"We had a bunch of child starvation and abuse deaths over my 19 years. Lots, unfortunately," said former Philadelphia District Attorney Lynne Abraham, whose office spent years investigating the 2006 death of Danieal Kelly, who weighed 42 pounds when she died at age 14.
"A lot of the parents are totally ill-equipped to take care of one child, let alone multiple children," Abraham said.
Kelly, who had cerebral palsy and used a wheelchair, died despite the family's enrollment in an intensive program for the city's most needy households.
More recently, 2-month-old twin Quasir Alexander weighed just over 4 pounds when he died at a homeless shelter in 2010, where his mother lived with her six children and received an array of social services.
Ensuing criminal trials revealed fraud in the Kelly case — social workers and contractors skipped the weekly home visits — and perhaps inexperience in the Alexander case. A social worker saw Quasir 36 hours before he died, but the baby was swaddled in clothing and the social worker found nothing amiss.
Danieal's mother was convicted of third-degree murder; her father of felony neglect. Quasir's mother was convicted of involuntary manslaughter.
Nathalyz's death may point to a third phenomenon, where families remain isolated from people who could help. It may be up to a jury to determine if that was intentional.
"When you have parents that are not invested in their children — sometimes they have mental health disease, sometimes they're so overwhelmed with life, that getting health care is not on their agenda — and you couple that with a child that's got medical problems, that's when you get into these kinds of situations," said Dr. Cindy Christian, a Children's Hospital pediatrician who serves as medical director of the city's Department of Human Services.
"But there should never be a child who dies of starvation," she said. "We know how to nourish children, even with the most complex health care needs."