Sudden unexpected infant death (cot death) has become much less common in recent years, and it is rare for a family to experience two such deaths. Carpenter and colleagues recently published valuable data on the repeat deaths that occurred among 5229 families in the Care of the Next Infant programme.1 This voluntary scheme funded by the Foundation for the Study of Infant Deaths provides extra support to families in England and Wales who have had a cot death and now have a new baby. There were 48 sudden unexpected deaths among babies on the programme between 1988 and 1999, including two third deaths. After examining all the circumstances and postmortem findings of the 46 second deaths, the authors concluded that all but six of the babies died from natural causes. This contrasts with earlier studies by Emery2 and Wolkind and colleagues,3 which concluded that a much higher proportion of repeat cot deaths were probably homicides.

Apart from two short letters,4 5 Carpenter and colleagues' report was initially unchallenged. It has proved very influential, being accepted by bodies such as the American Academy of Pediatrics.6 More recently, however, Gornall published a wide ranging critique of how the authors presented their data.7 The authors defended their classification,8 but we believe their dichotomy of the deaths into natural or unnatural is particularly open to criticism. Experience in child protection teaches that it is often impossible to determine whether the parents have been in some way and to some degree responsible for the unexplained death of their baby. In this article we show how many of the second deaths might be …