The last few years have seen a shift in understanding, research and policy in responding to sudden unexplained infant deaths, including multiple deaths, within a family.
The shift in case law began in England, with the now infamous trials of Sally Clark, Angela Cannings, Trupti Patel and others, all of whom were prosecuted for multiple deaths of their children; the former two were initially convicted and both were later overturned on appeal, and the latter was acquitted at trial. One major contention at both the trial level and later upon appellate review was whether multiple unexplained deaths within one family were more likely to be considered the result of criminal abuse. (For a good discussion of this controversy, see “Sudden Infant Deaths – Coincidence or Beyond Coincidence?”, Ray Hill, Paediatric and Perinatal Epidemiology 2004, 18, 320-326.
At roughly the same time here in the United States, researchers were identifying genetic mutation links to sudden infant death syndrome (See Medical Research News, August, 2004). This culminated in November 2006, with the publication of Multiple Serotonergic Brainstem Abnormalities in Sudden Infant Death Syndrome in the Journal of the American Medical Association (JAMA) and followed by Sudden Infant Death Syndrome: Review of Implicated Genetic Factors in the American Journal of Medical Genetics in January, 2007.
Thus, if in fact a genetic link exists in true SIDS cases, multiple deaths in one family would not necessarily indicate criminal abuse and would not alone indicate guilt. As with every sudden or unexplained infant death, whether a single child or multiple children over several years, a thorough investigation must be conducted and all factors considered. The American Association of Pediatrics includes this in their policy statement from the Task Force on Sudden Infant Death Syndrome:
Therefore, the task force supports the position that the vast majority of either initial or second sudden unexplained infant deaths within a family seem to be natural rather than attributable to abuse, neglect or homicide. However, the task force maintains that a complete autopsy, examination of the death scene, and review of the clinical history are necessary to obtain the most accurate diagnosis. (The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk, Pediatrics Vol. 166 No. 5 November 2005.)
It cannot be overstated, however, that multiple deaths in one family certainly can be the result of criminal abuse. For instance, there are numerous well-documented cases of munchausen syndrome by proxy mothers and other caretakers suffocating baby after baby. What should be taken from this is the reinforcement of the absolute necessity to consider the overall evidence and conduct a through investigation in each and every child death case. Further research into the genetic link to SIDS will hopefully lead to a clearer determination between those babies that died from a tragic genetic mutation and the even more tragic, and all too familiar, cases where babies die at the hands of their parents or caregivers. In the end, a thorough and complete investigation remains the essential key to justice in both cases.
