When SIDS Is the Mistaken Killer
Misled by a 1972 study that suggested that sudden infant death syndrome (SIDS) ran in families, pediatricians in the last 25 years have missed many cases of infanticide because they have been reluctant to suspect foul play when two or more babies in a family die, according to a new book.
“The Death of Innocents” (Bantam Books), by Richard Firstman and Jamie Talan, recounts how a paper published in the journal Pediatrics used the deaths of two infants of a New York woman, Waneta Hoyt, to advance the theory that some babies are predisposed to SIDS because they suffer periods of apnea--spells when they stop breathing. All five of Hoyt’s biological children died as infants or toddlers.
The paper, by Dr. Alfred Steinschneider, helped launch a profitable industry in home apnea monitors for babies suspected to be at risk, even though many subsequent studies have failed to show that devices that monitor babies’ breathing can prevent SIDS. Apnea has since fallen out of favor among scientists as an explanation for why some infants die unexpectedly.
In 1995, Hoyt was convicted of five counts of second-degree murder in the deaths of her children. In recent years, her case and a number of others have persuaded researchers that, in rare instances, parents injure or even kill their children because of a psychiatric disorder known as Munchausen by proxy, in which a parent tries to make doctors believe a child is sick to gain attention and sympathy.
More than 3,000 infant deaths are attributed to SIDS in the United States each year, a rate of 87 deaths per 100,000 live births, said Marian Willinger, special assistant for SIDS at the National Institute of Child Health and Human Development. Willinger said that in the 1970s and 1980s, pediatricians were more inclined to accept the idea that SIDS could occur two or three times in the same family. Now, she said, they recognize that multiple cases are an “extremely rare event.”
Reported homicides in children younger than a year are about 10 times rarer than SIDS--nine cases per 100,000 babies. But when more than one child in a family dies of apparent SIDS, doctors and medical examiners need to consider child abuse, Willinger said.
Jerold Lucey, who had just become the editor of Pediatrics when Steinschneider’s paper was published, still edits the journal and has written a commentary for the October issue urging all pediatricians to read Firstman and Talan’s book.
“When an unsupported hypothesis [such as the apnea theory of SIDS] attracts support from parents, government and becomes ‘a religion,’ it’s impossible to stop,” Lucey writes. “Monitoring is still going on, and some physicians still believe SIDS runs in families. It doesn’t--murder does.”
Steinschneider had studied two of Hoyt’s infants and reported their records showed periods of prolonged apnea, which he suggested had predisposed them to SIDS. But nurses who cared for the babies testified at Hoyt’s trial that they never saw any episodes of apnea in the hospital. But they noticed that Hoyt kept the babies at a distance and showed no attachment to them.
Lucey said researchers were too quick to accept the apnea theory without proof because it came along at an opportune time.
“The SIDS families were just getting organized, putting political pressure . . . to get the government to do something,” he recalled. “People were poverty-stricken for ideas. . . . Here was what we were waiting for.”
Steinschneider, director of the American SIDS Institute, a private organization in Atlanta, could not be reached. During Hoyt’s trial, he told a CBS interviewer, “I’m not sure what I could have done” to save the Hoyt babies. He said people who used his paper to argue that SIDS could run in families “misinterpreted the literature.”
Even at Boston’s Massachusetts General Hospital, a highly regarded medical center with a SIDS research program, doctors apparently failed to consider possible child abuse in dozens of cases where the circumstances suggested it, the book alleges.
It cites an unpublished study by Dr. Thomas L. Truman, a pediatrician who came to Massachusetts General in 1993 for a research fellowship in critical care. At the hospital, Truman encountered two patients whom he suspected were being abused, but he was unable to convince his superiors.
When Truman reported one case to authorities in New York state, his boss, Dr. Daniel Shannon, called the investigating nurse and told her the child had a medical illness, according to the book. When the baby died at home a year later, investigators strongly suspected homicide, but the local district attorney declined to prosecute.
Truman embarked on a review of the records of 155 babies who had been treated at the hospital since 1972 because they had allegedly suffered “near-SIDS” episodes at home or because a sibling had died of SIDS. In more than one-third of the cases, according to the book, he found “strong circumstantial evidence suggestive of Munchausen by proxy.” Yet there was no indication that doctors had reported any cases to state criminal authorities.
In an interview, Truman, now a pediatric intensive-care specialist in Florida, declined to discuss the details of his study because he was about to submit it to a medical journal. He said the book described his findings accurately. He said doctors’ failure to consider infanticide “is not malicious. It’s just very hard for people to consider.”
Despite increased skepticism toward multiple SIDS cases within families, Willinger said that occasionally an inherited abnormality of metabolism can show up in several family members and may cause deaths that are misdiagnosed as SIDS. But she added that medical examiners have learned to consider homicide when more than one death occurs in a family.
In recent years, since a campaign began to educate parents to put babies on their backs to sleep, SIDS deaths have declined about 30%--from 4,891 in 1992 to 3,279 in 1995. Willinger said doctors still don’t know why SIDS occurs.
