Intended for healthcare professionals

Rapid response to:

Education And Debate

Munchausen syndrome by proxy and sudden infant death

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7451.1309 (Published 27 May 2004) Cite this as: BMJ 2004;328:1309

Rapid Response:

Getting the facts right

Professors Craft and Hall state in their paper

"There is little evidence of familial clustering of sudden infant
death syndrome, and more than one unexplained infant death in the same
family suggests two other possibilities, w20: homicide or inherited
conditions such as metabolic disorders (for example, medium chain acyl
coenzyme A dehydrogenase deficiency), cardiac arrhythmias (including
prolonged QT syndrome), immune deficits predisposing to infection, and
abnormalities of ventilatory control.2 These conditions probably account
for a small fraction of cases,w21-23 but their existence and the
possibility that some may remain to be discovered add a dimension of
uncertainty in any death where autopsy findings are negative or
equivocal."

"In future this may sometimes need to include a search for genes that
might be associated with conditions predisposing to sudden death. Parents
have a right to expect that their baby's tragic unexplained death will be
investigated as thoroughly as would be the case for any other citizen."

Perhaps Alan Craft and David Hall would now like to rewrite this
paper in light of the identification of a gene that causes the sudden
deaths of infants, found in the Amish
community in the USA from which 21 infants from two generations died. I
shudder to think what would have happened if certain paediatricians had
been involved in determining the causes of death in this case. The
condition is called SIDDT and the babies appear normal at birth but
rapidly develop malfunctioning organs. Death occurs before the age of one,
caused by sudden heart and lung failure. [1]

So maybe we should be genetically testing ALL new-born babies, think
of the heartache that could be prevented and this is the only recent
discovery either, only last week research also showed that some babies
could be prevented from dying, researchers describe the specific group of
neurons that are responsible for gasping and what happens to these cells
when they are deprived of oxygen. Since gasping resets the normal
breathing pattern for babies, the scientists suspect that a malfunction in
these respiratory pacemakers is the cellular mechanism that leads to SIDS.
[2]

Don't take my word for it as a "lay campaigner" read the papers for
yourselves. General paediatricians are trained to deal with live babies
and children and their illnesses, they are neither paediatric pathologists
nor are they geneticists and in my opinion shouldn't give evidence either
to social services, police or to the courts on areas of medicine that they
have not specialised in.

I learn from what I read and regularly discuss aspects of SIDS with
forensic paediatric pathologists, not in the UK though because we only
have the one and he's retired now! (such is the value of a child's life in
this country the government/NHS couldn't or wouldn't pay for the right
expertise)!

If a baby dies form Long QT Syndrome it leaves NO MARK at death,
therefore it is essential that it is identified through genetic testing
whilst a child is alive so that a parent can't be accused falsely and for
the safety of any other family members who may carry the defective gene.
This condition is not as rare as previously thought. This condition is
believed to kill between one and two infants in every thousand and is very
likely to happen in clusters given that it is genetic in it's origins
(outside of drug induced arrhythmias). [3]

Prevention is better than cure isn't it?

[1] http://www.tgen.org/news/index.cfm?newsid=264

[2] http://www.news-medical.net/?id=3182

[3] http://www.qtsyndrome.ch/sidsp.html

Competing interests:
Campaigner against false allegations of MSbP etc. Pro bono researcher for law firms into the causes of sudden death in infancy.

Competing interests: No competing interests

27 July 2004
Penny Mellor
Advocate
Home WV9 5HX