GULFPORT — Four-month-old Emma was dressed in a pink onesie with a heart on it when her mother awoke to find her dead.
It was the second time in two years that Nicole Iannone had found one of her children dead after falling asleep with the baby, according to police reports. She had lost a baby boy after sharing a bed with him in Philadelphia, police found.
Just a few days after Emma’s death in January, Gulfport police arrested Iannone on a manslaughter charge.
But in May, prosecutors decided not to file charges. A medical examiner’s report detected that the child had a gene abnormality linked to heart problems and was unable to determine her cause of death.
U.S. public health officials discourage bed sharing between parents and infants, saying that babies should sleep on their backs in a crib with only a fitted sheet, free of materials that could suffocate them. Parent and child should share a room, but not a bed, for at least the first six months, they advise.
Criminal investigations can prove murky. In the United States, nearly 75% of unexpected infant deaths in 2020 were classified as sudden infant death syndrome or an undetermined cause of death.
Connie Shingledecker, chairperson of Florida’s Child Abuse Death Review Team, trains police and medical examiners to investigate these deaths. A retired major at the Manatee County Sheriff’s Office, Shingledecker advises law enforcement officers to gather as much information as possible before making an arrest.
“In that respect, you’ll feel that you have the best information,” she said. “And then you make a decision.”
“They don’t know”
Iannone told her fiance, Jack Gough, that she had always wanted to be a mom.
He worked two jobs to support the family. Iannone took on the majority of child care as a stay-at-home mom, according to a Gulfport police report.
The couple had moved to Florida to be closer to Iannone’s family. Police reports recorded their housing status as “transient.”
The couple’s first child, Ryder, died after Iannone took him into her bed and fell asleep. The 2-month-old boy was wearing an over-the-counter heart monitor, and Iannone woke up when it started going off. The baby had blood coming from his nose and his heart wasn’t beating, according to a hospital report.
On her first birthday after her son’s death, Iannone raised money for the American SIDS Institute in memory of her son.
Neither Iannone nor Gough could be reached for comment in recent weeks at phone numbers or addresses listed under their names in public records.
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Though some health officials had warned Iannone about cosleeping and the couple had resolved at times not to cosleep, Iannone told police she had seen information on social media promoting bed sharing.
She also told police that she hadn’t been told what caused Ryder’s death, and that she had been told he had died of sudden infant death syndrome. She asked if testing could be done on Emma because she wanted to know of health problems that could be passed on if she had other kids.
Yet her sleeping arrangements presented hazards flagged even by some researchers who champion bed sharing: The bed was wedged against a wall, where an infant can get stuck, and Emma was bottle-fed instead of breastfed, a risk factor that can make cosleeping more dangerous, as researchers believe breastfeeding moms are more attuned to their baby’s movements throughout the night.
The Pinellas-Pasco Medical Examiner’s Office had not completed its autopsy of Emma, but Iannone told officers she intended to move back to Pennsylvania. They arrested her before she could leave.
“Because she only recently moved to Florida from Pennsylvania, and didn’t have ties here, the likelihood of her fleeing prosecution was great,” Sgt. Thomas Woodman said in an email. “Based on the totality of our investigation, we had probable cause for her arrest and didn’t require the autopsy report to develop probable cause.”
When the Pinellas-Pasco Medical Examiner’s Office released its report, however, the case became more complicated. Genetic testing on Emma found that the child had an abnormality on a gene that has been linked to heart problems. As a result, the office couldn’t determine the cause and manner of the infant’s death.
That prompted prosecutors to drop the case without filing charges, according to Assistant State Attorney Christie Ellis.
While researchers were able to determine that Emma had a genetic abnormality, it’s hard to say whether it would have caused or contributed to the infant’s death. Mutations in this specific gene have been linked to atrial fibrillation and may also be connected to other heart problems. Still, not all genetic abnormalities cause health issues, according to Christopher Snyder, a pediatric cardiologist who reviewed the report for the Tampa Bay Times.
“They don’t know whether it causes lone atrial fibrillation or something else or potentially nothing,” Snyder said.
Safe sleeping practices
Though the medical examiner’s office could not determine the child’s cause of death, they did not categorize it as sudden infant death syndrome.
That’s because Pinellas-Pasco medical examiners stopped classifying infant deaths this way in 2000. They found that many of the deaths were caused by suffocation in unsafe sleeping situations. They believed that sudden infant death syndrome confused parents, making them think that the children died of unknown causes, rather than preventable factors, such as unsafe sleeping situations.
Still, sometimes the office classifies a death as undetermined when there isn’t enough information to identify a singular cause of death, as was the case here, said Bill Pellan, director of investigations for the medical examiner’s office.
Many infant sleep deaths are caused by asphyxiation and unsafe sleeping situations, Pellan said.
Some U.S. researchers have also found that there are ways to bed share safely, including James McKenna, a professor at Santa Clara University and professor emeritus at the University of Notre Dame. McKenna has spent about 40 years studying the connections between infant sleep, breastfeeding and unexpected infant sleep deaths.
Safe sleeping starts before the baby is born, McKenna said. Parents who smoked during pregnancy, for instance, should not bed share because it increases the risk of the baby dying in their sleep.
Parents also should not bed share if intoxicated or taking medication that would make them drowsy. They should also keep the child away from pillows, stuffed animals and soft bedding.
And they should never sleep on a sofa or couch with their infant.
“Just like you arrange a safe crib environment for your baby, there’s a way to arrange a safe bed-sharing environment for a baby,” McKenna said.
Conducting an investigation
Investigating infant deaths can be difficult for police, who must balance their responsibilities with sensitivity to grieving parents.
Determining criminal culpability in these cases can be difficult, and at times, controversial. When a Wisconsin state representative crafted a bill that would criminalize intoxicated parents who share a bed with their child, it was criticized by some who said the state should instead focus on prevention by addressing poverty, mental health and substance abuse. That bill ultimately failed to pass in two different sessions.
Such laws are also not always applied evenly. Dorothy Roberts, a law professor at the University of Pennsylvania, has studied the criminalization of mothers, in particular Black women who used drugs while pregnant. When mothers are prosecuted for harm to a child, women of color and low-income white women are more likely to face legal consequences, she said.
“Punishing mothers — marginalized mothers — has long been a way of diverting attention from the real harms to children and the kinds of radical changes we would need to truly support children and keep them safe,” she said.
When Shingledecker, the retired Manatee County Sheriff’s Office major, first began her career in the 1970s, police were told not to “retraumatize” parents by asking too many questions during investigations into infant deaths.
“I think, unfortunately, that during that time period, the lack of thorough investigation … probably led to untold numbers of child homicide cases that we’ll never know,” Shingledecker said, noting high-profile cases where moms smothered their babies.
Shingledecker teaches police how to use doll reenactments to learn more about how the child died, having parents show officers how the child was positioned and where they were, both after they went to sleep and after they were found dead.
“I tell these detectives … the most important thing that you’re doing right now is helping us by gathering as much information so we can prevent future death,” she said.