For debate

The increased awareness of deliberate harm to infants by parents and carers has prompted debate on the terminology used for “cot deaths.” These two papers give historical context of the debate and consider whether the use of “sudden infant death syndrome” should be abandoned.

Time to put “cot death” to bed?

In a recent editorial in the Journal of Clinical Pathology I argued that pathologists should approach sudden and unexpected death in the first year of life with greater caution than may have been applied in recent years.1 In consequence of the increased awareness of deliberate harm by parents and carers reported by Meadow and so graphically captured on video recordings by Southall and Banks,2^–4 I said that the term “not ascertained” should be used much more widely than it is at present. I am fully aware of the distress that such an approach may cause to recently bereaved and totally innocent parents. I am also old enough to recall the “bad old days” of the 1960s, when deaths were wrongly attributed to unsuitable bedding or inappropriate care, leading to unnecessary inquests and pillorying of the parents in the local press. At the other end of the spectrum we used to invent meaningless diagnoses such as “acute interstitial pneumonitis” and “viral bronchiolitis.”

Until late 1971 the registrar general would not accept the sudden infant death syndrome or any of its synonyms as a cause of death. This refusal had two undesirable consequences. Firstly, we had no idea of the true incidence of such deaths in the United Kingdom (or any other society) until reports such as that of Banks gave an indication of the size of the problem.5 Secondly, we focused our attention on an ever enlarging battery of laboratory investigations, rather than closely scrutinising the child's and the parents' histories, especially …