Sudden unexpected infant death: infanticide or SIDS?

Abstract

A few sudden unexpected deaths in infants are caused by a carer, most often a parent. The issue of how to deal with these deaths has always caused great soul-searching in society. Most unexpected deaths in infants remain unexplained after autopsy and are labelled as sudden unexplained infant death syndrome (SIDS). This term was invented in 1969 to acknowledge that, while unexplained, most of these deaths are natural deaths with no blame accruing to parents already burdened by a recent bereavement. Since then, SIDS parents' groups have been organised in most western countries and have successfully campaigned to promote research and improve the knowledge base of SIDS while improving the support services available to bereaved parents. This highly desirable involvement of parents has had the unintended effect of making it more difficult to discuss the small number of unexpected deaths where infanticide is suspected or proven (perhaps about 5%). The study deals with the issue of whether a repeat unexpected death in a family is natural (SIDS), with or without genuine concerns, or an unnatural (infanticide) death. The data-set is based on the Care of the Next Infant programme, in which families and infants, with a previous sibling dying from a cot death, were enrolled in a support programme facilitated by the Foundation for the Study of Infant Deaths. The strength of the study lies in its prospective nature, and the comprehensive assessment of the repeat unexpected deaths, including interviews with parent(s) and health carers, and an independent assessment of the autopsy, including interpretation of histology slides. The main conclusion is that the recurrence rate of unexpected deaths or SIDS is about 6 per 1000 and that most of these second deaths are from natural causes. So the mere occurrence of a second death is, in itself, insufficient to justify the label of infanticide. Although some families with an unexpected death have worryingly disorganised parenting skills and support structures, Carpenter and colleagues show that unexpected deaths recur, which implies that a diagnosis of infanticide should require more definite evidence.