Editor,—Intentional suffocation is a difficult diagnosis. Children often appear well in between such episodes and cannot tell their paediatrician that they are being intermittently assaulted. The evidence for intentional suffocation is often circumstantial, which means that doctors may have difficulty substantiating the diagnosis in court without evidence from covert video surveillance. We are surprised, therefore, that Daviset al state that a high proportion of suffocation victims were protected effectively without covert video surveillance.1 It may be that these cases were not contested or had evidence of other harm to the child in addition to the suffocation.

Davis et al reinforced the British Paediatric Association working party guidelines that “when there is a very high risk, children should not be exposed to danger simply to achieve a criminal standard of proof.”2 Covert surveillance has been used in our knowledge primarily to confirm the diagnosis and to ensure effective protection for the child and siblings. Even in civil proceedings, which rely on a balance of probabilities, the more serious the allegations of abuse, the higher the level of evidence the court requires. In a number of cases of suspected suffocation, we have seen children inadequately protected …