Intended for healthcare professionals

Education And Debate

Munchausen syndrome by proxy and sudden infant death

BMJ 2004; 328 doi: (Published 27 May 2004) Cite this as: BMJ 2004;328:1309
  1. A W Craft, professor of child health1,
  2. D M B Hall, professor of community paediatrics (
  1. 1Sir James Spence Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  2. 2Institute of General Practice, Northern General Hospital, Sheffield, S6 6GY
  1. Correspondence to: D M B Hall
  • Accepted 7 May 2004

Media vilification of paediatricians acting in cases of alleged child abuse has resulted in widespread confusion about research data and threatens the systems to protect vulnerable children. How should we move forward?

Everyone can empathise with the grief of parents who have lost a baby and even more so with the nightmare scenario of being wrongly held responsible for the child's death. It is therefore not surprising that the media showed intense interest in three recent cases in which mothers were accused of murdering their babies.1 Nothing in this article should be construed as personal opinion on any individual case, but we are concerned that everything we have learnt over the past 40 years about sudden infant death syndrome and the spectrum of child abuse seems to have been forgotten.

Attacks on paediatricians who give evidence in child protection casesw1 and journalists' use of phrases like “Meadow's discredited theory of Munchausen syndrome by proxy” have left the public and the health professions anxious and bewildered. In this paper we outline the evolving understanding of the relation between unexplained death in infancy and child abuse, draw lessons from recent events, and offer proposals for the future.


Caffey described what was undoubtedly child abuse in 1946w2 but was reluctant to draw the obvious conclusions. Another 16 years passed before Kempe and colleagues published their seminal paper on the battered child syndrome in 1962.w3 At about the same time, the problem of “cot death” began to attract interest. The phenomenon of unexplained death in previously well babies had been known for centuries and was blamed on overlying, “status thymolymphaticus,” witchcraft, and many other causes, including infanticide.

The first major conference on cot death was held in Seattle in 1963, and the possibility that some such deaths might be due …

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