Infant homicide - what is the evidence base for judgements? 

22 April 2004

Infant homicide - what is the evidence base for judgements?

FSID statement on its paper published today:
“Sudden unexpected death and covert homicide in infancy” by Dr S Levene and Dr C Bacon, Foundation for the Study of Infant Deaths, in Archives of Disease in Childhood, 2004; 89: 443-7

The Foundation for the Study of Infant Deaths (FSID) has been increasingly concerned over whether professionals are aware of the evidence, or lack of evidence, for factors claimed to be indicators of infant homicide as opposed to natural sudden infant death. This paper is intended to serve as a timely and balanced report of available information on a difficult and sensitive topic.

As the paper points out, the majority of parents whose baby dies suddenly and unexpectedly have suffered one of the most terrible natural tragedies that can occur, but in a small minority it is probable that undiagnosed maltreatment was involved. Distinguishing between natural and unnatural death in our present state of knowledge is problematic. What the current review highlights is that there are no easy, simple indicators of abuse – not for example time of death, not age of infant, not medical history, and not previous unexplained deaths in the family.

Joyce Epstein, Director of FSID, said

“There are no tick-boxes and few certainties to help decide whether a death is natural or not. There is no substitute for careful, comprehensive and unbiased investigation.

“More basic medical research is urgently needed into the possible causes of sudden infant death. Otherwise we will never solve the problem that still devastates hundreds of families in this country each year, and confusion will continue to surround many of these unexplained deaths – including those that do not reach the courts.

“In the meantime, there is an immediate need to require that each death is investigated to an agreed national standard (1), such as outlined in the paper published today, with local medical and forensic professionals working together to ensure that the investigation is thorough and fair and minimises confusion between natural and unnatural death, and that parents are treated with sensitivity. For the past four years, FSID has been talking to professionals throughout the country to encourage them to improve the standard of investigations voluntarily. Some progress is being made, but we think it is time to make these improvements mandatory.”

Beth Ferdinando, whose baby daughter Farah died as a cot death, said

“All the professionals have their job to do, but they should treat the parents sensitively and communicate effectively with the parents and each other. When Farah died, some were wonderful to us, but others made up their minds from the start that we were at fault and made terrible remarks. Worst of all, for three months nobody told us that the coroner had released her body for the funeral, because nobody knew.

“I hope FSID’s paper will make the professionals realise that they shouldn’t make automatic assumptions, and that they need to work together to support parents and find out as much as possible about why babies die.”

Media contacts:
Joyce Epstein, Director, 0870 787 0885; out of hours 07904 198 552

Notes
(1) FSID has been campaigning for the following multi-agency protocol to be adopted when a baby dies suddenly and unexpectedly:

• Within 24 hours a paediatrician, working with the police, should visit the family at home, take a complete medical history, and offer initial support;
• the post mortem should be conducted by a paediatric pathologist who has access to the information gathered in the home visit;
• all the health and judicial professionals involved should meet and review the available information to agree what factors may have contributed to the baby’s death and plan future support.

The Foundation for the Study of Infant Deaths is one of the UK’s leading baby charities working to prevent sudden infant deaths and promote baby health. FSID funds research, supports bereaved families and offers health and baby care advice to parents, carers and professionals.

 

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