Introduction

Back in the early 2000s, when I was a junior pediatrician, this was the typical advice that I would receive from my seniors when I was dealing with a case of sudden unexpected death in infancy (SUDI) in the Emergency Department; it was considered appropriate for junior staff to manage SUDI without direct consultant support. Parents would usually be offered an outpatient appointment with a consultant pediatrician some weeks later to discuss the results of the post-mortem examination, but few families attended as they had never met the consultant beforehand. Bereaved parents described saying goodbye to their dead infant in the Emergency Department, leaving the hospital, and never receiving any further information from medical staff about the possible reasons for the death. As a junior doctor, I felt that this process was wrong and that families deserved better care; thankfully, during the next few years the management of SUDI changed dramatically in England.

In 2008, a new joint agency approach (JAA) to investigating SUDI was introduced in England (1); this approach aimed to establish the complete causes for death, including any risk factors, and to address the needs of the family, including the need to safeguard other children. Professionals therefore have to balance the need to forensically investigate the cause of death and offer appropriate support to bereaved families (2). The JAA has been described in detail in Chapter 5, but is summarized here. Police, health, and social care jointly investigate deaths following national statutory guidance (2). The investigation is led by experienced pediatricians and the police response is provided by specialist teams with particular expertise in managing child death and child safeguarding enquiries. Key elements include taking the deceased infant to an Emergency Department, a pediatrician (possibly accompanied by the police) taking a detailed medical history from the parents, a joint examination of the scene of death by police and pediatrician, and follow-up for the parents. There is inter-agency communication throughout the JAA with a case conference to discuss the full causes of death. The process of the JAA is shown in Figure 7.1. Despite statutory guidance, the practice of joint police and pediatric examination of the scene of death is still variable, and often police examine death scenes alone.