Recent court cases into unexplained infant deaths have led to widespread confusion and have made many pediatricians reluctant to take part in child protection cases, warn experts. They call for an urgent review of procedures to restore faith in the child protection systems.

The term Munchausen syndrome by proxy received publicity when in Meadow reported a case with deliberate fabrication of symptoms. Many manifestations of the syndrome are now recognized. Yet recent events have raised questions about the diagnosis of the syndrome and have prompted some soul searching about the ways professionals respond to the unexpected death of an infant.

A non-adversarial approach needs to be introduced to deal with sudden infant deaths, say the authors of a new study appearing in the British Medical Journal. The emphasis must be first on assessing and minimizing the risk to any other children cared for by the parents and secondly on management of the parents' needs. Professionals who offer expert evidence must also not promote ideas that are unsupported by research.

"We must restore the faith of the public and the professions in the child protection systems that are vital for a civilized society," say the authors. "Munchausen syndrome by proxy has captured the public imagination, but there is still much that we do not know about other aspects of child abuse.

"We urgently need to review procedures and to fund more research into the causes, mechanisms, and diagnosis of child abuse. And we call on journalists, lawyers, and the judiciary to ensure that they are well informed about the mass of evidence and data gathered over the past 40 years in child protection."

To view the paper, go to http://press.psprings.co.uk/bmj/may/edd.pdf