Sir, The recent cases concerning cot deaths (letters, January 26) and suspected Munchausen syndrome by proxy (which has been redefined in recent years as “factitious or induced illness”) have confused the legal and medical professions and public.

If parents have indeed been condemned for a crime against a child that they did not commit, that is a terrible wrong — but an ineffective child-protection system, which cannot intervene decisively in cases where children are being abused by their parents or carers, is equally dangerous.

We accept that there must be a review of any cases involving unexplained infant deaths where there may have been a miscarriage of justice. However, this will do nothing to restore public and professional confidence in the management of child abuse. Many medical posts in the field of child protection remain unfilled and paediatricians are, not surprisingly, increasingly reluctant to act as expert witnesses in these complex cases.

Unless confidence is restored, the present crisis in child-protection work will worsen. The present state of affairs cannot be allowed to continue.

We therefore urge the Government to support a high-level review of both the medical evidence with regard to child abuse and the legal processes by which these cases are managed.

Yours faithfully,
ALAN CRAFT,
President,
Royal College of Paediatrics and Child Health,
50 Hallam Street, W1W 6DE.
January 31.

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