SPRINGFIELD, Mo. -- Greene County's medical examiner has seen what he calls an alarming number of infant deaths, having already performed 20 autopsies on babies this year from the 31 southwest Missouri counties he oversees.

There is no pattern, Medical Examiner James Spindler said. Some involved apparent negligence or abuse, while others are natural causes.

All are disturbing, he said.

"I'm really tired of seeing dead babies," said Spindler, who has done 12 autopsies on infants so far this month.

One of the most recent came Tuesday, when Spindler did an autopsy on a 10-week-old Joplin boy, whose father returned home and found him on a floor furnace.

His mother was sleeping nearby.

The boy had suffered third-degree burns to his back, legs and buttocks. Spindler determined he died of excessive heat caused by the burns. But he is awaiting more tests before deciding whether it was a criminal or accidental act.

Investigations continue

Authorities haven't made final rulings on most cases, but only a few of the 20 deaths are considered suspicious. Nearly all remain under investigation.

Even though the number of deaths seems high, state officials aren't worried about a trend.

"We try not to get alarmed by one or two months of data," said Guy Kolilis, deputy director of the legal division for State Technical Assistance Team, which reviews children's deaths across Missouri.

"There have been things in the Greene County area that are concerning to us -- negligent acts, criminal acts and medical care. Some of these deaths were obviously preventable, but we need to look at the big, long-term picture."

Greene County health officials have been watching the number of infant deaths, trying to see how education can be implemented to reduce the numbers.

Physicians and nurses also are working to provide new parents with brochures and information on safe sleeping environments for babies, a concern they noted after a handful of deaths involving infants sleeping with parents and siblings or in cribs padded with heavy quilts, comforters and pillows.

Review boards meet

Counties are required to gather their Child Death Review Board every time a child age 17 or younger dies. The boards typically include the law enforcement, medical and juvenile authorities.

Because of the sheer volume of infant autopsies and the emotional drain involved, Spindler hasn't yet gone through each report and made a tally on causes.

But from what he's seen, Spindler said parents and caretakers need to remember how fragile babies are.

"We have defense mechanisms and faith and that's what carries us through," Spindler said of how he and his staff cope with the autopsies' emotional toll.

"We do them one at a time and hope there's not another one. But we know there will be -- there always is."