9.1 Investigation of Sudden Unexpected Deaths in Childhood

1.

Background

2.

Definition

An unexpected death is defined as:

The death of a child (from birth to 18th birthday) which was NOT anticipated as a significant possibility 24 hours before the death;

OR

A similarly unexpected collapse leading to or precipitating the events which led to the death.

3.

Immediate Response to an Unexpected Child Death

In summary, the responsibilities of the Paediatrician (or Consultant in Emergency Medicine) include:

• Informing the parents about the death and explaining next steps. This should include an explanation of the process outlined in this protocol, which may be supported by a local leaflet.
• Ensuring full liaison with the police in the event of a suspicious death.
• Where there is concern that the death is suspicious, a decision as to what information is shared and how it is disclosed to parents should be determined by the senior investigating police officer.
• Deciding whether the death is unexpected.
• Notifying the Coroner.
• Taking history, examination and samples.
• Checking whether the child is known to Children's Social Care, and acting on immediate concern for siblings.
• Gathering early information via telephone discussion with Police, Children's Social Care, Coroner's Office and possible others involved in the child's care (depending on time of day) such as GP, school, Early Years setting.
• Collating all relevant information and sharing it with the pathologist prior to the post-mortem.
• Notifying the Designated Doctor for SUDIC as soon as possible (this may be the next working day depending when the child is brought in).
• Notifying the Named and/or Designated Doctor for Child Protection.
• Arrange for follow-up with parents.

The Emergency Department Nurse will provide immediate support to the parents.

The Paediatrician should immediately inform:

• The Coroner
• The Police (if not already aware)
• Children's Social Care

An immediate check should be done with Children's Social Care Services for the relevant area (see Local Contacts) to check whether the child is known to Children's Social Care, but this does not represent a referral. Children's Social Care Services can respond urgently if there are issues such as concern about the safety of siblings. This would represent a referral (see the Referrals Procedure) but should only be done if there are immediate concerns. Otherwise a formal notification should be made to the Safeguarding Unit in Children's Social Care for the relevant area (see Local Contacts).

4.

Early Information Gathering (Same Day)

The Paediatrician (or Consultant in Emergency Medicine) should lead the process of early information gathering, which will comprise an early discussion involving all lead agencies.

This will normally take place on the telephone and should include:

• Police
• Children's Social Care
• Coroner's Office
• Other involved in the child's care e.g. GP, School, Early Years, CAMHS (this will depend upon the time of day when the child is brought in).

The purpose of the discussion is to gain commitment to gathering as much information as possible about the circumstances of the death and also to plan the next steps, including arrangements for close collaboration and communication as appropriate.

5.

Notification to SUDIC Paediatrician/Team and Others (Same Day or Next Working Day for out-of-hours Cases)

The Paediatrician (or Consultant in Emergency Medicine) should notify:

• The SUDIC Paediatrician/Team
• The Designated and/or Named Doctor for Child Protection
• The General Practitioner
• Local Safeguarding Children Board

and others as indicated in local protocols

6.

Visit to the Place of Death

The following principles will be taken into account when deciding whether a home visit will take place:

• Visits will not be taken to the scenes of crime, except at the explicit request of the Police
• Visits will not take place to the scenes of road traffic accidents
• A visit must add value to the process.
• In general, nurses (notably health visitors) are the health professional with most expertise in visiting and assessing children within their homes.
• Safety is paramount, and health professionals will not attend the homes of families where a child died under suspicious circumstances on their own

Visits will not usually be undertaken by the SUDIC Paediatrician (or member of a SUDIC Team) alone, and one of the following options will be utilised, by negotiation, on a case by case basis, for example:

• A visit alongside the Police, who often visit the site of death again the following day.
• A visit alongside the primary health care team, providing the opportunity for support to the family from a professional whom they already know.

7.

Discussion at 5 to 7 Days

The SUDIC Paediatrician/Team will, in all cases, initiate multi-agency discussion (by telephone) within 5-7 working days, to review and update information. This discussion will include:

• The pathologist undertaking the post-mortem
• The Police
• Children's Social Care
• Consultant Paediatrician (or Consultant in Emergency Medicine) involved in the process
• Other relevant health care professionals involved in the care of the child before death or in the period surrounding death

8.

Provision of 28 Day Report to the Coroner

9.

Case Discussion Meeting

The purpose of the case discussion is:

• To share information to identify the cause of death and/or those factors which may have contributed to the death.
• To plan future care for the family.
• To identify potential lessons .
• To inform the inquest.

The case discussion should involve those who provided care to the child and family before death, and those involved in investigating the death. This will be determined by the age of the child and the circumstances of the death, and may possibly include:

• GP
• Midwife, Health visitor or school nurse
• Paediatrician and other relevant clinicians
• Pathologist
• Senior Investigating Police Officer
• Social worker
• Others as appropriate

The case discussion should be informed by the case records and other information regarding the child and other relevant family members.

The location for the case discussion should take into account the need to facilitate involvement of the GP and Primary Care Team

The outcomes from the meeting should be recorded and will include:

• An discussion of the possibility that abuse or neglect caused or contributed to the death.
• An agreement about how detailed information about the cause of the child's death will be shared, and by whom, with the parents, and those who will offer agency support (see Section 10, Keeping Parents Informed). The hospital paediatrician will usually undertake this role, but in cases where the child has been transferred between hospitals or wards, this may require clarification).
• An agreed record of the case discussion meeting and all reports should be sent to the Coroner, to take into consideration in the conduct of the inquest and in the cause of death notified to the Registrar of Births and Deaths.
• The record of the case discussions and the record of the core data set should also be made available to the relevant Child Death Overview Panel - see Reviewing All Childhood Deaths Procedure.

10.

Keeping Parents Informed