The 1995 conviction of Waneta Hoyt in Tioga County, New York, for the murders of her five children between 1965 and 1971 has resulted in considerable publicity.^1,2 Much of the notoriety stems from the fact that in a landmark 1972 paper by Alfred Steinschneider published in Pediatrics these same babies were described as having succumbed to sudden infant death syndrome (SIDS).³ The appellation landmark is warranted because this paper has been quoted more than any other in the SIDS field404 times between 1974 and 1996 in the journals surveyed by SciSearch⁴and led directly to the widespread practice of using cardiorespiratory monitors to prevent SIDS. With justification the public is bewildered at how such a heinous crime could go undetected for so many years, and how a prestigious medical journal could publish a paper that had so much influence and yet turned out to be so wrong. The Hoyt case, along with others where homicide was thought to have been misdiagnosed as SIDS,⁵ has given new strength to those who have always suspected parents of being responsible for a high proportion of the deaths of infants who die suddenly and unexpectedly.

Without intending to minimize the tragedy of innocent lives being taken, the question of undetected homicide should be viewed in the context of what was known about sudden unexpected infant death when these events occurred. The term "battered baby" was first put forth in 1962.⁶ It took at least a decade before the concept of infants being harmed by their care takers became generally accepted. Munchausen by proxy, of which the Hoyt case is a classic example, was not described until 1977,⁷ and even now the entity is insufficiently recognized by health professionals, let alone by judges and juries.

Etched in my memory is an x-ray conference during my internship at Boston Children's . . . [Full Text of this Article]