Recurrent child deaths rarely infanticide

In families in which more than one child dies unexpectedly, natural causes are the most likely explanation, UK investigators report.

"A presumption that second or third infant deaths within a family are due to homicide unless proved otherwise is unfounded," Dr. Robert G. Carpenter, from the London School of Hygiene and Tropical Medicine, told AMN Health.

"Every case of unexpected death in infancy should be investigated sympathetically with the greatest care," he said.

Carpenter and colleagues conducted a comprehensive study of repeat sudden unexpected and unexplained infant deaths among families enrolled in The Care of Next Infant (CONI) program.

This program, available in more than 90 percent of health districts in England, Wales, and Northern Ireland, offers home support for parents who have experienced the unexpected death of one child and now have a new baby.

By December 1999, a total of 5229 families had completed the CONI program. Forty-four families unexpectedly lost one more infant and two families lost two more, the team reports in this week's issue of the Lancet medical journal.

Detailed studies of these second and third deaths showed that the great majority occurred naturally, Carpenter said.

Only six deaths were likely to have been homicides, with one or both parents being the perpetrators in five of the deaths. There were two criminal convictions.

"For a host of reasons, not the least of which is the protection of parents from false accusations, it is essential that all sudden unexplained infant deaths are submitted to a detailed, expert investigation like this," the investigators conclude.

In an accompanying editorial, Dr. Tom Matthews from University College Dublin, applauds Carpenter's group for their "refreshingly realistic" study of the issue and their finding that "the mere occurrence of a second death is, in itself, insufficient to justify the label of infanticide."

SOURCE: Lancet, January 1, 2005.