A leading paediatrician has dismissed a suggestion from a British expert that Sudden Infant Death Syndrome was being used to cover up the deliberate killing of infants. However, he acknowledged that the problem of infanticide did exist and was not being discussed.
Prof Tom Matthews, chairman of the Irish Sudden Infant Death Association, was responding to the publication of a study in Britain where SIDS was wrongly diagnosed in more than half of a group of cases where infants were later found to have been killed by their parents.
Prof Matthews said that in every case here of the sudden unexplained death of an infant up to the age of two there was a post-mortem and gardai interviewed the parents. Pathology and Garda reports went to the coroner, who recorded the cause of death. In 10 per cent of cases the death was explained. In 90 per cent of cases deaths were registered as SIDS.
"We don't see SIDS as a diagnosis, but as the absence of a diagnosis of the cause of death," he said. "It is not a cop-out here."
Further precautions included taking samples of body fluids and tissue, which was stored in case something came up a few years later. "These are the sort of lengths we are encouraging pathologists to go to," he said.
Writing in the Archives of the Diseases of Childhood, Prof Roy Meadow wrote: "SIDS has been used, at times, as a pathological diagnosis to evade awkward truths."
Prof Meadow carried out a study of the records of 81 children in Britain where the courts had found they were killed by their parents. In 49 of the cases, the initial diagnosis was SIDS, and in a further 29 other natural causes were initially blamed.
The mother was judged responsible for the death, usually by smothering, in 80 per cent of the cases.
He said glaring signs of abuse, including broken bones, blood and foreign bodies in the airways, were ignored. Some had foreign objects, coins or balls of paper in their airways or intestines. Nearly half the children had been discharged from hospital within the week preceding their death after being admitted for an "unusual or unexplained event".
He added: "It is sad that the term SIDS has become a barrier to the sensible and sensitive investigation of infant deaths. Despite the compassionate and constructive work of so many lay and medical people concerned with SIDS organisations in different countries, the label has become counterproductive."
Prof Matthews disagrees. "Nowadays we are so aware of child abuse issues, I can't believe that if people have genuine suspicions they do not air them. For example, if there are two deaths in a family it is a very obvious reason for suspicion."
He said Prof Meadow's was a very selected group, involving cases where there were convictions in the courts. The proportion was small - 81 over 18 years. In this period, the total number of cot deaths in Britain ranged from more than 1,000 a year in the 1970s to 393 in 1997.
Prof Matthews added that there was still no way of distinguishing a cot death from an inflicted death by gentle smothering, which did occur in certain cases, usually inflicted by the mother.
"This is an issue that has never been discussed. How do we deal with it? Through the judicial system or through treating the mother for depression? Between 5 and 10 per cent of cot deaths are probably caused by somebody."
The Irish Sudden Infant Death Association also acknowledged the difficulty of distinguishing between infanticide and SIDS, adding that there was a need for further research in this area.
"In the absence of a positive diagnosis it most certainly does not help the situation to apportion blame to parents who are already suffering great grief," the association said in a statement.