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Tuesday, 16 April, 2002, 14:52 GMT 15:52 UK
Controversy surrounds cot death
Cot death rates have fallen in recent years
Cot death, or sudden infant death syndrome (SIDS), is a mysterious condition for which the cause is not known.

It is estimated that seven babies die for no apparent reason every week in the UK, and cot death is the main reason for death in infants over one month old.

Sudden Infant Death Syndrome
Most common among babies aged between four weeks and one year
Boys, twins and babies with low birth weight are more likely to suffer
More common during the autumn and winter months
Bottle-fed babies are more at risk
In fact, the term "sudden infant death syndrome", as with many other medical syndromes, is a catch-all term, used to describe any death of an baby which remains unexplained - even after a full post mortem has been carried out.

Allergies, breathing problems during sleep, and passive smoking have all been associated with SIDS.

There has also been much controversy over whether certain substances used as fire retardants in mattresses can harm the baby.

However, research suggests that some form of maltreatment, either deliberate harm, or simply cases of poor care or neglect is probably to blame in a small percentage of cot death cases.

Fall in numbers

A government study, known as the confidential enquiry into sudden deaths of infants, looked at deaths in the UK between 1993 and 1996, and put the figure at 6%.

Another University of Sheffield-based study suggested that only a total of 2.5% of deaths were either infanticide, or suspicious.

The fall in cot death rates over recent years means that cases are subject to more scrutiny than before.

There are few telltale signs for the pathologist to spot. The presence of bleeding in the lungs has been taken by some as a clear result of smothering of the child, but many commentators say that this is an unreliable method of diagnosis.

So, are some parents still getting away with murder?

Sir Roy Meadow, head of the Department of Paediatric and Child Health at St James' Hospital, Leeds, looked at 81 cases of children in which the courts had found the parents guilty of killing them.

He found 49 of these had originally been certified as cot deaths following post mortem.

He wrote in the journal Archives of Childhood: "SIDS has been used, at times, as a pathological diagnosis to evade awkward truths."

'Think dirty'

An investigative guideline sent to Canadian pathologists urged them to "think dirty" when confronted with a possible SIDS case, just to be sure to exclude all possibility of foul play.

The Foundation for the Study of Infant Deaths is at pains to stress that the vast majority of cot deaths are natural - in fact, it says it has evidence that one family every year in the UK loses a second child to the syndrome.

A spokesman said: "If a couple have a child who dies suddenly and unexpectedly the risk of it happening again does increase.

"The reasons for this are varied and range from metabolic disorders, to maltreatment and environmental and social factors.

"Certainly second cot deaths can be true cot deaths, where all other causes have been excluded."

The problem facing doctors confronted with an apparent case of cot death is that medical science simply does not conclusively know what causes it.

It is virtually impossible for them, in the absence of unequivocal signs of physical abuse, to rule it out entirely.

More questions

Barbara Bryan, of the US National Child Abuse Defense & Resource Center, told BBC News Online said there was no guarantee that a post mortem would always uncover causes of death that had nothing to do with foul play.

These include adverse reactions to drugs and vaccinations annd inherited genetic disorders.

She said: "Past, current, and future autopsies have been, are, and will be of insubstantial value unless and until known science is employed in the service of learning the discoverable cause of more cot deaths."

See also:

16 Apr 02 | England
Baby deaths mother found guilty
28 Feb 02 | England
Expert view in baby deaths trial
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