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Verdict reawakens cot death debate
Cot death rates have fallen in recent years
The Sally Clark case highlights the difficulties faced by doctors trying to judge between genuine cot death cases, and those in which a parent played a part.

Solicitor Mrs Clark was convicted of murdering her two babies Christopher and Harry - within 14 months of each other.

She said that sudden infant death syndrome (SIDS) was to blame for both.

Much of the available evidence on cot death is contradictory.

The court was told by one expert witness that the chances of the both children suffering cot deaths were one in 73 million.

However, cot death support and research groups point to strong evidence that families which suffer the trauma of a genuine cot death are at higher risk of suffering a second such tragedy.

The verdict will reawaken the controversy over whether doctors, and the statistical analysis they produce, are able to distinguish between genuine tragedy and foul play.

And parents who have suffered the trauma of cot death will be distressed that suspicions could be aroused, regardless of the presence or absence of clear physical evidence.

Medical catch-all

The term "sudden infant death syndrome", as with many other medical syndromes, is a catch-all term, used in this case to describe any death of an baby which remains unexplained - even after a full post mortem has been carried out.

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.

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 six percent.

Another University of Sheffield-based study suggested that only a total of 2.5 per cent 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'

A recent 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.

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05 Aug 99 | Health
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