Correctly determining the cause of death is key to
saving babies, experts say.
Hundreds of Americans kill their babies every year.
Depending on where they live, they may well get away with it.
States that aggressively review infant death investigations are finding twice as many homicides as states with little or no such oversight, a Scripps Howard News Service study of 40,000 infant deaths has found.
The Scripps findings are the first statistical evidence that geography largely determines if a parent or caregiver will get caught after suffocating or smothering a baby — deaths that can appear so similar to sudden infant death syndrome (SIDS) that only a thorough investigation and review can determine the difference.
Child safety experts unanimously agree that correctly diagnosing the cause of death is essential to saving babies in the future. Yet there are no national standards, or even incentives, for state and county governments to conduct careful reviews of sudden and unexpected infant deaths.
One tragic result is that some people are getting away with the murder of infants in their care.
“I often tell people that if you want to commit murder and get away with it, come see me,” said Dallas-based forensic pathologist Linda Norton, a nationally prominent consultant in child murder cases. “I know the best places to go.”
Norton became famous when she convinced New York authorities to seek a serial killer after reading a 1972 medical journal that concluded the deaths of three children in the same family showed SIDS has a genetic link. Police eventually confronted Oswego, N.Y., housewife Waneta Hoyt, who confessed in 1995 that she had smothered all three to silence their crying. She also admitted she’d killed an additional daughter and son after the journal article had been written.
One place where killing a baby is most likely to be discovered is Arizona, the Scripps study found.
Infant deaths in Arizona are investigated by professional medical examiners who are also medical doctors, a stark contrast to the more than two dozen states that allow election of coroners who often don’t have college educations or formal medical training.
Arizona also has a network of local child death review teams overseen by a statewide Child Fatality Review Program with authority to order further investigations if foul play is suspected, a standard most states don’t have.
As a result, Arizona leads the nation in the detection of infant homicide. One out of every six sudden infant deaths in that state was ruled a homicide during the five-year period from 2000 to 2004, the Scripps study found.
“That’s depressing. But, in a way, it’s also very good that we are picking up on these cases,” said Mary Ellen Rimsza, chairwoman of the Arizona Child Fatality Review Program. “My experience, definitely, is that sometimes child abuse deaths are misdiagnosed as accidents.”
At the other end of the spectrum is the state of Idaho, which is the only major jurisdiction in the United States that has no formal review process for the deaths of children.
Only one of every 14 cases of sudden and unexpected infant death in Idaho was declared by the state’s all-elected coroners to be a homicide. (Coroners with medical degrees are in the minority there.) Idaho is reporting infant homicides at a rate at least 14 percent below the national average.
Idaho authorities said they are not proud of their status as the only place not reviewing juvenile deaths and they do not dispute Scripps’ findings that the state lags the national average in reporting cases of infanticide.
“You don’t have to convince me that not having a child death review team is a bad thing,” said Boise attorney Kirtlan Naylor, chairman of the Idaho Children at Risk Task Force. “This study will be very beneficial when we contact our Legislature. We don’t want to be the only state in the U.S. not to have a child death review team.”
Theresa Covington, director of the Child Death Review Policy Center at the University of Michigan, said the Scripps study is the first published proof that oversight of death investigations will increase the detection of murder.
“Absolutely, the process of review improves the quality of death investigations. That’s clearly what these data show,” she said.
Rep. Frank Pallone, D-N.J., who chairs the House Energy and Commerce Subcommittee on Health, said the Scripps data has convinced him to contact the national Centers for Disease Control and Prevention “to see how we can improve the accuracy of the data and, therefore, our response to the tragic problem of infant deaths.”
“This study clearly shows that a more accurate and aggressive approach to children’s death reviews is needed,” Pallone said.
Covington early next year will publish similar findings in the American Journal of Public Health. She found that death review teams are reporting significantly more “child maltreatment fatalities” than coroners and medical examiners are recording on death certificates.
Covington and other experts warn that infant homicide “is a very rare event” and should not tarnish the overwhelming majority of grieving families who have lost children because their babies spontaneously and mysteriously stopped breathing.
Almost all of the parents touched by sudden infant death are innocent of any crime, they say. But it is also true that significant numbers of infanticides are overlooked every year because of failures of the medical investigation into their deaths.
The Scripps investigation found that, as a group, states with both local and statewide child death oversight boards detect 27 percent more infant homicides than do states with little or no review. Some individual states with aggressive review policies detect infanticide at even greater rates.
Investigators have long suspected that most infant homicides go undetected or, at least, unproved. Instead, these deaths frequently are misdiagnosed as the result of SIDS or, increasingly, by the medically useless designation of death by unknown causes.
The U.S. Advisory Board on Child Abuse and Neglect warned in 1995 that its analysts believe the actual number of homicides among very young children is double the official reports. If so, then only a fraction of infant homicides result in successful prosecutions of the killers, although the exact number of convictions for infanticide is not known.
“The problem is there is no hard and fast sign that a child has suffocated,” said Norton, the forensic pathologist.
Veteran homicide investigators agreed that infant killings are often overlooked.
“It certainly doesn’t surprise me. Around here, someone’s uncle is the sheriff and so the nephew is the coroner,” said Danny R. Smith, a private investigator in Boise, Idaho, who investigated many infant deaths during his 21 years at the Los Angeles Sheriff’s Department.
“Cases that are misclassified as SIDS are the least likely to be resolved, in my experience. I had one case of a woman who suffocated her child while sleeping. It was ruled accidental. But she’s also had another so-called SIDS case earlier with another of her children. We just couldn’t prove anything,” Smith said.
If the entire nation detected infant homicides at the rate in Arizona, nearly 700 baby killings would be reported each year. But if the nation detected infant murders as infrequently as Idaho, the annual homicide figure would drop below 300.
In 2004, the most recent year for which complete information is available, medical authorities reported only 379 infant homicides. The figure has been closer to 300 in other recent years. Many of these were not prosecuted for lack of evidence that would convince a jury.
Medical authorities consistently report much larger numbers of infant homicides to the CDC than local police departments are reporting to the FBI, since coroners do not have to identify a suspect or determine criminal intent. Police documented only 201 infanticides in 2004, for example, according to the FBI’s Supplemental Homicide Report issued last year.