Death in the Crib

Every time a baby is found dead in his crib, apparently smothered by bedclothing or a soft pillow, the mother is tortured by the feeling that she should have been more careful. Neighbors and kin often brand her as negligent. Almost all such blame and remorse are pointless, says Dr. Keith Bowden in the current Australian Medical Journal: cases of "baby smothering" are usually due to unsuspected disease.

Many infant deaths are reported as due to "accidental suffocation" because few autopsies are made, and most of these are not thorough enough. Dr. Bowden, chief pathologist for the state of Victoria and head of the Melbourne morgue, did a series of 40 detailed autopsies on babies who had died in their cribs, most of them supposedly from simple suffocation. He did not find a single case which clearly fitted the diagnosis. Sometimes, he reported, "the exact mechanism of death is obscure," but "in almost every case natural disease was present."

The real explanation, says Dr. Bowden, is the "appalling swiftness with which death in the form of natural diseases snatches the young." A baby may be overwhelmed in a few hours by a disease of such an "explosive" type that no symptoms are showing when the child is put to bed. Most of the explosive diseases which kill infants in bed (sometimes by suffocation) involve the upper respiratory tract, ears or heart.

Parents sometimes blame a baby's death on the fact that he was found face down. Up to the age of six months, says Dr. Bowden, nearly all babies like to sleep flat on their backs, though some can turn over at four months. As soon as he can turn over, the baby usually prefers to sleep on his face, with knees drawn up. There is no clear connection, Dr. Bowden found, between a baby's sleeping position and sudden death in bed.

A healthy baby can take care of himself. When Dr. Bowden lowered a blanket over the face of a sleeping infant only 26 days old, the child turned his face to the side. A six-weeks-old was put face down on a mattress, and turned his head freely from side to side in sleep. At 15 weeks, a baby wrapped in a blanket and put face down on a mattress turned on his back, pushed the blanket away from his face and contentedly sucked his thumb without once waking up.

A healthy baby actually being suffocated would fight for life and yell to attract attention, says Dr. Bowden. "Why," he asks, "should a healthy baby die without much fuss just because he is face downward or his face is covered? But a baby dying of natural disease might well be expected to make a quiet exit."

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