Social perception is always evolutionary. According to the Centers for Disease Control and Prevention, the homicide rate for children less than a year old climbed steadily from 1979 to 1991—from 4.86 to 9.24 per 100,000 babies. More than a growth in incidence, the statistics suggest heightened awareness and better medical and criminal investigation. They also mean that by the start of this decade, a baby a day was being murdered in America. But those were only the ones that were being uncovered.
If, as researchers such as David Southall and Roy Meadow have surmised from their studies, some five to ten percent of deaths attributed to SIDS are actually homicides, there may be several hundred undetected murders of babies each year in the United States. But which ones are they? SIDS can claim any baby, regardless of the social, racial, or economic circumstances into which that baby is born.
Therein lies the conspicuous ethical challenge that we faced in the research and writing of this book. Almost from the moment we first learned of Waneta Hoyt on the day of her arrest in March 1994, we heard pleas from many we met in the SIDS world—physicians and social workers from across the country, as well as SIDS parents themselves—that we take care to avoid casting suspicion on the thousands of unfortunate parents who have lost babies to SIDS. This issue was an enduring backdrop to our reporting. We agree that this much is clear: Though some babies who die suddenly and without explanation are the victims of homicide, they are a minority—and most probably a very small one. After decades of research by dedicated scientific investigators, several thousand babies still die mysteriously each year and legitimately fall into the category of Sudden Infant Death Syndrome. Their parents are utterly blameless. Though the central theme of this book is the emotionally charged intersection of SIDS and infanticide, and how the former has sometimes masked the latter, it is essential to bear this in mind.
Likewise, we hope that parents of SIDS babies, and others in the field, will recognize the value of bringing into view the cases and consequences examined here. It is a balancing act for the writers and readers both. Our new friend Carrie Sheehan, who lost her baby to crib death forty-two years ago in Seattle and has since worked professionally with younger SIDS parents, discerns two levels of pain that someone like Waneta Hoyt, a mother of healthy children, inflicts on parents who have not been so blessed. “To use SIDS to rationalize infanticide can turn the clock back to ignorance and isolation,” she wrote to us. “But to a SIDS parent any form of child abuse is unspeakable. The act spreads like a poison, mocking the innocence of all families of newborns.”
Ultimately, legal as well as medical authorities must take care to avoid the kind of cruel and reckless suspicion that marked earlier eras—while still thoroughly investigating reported cases of multiple SIDS and those presenting conspicuous circumstantial evidence of Munchausen by proxy. This is not the standard response now. In June 1996, the federal government issued guidelines intended, in part, to help pathologists, medical examiners, and coroners detect child abuse as well as other causes when dealing with deaths customarily attributed to SIDS. But the rigorous death-scene investigations the government recommended are still not routinely performed in most jurisdictions. Even when they are, and even when the circumstances are suspicious, cases are commonly left unresolved because everyone involved knows how hard it can be to prove parental abuse in court. As the Texas detective once told medical examiner Linda Norton: “I’m not wasting my time. The D.A. doesn’t do child abuse.” Another bias goes to the core of our expectations: “Our society has an endless need to see mothers as good,” a Munchausen expert in Alabama, Dr. Marc Feldman, pointed out. This attitude becomes easy to adopt when there is no one speaking for the children—when the person who would normally press for action is the accused herself. Ultimately, of course, what is needed most is not prosecution so much as intervention. The patterns are now known. Murder may be one of the most preventable forms of sudden infant death.
The SIDS movement has brought one valuable moral obligation to the proceedings. No one should lose sight of the fact that the vast majority of SIDS deaths are not suspicious. But this fact also makes it easier for some other babies to slip away, victims of the perfect crime. That is the conundrum that has not changed in the thirty-five-year history of the SIDS movement—indeed, in the centuries since King Solomon brandished his sword the morning after the first recorded crib death.