'Sudden unexpected death in infancy: A multi-agency protocol for care and investigation', the report of a working group convened by The Royal College of Pathologists and The Royal College of Paediatrics and Child Health, and chaired by Baroness Helena Kennedy, is now available online. The report calls for a national approach to investigating cases of sudden infant death syndrome (SIDS)and other unexplained deaths in children.
The protocol calls for a paediatrician working with a specially trained senior police officer to visit a bereaved family at home within 24 hours of a death to take a complete history and offer initial support. This provides an opportunity for the family to explain events in the setting where they took place and the sleeping arrangements can be seen in situ.
Unlike the situation in most adult deaths, parents usually lift the child and attempt all manner of resuscitation when a small child or baby dies. They clean away sputum and vomit from the airways. They apply damp cloths; blow into the mouth. Those descriptions flood back to parents as they relive events back at their home and they can explain the absence or presence of different features. It is important that a doctor is at the heart of this investigation of the scene as someone who understands the normal care of babies and who can talk the family through the events in a sensitive way.
This home visit conducted by medical and police professionals is at the heart of the protocol and is not a negotiable element. The medical royal colleges should develop multi-professional training packages as soon as possible.
The protocol also requires that the post-mortem examination is conducted by a paediatric pathologist who has access to the information gathered at the home visit. On a number of past occasions, the pathologist engaged in these cases has had extensive experience of adult deaths but is inexperienced in dealing with babies. It is for this reason that the report recommends the use of paediatric pathologists or of a forensic pathologist with some training in paediatric pathology, who is properly accredited to do this work. It should be noted, however, that there is currently a severe shortage of both forensic pathologists and paediatric pathologists, a problem that will have to be addressed with some urgency, as our subsequent recommendations indicate.
The protocol also requires all the professionals to meet after full information about the family and the death is available, to agree what factors might have contributed to the death, provide a multidiscipline report for the coroner and plan further support for the family.
In addition, the Working Group felt that it was essential to set out the standardised protocols for pathologists involved with sudden unexpected deaths in infancy so that all the proper examinations are conducted, records of all interventions are made available (including information as to efforts at resuscitation), a skeletal survey organised, tissue samples taken (including frozen liver sections) and clear records kept for any future need. This is another of the crucial elements of these recommendations.
Similar protocols with regard to record keeping should be a requirement for the clinicians and paediatricians who are involved at accident and emergency (A&E) departments or at any other stage of the process. There needs to be clear guidance for all doctors in these cases on the collection of non-biological data and instructions for history taking, with a minimum dataset. This is so that parents can access this information at any future date should genetic information be forthcoming or scientific advances take place that will provide explanations for the loss of their baby. It also means that an expert engaged at a later stage, for whatever reason, has a solid basis upon which he or she can base an opinion. Recommendations incde:
- the creation of a compulsory national investigation protocol.
- the reinforcement of the standardised protocol for pathology with
- additional requirements in the cases of sudden unexpected infant death.
- the creation of a protocol for doctors such as paediatricians dealing with the central components of history taking, examination and investigation, which must include family structure, relevant family history and psychosocial factors.
The report also covers the role of doctors as expert witnesses in such cases.