The Nursery's Littlest Victims
THERE WAS TALK, OF course--how could there not be when all five children in one family died as babies? But doctors, police and neighbors accepted Waneta Hoyt's explanation: her little Eric and James and Julie and Molly and Noah, she said, were all victims of crib death, or sudden infant death syndrome (SIDS). Even after Hoyt was convicted of five counts of murder, in 1995, it seemed like an isolated instance of a disturbed woman almost getting away with murder.
But the Hoyt case may have been even deadlier than anyone thought, claiming--indirectly--many more than five young lives. According to a new book, ""The Death of Innocents'' (632 pages. Bantam. $24.95), by reporters Richard Firstman and Jamie Talan, the deaths of the last two Hoyt babies became the basis for a SIDS paper so influential that it put blinders on pediatricians and researchers for 25 years, preventing most of them from considering homicide when babies died for no apparent reason. In that paper, published in the journal Pediatrics in 1972, Dr. Alfred Steinschneider, who had cared for Molly and Noah Hoyt, argued that SIDS runs in families and is caused by prolonged sleep apnea (a cessation of breathing for 15 seconds or more). The paper became an instant classic. It gave birth to a multimillion-dollar apnea-monitor industry. But it also provided cover for families where more than one child died of SIDS. A quarter-century later, Dr. Jerold Lucey, editor of Pediatrics then and now, writes in the October issue, ""We should never have published this article . . . [S]ome physicians still believe SIDS runs in families. It doesn't--murder does.''
Every year in the United States more than 3,000 infant deaths are listed as SIDS, while 300 or so are identified as infanticides. Now two scientific papers suggest that some in the first category belong in the second:
In a study scheduled for publication in Pediatrics in November, Dr. David Southall of City General Hospital in Stoke-on-Trent, England, describes how he set up video cameras in the hospital rooms of children brought in after parents reported that they had stopped breathing and nearly died. The cameras captured 39 instances of mothers trying to smother their babies. Fully one third of these ""near-miss SIDS'' cases, Southall estimates, are actually cases of MUnchhausen by proxy, in which a parent injures a child in a bid for attention and sympathy. Overall, Southall concludes, 5 to 10 percent of SIDS deaths are in fact infanticides.
In an unpublished study, Dr. Thomas Truman concludes that as many as one third of repeated near-SIDS cases at what may be the most prestigious SIDS center in the United States may be cases of MUnchhausen by proxy. While serving a fellowship at Massachusetts General Hospital from 1993 to 1996, Truman told Firstman and Talan, he analyzed the medical records of 155 children treated in MGH's apnea program. In 56 of these cases, says Truman, the child's chart contained circumstantial evidence of possible abuse. One baby suffered repeated breathing crises at home, turning blue and limp--but only when the mother, and no one else, was present. Another had no breathing problems during the six months he spent in a local hospital; the day he went home, alone with his mother, he had a life-threatening breathing emergency. When Truman alerted New York authorities to the possibility of abuse in the case of ""Emily,'' 1, his superior dismissed it. Emily died one year after being sent home from MGH.
None of these cases prompted formal investigations. As a result, it is impossible to determine what really happened to the children. Last week MGH declined to respond to the allegations beyond issuing a statement that SIDS is ""constantly debated within our department.'' The doctors who run the apnea program refused to be interviewed.
Whatever the individual pathology of mothers who kill their children, there is a larger pathology at work here: the medical community's. Perhaps the most important pages in ""Death of Innocents'' explore how ""misguided science . . . arguably shielded countless other infanticides'' besides Waneta Hoyt's. In a chilling demonstration of the power of a scientific paradigm to blind researchers to reality, the medical establishment embraced the apnea-runs-in-families hypothesis uncritically. As a result, few doctors entertained the possibility that their SIDS and near-SIDS cases were murder or MUnchhausen. Yet as early as 1982 Southall presented data that should have sunk the apnea idea. He had monitored, for 24 hours, the breathing of 9,251 babies; 27 later died of SIDS. Not a single little victim had had prolonged apnea. But the idea that apnea causes SIDS was so powerful, says Dr. Marie Valdes-Dapena, a pediatric pathologist, that she and the rest of the scientific community ""bought it hook, line and sinker.''
With the claims that SIDS runs in families and is caused by apnea now in tatters, the hope that it can be prevented with a monitor is also on the ropes. Since the 1970s worried parents have been relying on these electronic devices to signal when a sleeping baby stops breathing. In one ongoing study, Dr. John Keens of the University of Southern California School of Medicine has found that some babies indeed stopped breathing while they slept and died. Monitors sounded, but the children could not be revived. That suggests that death (perhaps from heart defects) caused their apnea, rather than apnea causing death. No studies have found monitors to save lives of normal babies (they do protect preemies). ""Huge amounts of time and money have been wasted over the last 25 years in a useless attempt to "do something' for SIDS victims by monitoring,'' editorializes Lucey in the upcoming Pediatrics. Neither Steinschneider nor Healthdyne, the leading monitor manufacturer, responded to NEWSWEEK'S requests for comment.
Although apnea monitors are saving few babies, SIDS cases fell 30 percent, from 4,891 to 3,279, between 1992 and 1995. In 1992 the American Academy of Pediatrics recommended that babies sleep on their backs or sides rather than their stomachs. Yet even today Steinschneider's organization, the American SIDS Institute, does not include that advice in its brochure on preventing SIDS.
No one denies that thousands of babies do die in their sleep of natural, if mysterious, causes. Some may have cardiac defects; others may have rebreathed oxygen-poor air formed by pockets in their cribbing. SIDS support groups worry that grieving families who have already suffered the tragedy of a baby's dying will now be subjected to suspicions that the death was actually murder. ""The kinds of cases they're sensationalizing are few and far between,'' says Phipps Cohe of the SIDS Alliance. How few? Last week Massachusetts authorities said they would study Truman's allegations before decid- ing whether to reopen any cases of infant deaths. And, thankfully, videotaping is becoming standard practice at hospitals' apnea clinics. But no one, of course, is watching what goes on at home.
Nothing cut the rate of SIDS-until a 1992 recommendation that babies be put to bed on their back.