and Australia (Al-Yaman, Bryant, & Sargeant, 2002; Australian Institute of Health and Welfare [AIHW], personal communication, April 4, 2005;Child andYouth Health, 2002, 2003) all similarly indicate that although the rate of SIDS has declined considerably during the past decade, it remains the leading cause of death for postneonatal infants (i.e., those aged between 1 month and 1 year) and constitutes the third largest category of infant death overall in these countries.…”

“…Other researchers have argued that the SIDS term is used to avoid a more thorough autopsy, to "mercifully" conclude investigations where child abuse may be suspected (Nam, Eberstein, & Deeb, 1989) and to "avoid awkward truths" (Meadow, 1999, p. 12). It is suggested that SIDS has become synonymous with a natural death (Hobbs & Wynne, 1996;Meadow, 1999) and is thus a "seductive" diagnosis-one that protects parents and professionals, absolving them from all sense of guilt (Emery, 1993b). Similarly, Reder and Duncan (1999) and Wilczynski (1994Wilczynski ( , 1997 have pointed to a general reluctance on the part of pathologists and coroners to act on suspected cases of filicide, particularly in ambiguous situations where there is no conclusive proof to support their suspicions (as can be the case in many instances of SIDS).…”