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- W130594328 abstract "Editor—Green's article is obviously intended to stir up the cot death establishment.1 When cot death was introduced as a registerable cause of death, largely under the influence of forensic pathologists Bernard Knight of Cardiff and Francis Camps of London, some of us working in paediatric pathology were not in favour of this as we knew that it had many different causes.We have known from the outset that a proportion of the deaths were technically filicide. In the early 1980s, when we publicly gave the figure of 10%, our findings were fiercely contested, but they were confirmed recently.2 The recent studies by Meadows and Southall et al showing parents deliberately and calculatingly harming their infants apply to only a small proportion of the group of cot deaths that could be classified as infanticide.3,4 In our experience of hundreds of confidential inquiries into sudden unexpected deaths the most usual scenario for filicide is for the baby to have been suffocated by an exhausted parent (usually the mother) while trying to quieten his or her crying. These parents usually barely knew what they were doing and did not intend or want to kill their child.We need to prevent these deaths, not victimise the parents.Green's advice to “think dirty” needs to be considered against our experience with the care of next infant (CONI) programme. This programme, funded by the Foundation for the Study of Infant Deaths, provides support for families with children born after a cot death. Of 5000 babies from 4182 families in the programme, 44 died (8.8 per 1000 live births), 35 unexpectedly.5 After confidential inquiries 20 were considered to be natural deaths, of which 12 were classified as inevitable because of congenital anomaly or specific diseases and eight as unexplained because there was minimal or no disease. Fourteen were classified as non-natural deaths, including four attributed to overlaying. Ten deaths were not fully investigated (in seven cases the family declined investigation, in two cases no histology was done, and in the last the mother could not be traced). Thus at least 20 of the second deaths in these families were due to natural causes.We found that before the death that led to enrolment the 4182 families had had 6406 infants, of whom 112 died (17.5 per 1000 live births). The difference between the earlier mortality and that on the programme cannot be explained simply by falling infant mortality over the period. What is needed are deeper non-critical confidential inquiries into all unexpected deaths that include interested paediatric pathologists and are followed by systematic support. We do not need to create a pool of parents to which a label of unproved homicide is publicly attached." @default.
- W130594328 created "2016-06-24" @default.
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- W130594328 date "2000-01-29" @default.
- W130594328 modified "2023-09-25" @default.
- W130594328 title "Debate on cot death" @default.
- W130594328 cites W2161272691 @default.
- W130594328 doi "https://doi.org/10.1136/bmj.320.7230.310" @default.
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