Sudden Infant Death Syndrome: Risks and Realities

Formerly called "crib death," Sudden Infant Death Syndrome (SIDS) is the unexplained death of a child under the age of one that remains a mystery after a complete investigation, according to the Center For Disease Control. SIDS is the number one cause of death for infants between one month and one year of age. Most instances occur between two and four months. A SIDS diagnosis is reached after a thorough investigation finds no medical reason for the infant's death. The investigation of a SIDS death is threefold. SIDS investigations include an autopsy, scrutiny of the death scene and clinical and family history. First, a complete medical autopsy is performed to determine cause of death. Second, the death scene is examined for possible clues about the circumstances of the death. And finally, the family history is thoroughly examined.

Research at Massachusetts General Hospital done by Dr. Thomas Truman concludes that 5-10% of diagnoses reported as SIDS were incorrectly identified in the past 10-20 years. While he acknowledges the difficult nature of a SIDS investigation, Dr. Truman explains the obstacles the medical team faces in the different phases of the investigation. In an infant's autopsy, it is harder to detect smothering because suffocating an infant can be done with relevant ease. This type of "gentle murder" shows so signs whatsoever, and a smothered infant could appear exactly as SIDS in the autopsy.

The second phase of investigating, the death scene, is usually in the home or a day care facility. Many times infants are simply found in the morning when the parent wakes for the day. Blankets and bedding are shifted. Death scenes are often tampered with, simply because babies are poked and picked up in attempts to resuscitate the infant.

The third obstacle for authorities is the sensitive and emotional family being investigated. The investigation is an emotional procedure for the family and authorities have to conduct it with the utmost care, as to not imply incorrect suspicions to the grieving mother and father.

Dr. Truman insists one instance of sudden infant death in a family is typically a true SIDS case. Two or more SIDS death within a family looks suspicious and abuse should be considered as a possibility. It is during the third phase of the investigation that doctors face one of their biggest dilemmas. Do the doctors consider abuse? Is infanticide too difficult to conceive? Did the examining team consider the possibility that they were dealing with infanticide, but decide against making the accusation against a grieving family due to a lack of proof? Dr. Truman asserts, "That's wrong, because if you suspect abuse, you are obligated by law to call it in. As physicians, we're not expected to prove it; we're just expected to report our suspicions by law."

In a 1994 policy statement, the American Academy of Pediatrics, estimated that cases of sudden infant death diagnosed as SIDS were correct 95-98% of the time. The American Academy of Pediatrics also claimed infanticide misdiagnosed as SIDS is uncommon. However, in 2001, The American Academy of Pediatrics recommended all cases with a SIDS diagnosis should be investigated by a child abuse expert because of continually growing suspicions that some SIDS deaths are instead murders. A member of the child-abuse committee, Dr. Kent Hymel admits, "It is virtually impossible to distinguish at autopsy between SIDS and accidental or deliberate asphyxiation with a soft object."

The cause of SIDS is obviously unknown. While doctors have not identified any means to eliminate SIDS from occurring, risk factors have been identified which can reduce the chances of sudden infant death. One of the biggest risk factors is infants sleeping on their sides or stomachs. This position puts the child at risk of overheating. As a result of educational campaigns, such as the Back To Sleep program, SIDS cases have been reduced across the country. The Back To Sleep campaign, which began in 1992, launched education which is credited for the biggest decrease in history, dropping the SIDS cases over 40% by 1998.

Loose bedding is another risk for infants. Parents and caregivers are encouraged to remove all loose bedding, blankets and pillows. Infants should be dressed in warm sleepers as an alternative to blankets. The mattress should fit snugly in the crib to prevent suffocation between the mattress and the crib rails. Parents are advised against placing infants on sofas, waterbeds or bean bag chairs while sleeping. Sharing bedding is also frowned upon, as it increases the likelihood of suffocation.

Exposure to second hand smoke has been identified as a third risk for SIDS. Mothers who smoke during pregnancy are three times more likely to have a child die from SIDS than non-smokers. Infants who are exposed to second hand smoke after birth have an increased risk as well. Exposure to second hand smoke is believed to inhibit the development of both the lungs and nervous system.

Another factor for SIDS is room temperature. Infants should not get too warm while asleep. Overheating causes some infants to go into a deeper sleep which makes it more difficult to wake up. Babies who fall asleep, especially after exhausted from a bout of crying, can go into a warm deep sleep which some researchers think could reduce the brain's natural signal to wake up.

Common factors have been linked to SIDS victims, including being born to mothers under the age of 20, being born to mothers who received little or no prenatal care and low birth weights. Boys are more likely to die from SIDS than girls. African American and Native American babies are more likely to die from SIDS than Caucasian children. Instances of SIDS seem to increase in colder weather.

While research has given inclinations about the risks, SIDS still claims the lives of over 2500 children in the United States each year. The mystery surrounding SIDS still brings about conflicting reports. Genetic testing has been done, yet no viable link has been found in DNA to suggest that SIDS is hereditary. Therefore, when doctors find themselves faced with multiple sudden infant deaths in a family unit, the impending investigation must include considering the possibility of child abuse leading to infanticide.

A baby's death is a sad, tragic time which can only be understood by a person who has experienced the loss. The American SIDS Institute offers bereavement counseling for families as they endure the heartache of losing a child. This is one of the many functions of this organization. Parents who have lost a child to sudden infant death can benefit from understanding and support during the ordeal of the funeral, the investigation and beyond, to the next phase of life.

Parents who are grieving and emotional must understand investigators are not on an opposing side. The mission of the investigation is to learn what happened in an effort to prevent it from happening to another child. Though it may seem that accusations are heartlessly thrown out, parents must be patient with the system. The system put in place, following the recommendations of The American Academy of Pediatrics, is designed to help families understand what happened as well as to prevent further needless deaths of America's babies. The investigation does not deny a parent's right to grieve. On the other hand, an incomplete or haphazard investigation denies the children's rights.

The changes in The American Academy of Pediatrics recommendations were influenced by a few cases which have resulted in convictions as well as the 1997 findings of British researchers. The researchers documented a horrific recount of 39 babies who were hospitalized after an "accident" at home. The research included 39 cases of hospitalized children and their parents. Of the 39 cases, 30 parents were caught on videotape trying to suffocate their children in the hospital. Researchers further confirmed that 11 of those children had a sibling who died, and the diagnosis was SIDS. Of the 11 involved in the scrutiny, 8 parents confessed they had suffocated their children. The shocking numbers reveal an urgent need to continue family history investigations.

Causing emotional heartache to parents who have lost children to sudden infant death, several SIDS cases have been reviewed and resulted in murder convictions in the last decade. Australia's New Weekly magazine featured an article by Judy Wright. The criminologist at the Australia Institute of Public Safety in Melbourne concluded that results from her own research show that women are "getting away with murder." Wright did a study in 1990 which revealed the intrinsic hardships prosecutors face while dealing with mothers that kill their children. Clearly, "a mother's role is revered in society." She adds, "It's a tragic excuse because it really devalues the pain of parents who genuinely lose children to SIDS."

A highly publicized case in New York, the Hoyt circumstances caused damage to the advancement of SIDS research. Without providing additional examples, Dr. Alfred Steinschneider wrote an article featured in a 1972 edition of the Journal of Pediatrics portraying the Hoyt case as evidence that SIDS is a hereditary disease. In this report, Dr. Steinschneider suggested a genetic problem may cause extended sleep apnea which would lead to SIDS. He supported his thesis with the deaths of five babies in one unidentified family, which later became known as the Hoyt family. Medical examiner Linda Norton had a different idea about the article. She said, "When you read the article, you may decide you have a serial killer here."

Jerold Lucey, the editor of Pediatrics when Steinschneider's paper was published in 1972, is still the current editor and has offered his observations: "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. Monitoring is still going on and some physicians still believe SIDS runs in families. It doesn't - murder does."

Twenty years after the deaths of her children, Waneta Hoyt confessed to killing her babies. Between 1965 and 1971, the Hoyt children: Eric, James, Julie, Molly and Noah were murdered by their mother's hands. Confessing to state troopers, Hoyt admitted she had smothered her children because of the crying. She claimed she used pillows to suffocate three of the children. One of the infants was smothered by being pressed into her shoulder. James was 2 years and 4 months old, which is far beyond the at risk age of SIDS. Hoyt confessed that she used a bath towel to smother him when he cried as she pushed the boy out of the bathroom because she was getting dressed.

Although Hoyt later recanted her confessions, she was convicted of murder in 1995. The majority of an emotional jury cried as the guilty verdict was read in court. While serving time for her 75 years to life sentence, Hoyt died in prison in 1998.

Schenectady, New York residents Joe and Mary Beth Tinning had nine children, none of whom lived beyond age 5. In 1987, Mary Beth Tinning was convicted of Tami Lynne's death. Although she admitted causing two of the other deaths, due to a lack of evidence, prosecutors were unable to prove Tinning was responsible for the deaths of her eight other children: Barbara, Joseph, Jennifer, Timothy, Nathan, Michael, Mary and Jonathan.

Tinning is currently incarcerated at the Bedford Hills Prison for Women in New York. She was denied parole in March of 2007 due to the board noting Tinning "appears to have little insight into [the] crime and displays little remorse." She will be eligible for parole again in March of 2009.

Between 1987 and 1993, Denise Buchanan had five baby boys: Joseph, Joshua, Jeremiah, John and Jacob. Jeremiah died at four months old with SIDS listed as the cause of death. John was three months old when he died. The pathologist, Dr. Ellen Clark found capillary bursts under the tissue surface of the lungs, which could be a sign of suffocation or could also indicate a SIDS case. John's cause of death was listed as "undetermined." Jacob died just before his first birthday. With a multitude of conflicting stories from Buchanan concerning the events leading up to Jacob's death, coroner Dr. McCarthy proceeded with the investigation, and eventually listed Jacob's cause of death as "undetermined," but also listed the manner of his death as a homicide. According to McCarthy, statistical evidence shows SIDS occurring at the rate of 1 in 1,000 births; therefore, statistically, it is almost impossible to have more than one SIDS case in one family.

In 1999, Buchanan was found guilty of two counts of first degree murder for her sons, John and Jacob. She was acquitted of the charge for Jeremiah's murder. Buchanan received two consecutive life sentences for the charges. She appealed, but the Nevada Supreme Court upheld her conviction. Denise Buchanan is eligible for parole in 2019.

In April 2001, Kathleen Folbigg was taken into police custody, and charged with murdering her four children. Caleb died at 20 days old. SIDS is listed as the cause of death. Patrick was 8 months old when Folbigg called her husband, Craig at work to say, "It's happened again." Eleven month old Sarah was found unresponsive in her bed. Her death is officially listed as SIDS. The youngest child, Laura, lived the longest. Laura had allegedly stopped breathing and CPR attempts did not resuscitate the child. Considered too old to be a SIDS risk, Laura's death was labeled "undetermined," and a police investigation was requested.

Craig found some of his wife's diaries after the couple separated. The contents shocked him. Ms. Folbigg wrote about the stress that "made her do terrible things." She admitted "flashes of rage, resentment and hatred" toward her children. Writing about Laura, Kathleen Folbigg created a chilling entry, "She's a fairly good-natured baby - thank goodness, it has saved her from the fate of her siblings. I'm sure she's met everyone and they've told her; don't be a bad or sickly kid, mum may, you know, crack. They've warned her - good."

In May of 2003, Folbigg was found guilty of the murders of Patrick, Sarah, and Laura. She was also found guilty of manslaughter of Caleb. Justice Graham Barr sentenced her to 40 years in prison with a non-parole period of 30 years. The NSW Court of Criminal Appeal later ruled that sentence was

too harsh, reducing her maximum sentence by 10 years and her non-parole period by five years. Currently serving her sentence in isolated segregation, Folbigg maintains her innocence. She will be eligible for parole in 2028

The most prominent instance of infanticide hidden by a SIDS diagnosis is the Noe case in Philadelphia, Pennsylvania. In 1999, Marie Noe confessed to killing eight of her children. She later changed her story, admitting she killed 4 of them, but could not remember what happened to the other 4. She later changed her story again, saying she clearly remembered smothering 3 of her children. Noe told homicide detectives she recalled that, "Elizabeth was a lot stronger than Richard was and she was fighting when the pillow was over her face."

At the age of 70, Noe was arrested at her home in Philadelphia and charged with first-degree murder. She was accused of suffocating eight of her children to death. The eight children were otherwise healthy infants. Reviewing a 30 year old case, District Attorney Lynne M. Abraham said, "Science has been solving old, unsolved cases," using the technology made available by DNA, fingerprinting and other advances in medical science. "Certainly children die of SIDS," admits Ms. Abraham, "but in 1 to 20 percent of the cases they actually die of something else, including murder." A Philadelphia judge followed the district attorney's recommendations on sentencing and Noe was sentenced to 20 years of probation for the murders, with the first 5 years on house arrest.

A family physician's description of Noe depicts her as "an unstable schizophrenic personality." Her actions display characteristics of "Munchausen's syndrome by proxy," a condition in which a sympathy-seeking person causes and fakes medical problems in hopes of receiving attention and sympathy. Receiving the desired attention, Noe attracted national interest when Life magazine published the family's story in July 1963. She instantly became the most famous grieving and heartbroken mother in America.

The Noe family is the most recognized set of sudden infant death syndrome fatalities within a familial unit. Referred to often, the case is noted when debating the outdated conviction that SIDS is a hereditary disease. Health officials warn that multiple SIDS deaths occurring within a family is sufficient reason for doctors to consider the possibility of infanticide.

The coroner for several Noe children, Halbert "Homicide Hal" Filliger says, "The first death of a child is a tragedy. The second is a medical mystery. The third is murder." In agreement with Filligar's professional opinion, Vincent Di Maio, a medical examiner in San Antonio, Texas, believes that one SIDS death is a true sudden infant death, but warning flags should fly for medical personnel when handling multiple SIDS deaths in a family. He says, "Two SIDS deaths is improbable, but three is impossible."

Judy Wright is correct in her conclusion that, "a mother's role is revered in society." Typically, mothers are the primary caregiver. Mothers are looked upon with complete trust. Infanticide in industrialized nations is a serious issue, and according to The World Health Organization, a majority of the infants are killed by their own mothers. The US Department of Health and Human Services asserts that a custodial mother is 5 times more likely to murder her own children as a custodial father. Two thirds of the women who are convicted of infanticide avoid serving prison time. Crime journalist, Patricia Pearson says women who kill are using sympathetic emotion as an ally. Defenses such as postpartum depression, Pre-Menstrual Syndrome and Battered Wife Syndrome shift the violent criminals into victims, and successfully sway empathy and condolences in their favor. Wright adds, "It's a tragic excuse because it really devalues the pain of parents who genuinely lose children to SIDS."

Frequently called "rock spiders" within the confined walls of Australian prisons, women who kill children do not deserve sympathy or pity. Not only are these "rock spiders" guilty of fatally betraying their own children, but just as evil, they mock the pain, agony and grief of mothers and fathers who lost a baby to an unexplainable, sudden infant death.

While painful, the SIDS investigations must continue for grieving families. Investigation of the family's history is the key to exposing the "rock spiders" who ruin spring days with their poisonous bites. Similar to lightening, SIDS does not strike the same spot over and over and over and over. Family members must struggle through their pain to shed light on the many truths of sudden infant death. SIDS is not hereditary. SIDS is not genetic. SIDS is not an excuse to shield murderers. SIDS will no longer be a scapegoat for crime.

Babies are nature's way of renewing the world, making it fresh and innocent once more. Each generation born into the family represents spring: its warmth, blossoms and beauty. Unfortunately, every once in a while, a chilling wind rushes in, and spoils the promise of a new spring morning. The warmth disappears. Newly formed blossoms are scattered in the blustery winds. And beauty is nearly impossible to see. This is SIDS.