Some `cot deaths' may be murders

BABIES WHO have died at the hands of their parents have been wrongly identified as victims of cot death, the country's leading medical expert on child abuse says today.

Professor Sir Roy Meadow, a specialist at St James's University Hospital, Leeds, says doctors and coroners have in some cases overlooked signs of bleeding, broken bones and foreign bodies blocking the airway because they were under pressure to resolve unexplained cases swiftly and without controversy. In doing so, they may have helped parents get away with murder.

Sir Roy, a former president of the Royal College of Paediatrics and Child Health, was the first person to describe Munchausen syndrome by proxy, the condition in which parents, usually mothers, induce illnesses in their children requiring extensive investigation as a way of gaining attention for themselves. Since the Sixties, when he published his first paper on the syndrome in The Lancet, he has become a world authority and a widely respected expert on child abuse.

Writing in Archives of Disease in Childhood, Sir Roy returns to the emotive issue of the causes of Sudden Infant Death Syndrome (Sids) which claims more than 400 lives a year. He says the diagnosis of Sids "has been used at times as a pathological diagnosis to evade awkward truths" and should be revised or abandoned.

His view is based on a study of the records of 81 children judged by criminal and family courts to have been killed by their parents. In 49 cases, the children had initially been certified as dying from Sids and a further 29 were classified as dying from other natural causes. The mother was responsible for the death - usually smothering - in more than 80 per cent of cases. In 24 of the families, more than one child had died and in five of them, three children had died.

Up to 27 children were found with blood in the mouth, nose, or on the face, and 10 had unusual bruises on the face. Some had foreign objects - coins or balls of paper - in their airways or intestines. These were explained away on the basis that the infant had grasped or eaten the object, even though they were too young for that to have been possible.

Five children were categorised as cot-death victims aged more than a year old - six months older than the usual upper limit for Sids. Nearly half the children had been discharged from hospital within the week preceding their death after being admitted for an "unusual or unexplained event". Sir Roy wrote: "Currently many paediatric units are failing to heed warning signs and failing to protect some very vulnerable children."

Although the number of Sids cases in Britain a year had fallen below 400, the acceptance of a situation in which so manychildren died of unknown causes was a "national scandal", Sir Roy said. "If one out of every 1,000 21-year-olds died suddenly and unexpectedly without an identifiable cause there would be a national outcry."

The Foundation for the Study of Infant Deaths said Sir Roy's paper covered cases he was personally involved in and should not be viewed as a representative study. It had always accepted that "a small number" of cot deaths may be unnatural.

It added: "It would be unfair to exacerbate the pain of cot-death parents by casting general suspicion on their tragedy."

The foundation agreed with Sir Roy that there should be a comprehensive investigation of all unexpected infant deaths.