Care after death, unexpected child death and family support — formative SAQs

SAQ 1 (10 marks)

A previously well 10-week-old infant is found limp and not breathing in the parental bed at 6 a.m., lying between both parents on a soft doona, with the mother a smoker. Resuscitation is unsuccessful. You are the paediatric registrar in the emergency department.^[2][3]

Question. Outline your immediate care-after-death response, including the legal duties regarding certification and coroner referral. (6 marks) Describe the subsequent multi-agency SUDI investigation. (4 marks)^[2][4]

Model answer

Immediate response (6 marks). Confirm death by the clinical signs — fixed dilated pupils, absent heart sounds and central pulse on auscultation, absent respiratory effort and absent brainstem reflexes — and record the time.^[3]

This is an unexpected death (sudden, not anticipated, of unknown cause), so it must be reported to the coroner and must NOT be certified with a Medical Certificate of Cause of Death; only the coroner authorises release of the body. Preserve the scene and any clothing and bedding — do not wash the infant or remove lines.^[2][3]

Break the news using SPIKES: a private Setting, Perception of what the parents know, an Invitation, a Knowledge warning shot then the news in plain words ("your baby has died"), allow the Emotions, and a Strategy for next steps. Note the high-risk sleep setting (bed-sharing with a smoker, soft doona) without blaming.^[3]

Offer family time and memory-making — holding, handprints, a lock of hair, photographs, a keepsake box — after the brief evidence-preservation steps. Involve the SUDI team and designated paediatrician, and arrange a staff hot debrief.^[10]

Multi-agency SUDI investigation (4 marks). A designated paediatrician and a police officer conduct a joint home visit, usually within 24 to 48 hours, to review the scene, take the structured sleep-environment history (position, bedding, heating, smoke exposure, feeding, intercurrent illness, family history), and refer for a specialist post-mortem with histology, microbiology, virology, metabolic and toxicology, plus time-critical samples (blood, urine, vitreous, skin for fibroblast culture). A skeletal survey and, increasingly, post-mortem imaging and a molecular autopsy (cardiac gene panel) are performed. SIDS is only assigned if the investigation is completely negative.^[2][4]