Pediatricians aren't particularly known as aficionados of true crime books.
But in this month's issue of the journal Pediatrics, Editor Dr. Jerold Lucey suggests his readers take a look at the genre.
Lucey specifically recommends one of the newest, "Goodbye, My Little Ones" (Onyx Books, 1996), a paperback account of the life of Waneta Hoyt, a New York state mother whose five babies died between 1965 and 1971. Because the infants were presumed victims of sudden infant death syndrome, Hoyt and her husband, Tim, quickly captured the sympathy of their neighbors in the tiny settlement of Davis Hollow.
But more than two decades later, police caught up with Waneta Hoyt, who eventually confessed that she killed her kids because she was tired of their crying. She later recanted the confession. Last year she was convicted and is now serving 75 years to life. (Her husband was not implicated.)
The Hoyt case is not the only example of murder masquerading as SIDS--loosely defined as the unexplained death of a child younger than age 1--but it is perhaps the best known.
Besides the Hoyt book, Lucey recommends that pediatricians read "Sleep My Child, Forever," by John Coston (Onyx, 1995); Mommy's Little Angels: The True Story of a Mother Who Murdered Seven Children," by Mary Lou Cavenaugh (NAL / Dutton, 1995); and "Precious Victims," by Don W. Weber and Charles Bosworth Jr., (NAL / Dutton, 1991), all books on mothers who murdered their children.
Pediatricians should be ever aware of the possibility that SIDS may actually be murder, says Lucey, whose journal circulates to 58,000 readers. His advice to them? "One SIDS death, and you should think about murder. Two SIDS deaths [in the same family] and you should have a professional investigation of the possibility this child was murdered."
Says Dr. Henry Krous, director of pathology at Children's Hospital-San Diego and medical advisor to the SIDS Alliance, a Maryland-based organization: "When there is a sudden unexpected death, one has to have an open mind to all sorts of possibilities, including undiscovered disease. The vast majority of unexpected infant deaths are due to natural causes, including SIDS, and in fact most are SIDS."
Experts disagree, Krous says, about the number of deaths attributed to SIDS that are actually murder, with many experts saying 1% to 2% and less than a handful saying 70% or 80%.
"Parents of babies who die of SIDS desperately want an investigation of the baby's death," Krous adds. "[But] parents want the information collected in a non-accusatory fashion."
In the wake of the Hoyt case and others, public health officials are taking a closer look at how to better differentiate SIDS and other causes of infant death.
In late June, the federal Centers for Disease Control and Prevention issued investigation guidelines aimed at helping coroners and police differentiate SIDS and homicide by noting such facts as the position of the infant's body, any suspected injuries and any evidence of parental drug use.
Other officials are calling for a nationwide child death registry, mandatory autopsies (now required by some states and endorsed by the SIDS Alliance) and death reviews to uncover any similar cases.
In Hoyt's home state, the trio of newspaper journalists who wrote the "Goodbye" book--reporters Todd Lighty and John O'Brien and editor Charles Hickey--also produced a series on SIDS that spurred the Post-Standard and Herald American in Syracuse to call for reforms on the editorial page. Now, Onondaga County officials are reviewing the deaths of every child younger than 13 during the past 30 years.
In California, the coroner is required to look into a death if the suspected cause is sudden infant death syndrome.
Nationwide, SIDS deaths have dropped by 30%, federal officials from the National Institute of Child Health and Human Development announced last month. Until recently, the annual SIDS toll in the United States was 5,000 to 6,000.
The decline is largely due, officials say, to a "Back to Sleep" campaign launched in 1994 by the American Academy of Pediatrics and other organizations devoted to child health. Since 1992, the academy has urged parents to put their healthy newborns to sleep on their backs or sides, not their stomachs, to help reduce the risk of SIDS.
Besides sleeping position, factors such as soft mattresses, pillows and exposure to smoke increase the risk of SIDS, according to researchers from Loyola University Medical Center in Chicago, who presented preliminary findings from the Chicago Infant Mortality Study at the fourth SIDS International Conference in Bethesda last month. The study is funded by the Centers for Disease Control and Prevention and the National Institutes of Health; the preliminary findings are based on the analysis of 195 of the 250 cases.
Meanwhile, researchers continue to seek the cause or causes of SIDS, with recent research suggesting there may be a chemical defect in a part of the brain stem that appears to control breathing while the infant sleeps.