Paeds · acute-care-resuscitation-and-toxicology
Care after death, unexpected child death and family support
Also known as Care after death · Sudden unexpected death in infancy (SUDI) · Sudden infant death syndrome (SIDS) · Sudden unexpected death in childhood (SUDIC) · Bereavement support in paediatrics · Coronial referral and child death review · Breaking bad news after a child death
Fellowship guide to care after a child's death and the unexpected child death: distinguishing expected from unexpected death, confirming death and the certification and coronial referral rules, breaking bad news with SPIKES, family time and memory-making, the SUDI and SUDIC definitions and the triple risk model of SIDS, the AAP 2022 safe-sleep recommendations, the multi-agency SUDI response with a joint paediatrician-and-police home visit, bereavement follow-up and sibling support, team welfare and child death review, with the ANZ, UK and North American differences.
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Red flags
- An unexpected child death (a death not reasonably anticipated within the preceding 24 hours, or sudden, violent, of unknown cause, or in custody) must be reported to the coroner and must NOT be certified by the attending doctor — issuing a death certificate for an unexpected death is a serious error
- Never assume SIDS at the scene — SIDS is a diagnosis of exclusion made only after a complete negative investigation (history, scene review and post-mortem); an unsafe sleep arrangement, marks, an inconsistent history or a delay in calling for help demand safeguarding and forensic consideration
- Bed-sharing with a smoker, with someone impaired by alcohol or drugs, on a soft surface or with pillows and doonas, or with a normal infant under 4 months (and any premature or low-birth-weight infant), carries a markedly higher sudden infant death risk — these are the specific situations to warn about, not blanket reassurance
- Offer memory-making and time with the child early and never rush removal of the body — once the opportunity is lost it cannot be given back, and parents repeatedly identify this as the thing they value most
- A parent whose grief is still intense and disabling more than 6 to 12 months after the death, with persistent preoccupation, avoidance or despair, may have prolonged grief disorder and needs specialist mental-health referral
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- Professional practice and ethics
- Care of the dying child and bereavement support
- Safeguarding and the unexpected death of a child
- Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Professional practice, ethics and safeguarding
- Bereavement and breaking bad news after a child's death
- Sudden unexpected death in infancy and the multi-agency response
- Ethics and law
- Death certification, coronial referral and the unexpected child death
- Communication with families and bereavement
- Communication scenarios
- Breaking bad news and supporting a bereaved family
- Structured oral on the SUDI response and safe-sleep counselling
- 7. Safeguarding
- Level 2: Recognises and responds to the unexpected death of a child
- Patient management: end-of-life care and bereavement
- Applied Knowledge in Practice (AKP)
- Sudden unexpected death in infancy; safe-sleep and SIDS prevention
- Death certification and coronial referral
- Communication skills
- Breaking bad news and a safe-sleep counselling role-play
- History taking and management planning after a child death
- General Pediatrics Content Outline — Domain 4: Child Abuse and Neglect (Safeguarding)
- General Pediatrics Content Outline — Domain 15: Adolescent care and the sudden death of the young
- EPA: Lead a family meeting and bereavement discussion
- Patient Care 4: Clinical Reasoning and disclosure of difficult information
- Interpersonal and Communication Skills: breaking bad news
- Systems-Based Practice: child death review and coronial process
- Professionalism: care after death and family support
- Medical Expert and Communicator
- Pediatrics: Core EPA — Break bad news and support a bereaved family
- Collaborator: multi-agency response to the unexpected child death
Overview & Definition
A child's death is the single hardest event in paediatric practice, and the way you behave in the hours around it is remembered by the family for the rest of their lives. This page covers two overlapping jobs: the immediate and longitudinal care after death delivered to every bereaved family, and the structured response to the unexpected child death, which carries safeguarding, coronial and public-health duties that an expected death does not.[7][8]
The first decision, made within minutes, sorts the death into one of two streams that determine everything which follows. An expected death is the death of a child with a known life-limiting or life-threatening condition, anticipated on an advance care plan, and it can be certified by the attending doctor. An unexpected death is a death that was not reasonably anticipated within the preceding 24 hours, or that is sudden, violent, of unknown cause, or occurs in custody, and it must be reported to the coroner and must not be certified.[2][3]
Within the unexpected stream sits the most studied entity in paediatric mortality: sudden unexpected death in infancy (SUDI), defined as the sudden and unexpected death of an infant under one year in whom the cause is not immediately obvious. After a complete investigation — history, scene review and post-mortem — a SUDI is reclassified as either explained (an identified cause such as infection, metabolic disease, cardiac disorder, accidental or inflicted injury) or unexplained.[3][4]
Only the unexplained subgroup, after that complete negative work-up, may be labelled sudden infant death syndrome (SIDS). SIDS is therefore a diagnosis of exclusion, never a scene diagnosis. For older children the parallel term is sudden unexpected death in childhood (SUDIC), covering the sudden death of a child beyond infancy.[11]
The clinician's task across both streams is to confirm the death, disclose it with compassion, offer time and memory-making, meet the legal and investigative duties without compromising them, and then sustain the family through bereavement. This page walks that pathway in the order it happens at the bedside.
[3] [7]References12ShowHide
- [1]Moon RY, Carlin RF, Hand I, et al. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics, 2022.PMID 35726558
- [2]Jeffery HE, Carberry AE, Gordon A, et al. The investigation of sudden unexpected deaths in infancy in Australia. Med J Aust, 2023.PMID 36653164
- [3]Fitzgerald DA, Jeffery H, Arbuckle S, et al. Sudden Unexpected Death in Infancy [SUDI]: What the clinician, pathologist, coroner and researchers want to know. Paediatr Respir Rev, 2022.PMID 34998675
- [4]Garstang J, Ellis C, Sidebotham P. An evidence-based guide to the investigation of sudden unexpected death in infancy. Forensic Sci Med Pathol, 2015.PMID 25999133
- [5]Spinelli J, Collins-Praino L, Van Den Heuvel C, et al. Evolution and significance of the triple risk model in sudden infant death syndrome. J Paediatr Child Health, 2017.PMID 28028890
- [6]Jullien S. Sudden infant death syndrome prevention. BMC Pediatr, 2021.PMID 34496779
- [7]October T, Dryden-Palmer K, Copnell B, et al. Caring for Parents After the Death of a Child. Pediatr Crit Care Med, 2018.PMID 30080812
- [8]Gijzen S, L'Hoir MP, Boere-Boonekamp MM, et al. How do parents experience support after the death of their child? BMC Pediatr, 2016.PMID 27927172
- [9]Sanders C, Fisher-Smith D, Neill S, et al. Lessons for the future: Reflections on a review of child death overview panels through a local lens in the United Kingdom. J Child Health Care, 2020.PMID 31067977
- [10]Thornton R, Nicholson P, Harms L. Scoping Review of Memory Making in Bereavement Care for Parents After the Death of a Newborn. J Obstet Gynecol Neonatal Nurs, 2019.PMID 30946804
- [11]Quinn S, Dierckx E, Long T, et al. Sudden Unexpected Death in Childhood in Greater Manchester (United Kingdom): A Five-Year Review (2015-2020). Compr Child Adolesc Nurs, 2022.PMID 36440870
- [12]Das MK, Arora NK, Chellani HK, et al. Perceptions of the parents of deceased children and of healthcare providers about end-of-life communication and breaking bad news at a tertiary care public hospital in India: a qualitative exploratory study. PLoS One, 2021.PMID 33735296