GUIDE TO HELP FIND CRIB-DEATH CAUSES

It's about time national guidelines were established to help coroners and pathologists distinguish crib death from homicide, says the Cape Girardeau County coroner.

The Centers for Disease Control and Prevention in Atlanta released a standardized, six-page form Thursday to be used by coroners and police when they investigate sudden deaths in infants.

The form is used to note such things as the position of the infant's body, any suspected injuries and any evidence of drug use in the home.

"They're behind the times," said county Coroner John Carpenter. "Missouri was the first state to have those guidelines, and now we teach the other states. Their guidelines are identical to Missouri's."

Missouri is one of four states with detailed, written guidelines for investigating sudden, unexplained infant deaths. The other states are California, New Mexico and Minnesota.

In some cases a child's death tragically attributed to sudden infant death syndrome can actually have a more sinister cause, investigators around the nation have found.

All of Missouri's counties have Child Fatality Review Panels that investigate the sudden deaths of all children under 14.

In 1994, Cape Girardeau County's panel helped catch a killer, said Prosecutor Morley Swingle.

Lorena Barnett, 2, was found dead on the morning of June 5, 1994. Her mother, Sabrina Strange, and the man who would later be sentenced to life in prison for the child's murder, Samuel J. Denny, told investigators they didn't know what happened.

But an autopsy revealed Lorena had been raped, sodomized and suffocated. Denny, who lived with Strange and her daughter in their Delta mobile home, pleaded guilty to murder "after the medical examiner's testimony," Swingle said.

"In looking at her, there were no obvious signs of any wounds, but this was a case based upon the way the blood settled in the body not matching the way she was lying when she was found," Swingle said.

That indicated the body had been moved, he said.

"I can't say the (review panel) solved the crime," Swingle said. "But it was helpful because the sheriff's department had done the investigating and we had the medical expertise there to help review the evidence."

"That was one of the best-case scenarios to teach from," Carpenter said.

When investigating so-called crib deaths, he said, it is important to take into account the child's medical history, the accounts given by people at the scene of what happened and all the physical evidence. Sometimes even the bedding surrounding the body can tell investigators how the child died, he said.

Nationally, about 6,000 deaths are attributed annually to SIDS.

Standardized investigative tools include diagrams for the position of the infant's body and the layout of the room, as well as places to note the infant's condition, the type of sleeping surface, items in the crib, the family's income and the number of smokers in the house.

Missouri law requires investigation of all sudden deaths in children 14 and under, and autopsies must be performed in the deaths of all infants under a year old with no history of chronic health problems.

"That has helped tremendously," Carpenter said. "Not only has it helped with the criminal part of it, but it's helped with a lot of deaths that were classified as SIDS that were not criminal."

Dr. Gary Olson, a Cape Girardeau pediatrician, agreed. Requiring autopsies has helped identify natural causes of death such as brain tumors, cancers, respiratory disease or metabolic disease, he said, making the state's statistics more accurate and letting parents know of hereditary or genetic conditions that may affect their other children.

"I think it's important to check it out," Olson said. Beyond confirming whether or not foul play occurred, he said, "sometimes there's some inherited diseases that can present like SIDS."

Statewide, 88 deaths were attributed to SIDS in 1994, according to the most recent available figures from the Missouri Department of Health. That works out to 1.222 SIDS deaths for every 1,000 live births in the state.

In Southeast Missouri eight SIDS deaths were reported that year, or 1.15 deaths per 1,000 live births.