Intended for healthcare professionals

Clinical Review

Investigating sudden unexpected deaths in infancy and childhood and caring for bereaved families: an integrated multiagency approach

BMJ 2004; 328 doi: (Published 05 February 2004) Cite this as: BMJ 2004;328:331
  1. Peter J Fleming, professor of infant health and developmental physiology (,
  2. Peter S Blair, edical statistician1,
  3. Peter D Sidebotham, consultant paediatrician2,
  4. Tracy Hayler, detective superintendent3
  1. 1University of Bristol, Institute of Child Health, United Bristol Healthcare NHS Trust Education Centre, Bristol BS2 8AE
  2. 2Community Child Health, Designated Child Protection Doctor, Department of Community Paediatrics, Bristol BS2 8EF
  3. 3Avon and Somerset Constabulary, Criminal Investigation Department, Portishead, Bristol BS20 8QJ
  1. Correspondence to: P J Fleming


The sudden unexpected death of an infant or child is one of the worst events to happen to any family. Bereaved parents expect and should receive appropriate, thorough, and sensitive investigations to identify the medical causes of such deaths. As a result, several parallel needs must be fulfilled. Firstly, the needs of the family must be recognised—including the need for information and support. Further, there is the need to identify any underlying medical causes of death that may have genetic or public health implications; the need for a thorough forensic investigation to exclude unnatural causes of death; and the need to protect siblings and subsequent children.15 Alongside this, families need to be protected from false or inappropriate accusations. Limitations in the present coronial system have led to delays or failures to detect deaths caused by relatives, carers, or health professionals.6 w1 w2 w3 Several recent, highly publicised trials have highlighted the possibilities of parents facing such accusations. As a result of this the whole process of death certification has come under intense scrutiny.79 w1 w2 w3

We review the medical, forensic, and sociological literature on the optimal investigation and care of families after the sudden death of a child. We describe the implementation in the former county of Avon of a structured multiagency approach and the potential benefits for families and professionals.


We conducted a literature search of Medline, the Social Science Citation Index, and the International Bibliography of the Social Sciences from 1966 to 2002, and CINAHL from 1982 to 2002, using the search terms “death scene” plus “sudden infant death syndrome,” and “child abuse” plus “sudden infant death or death, sudden.” We also searched the extensive database of relevant publications held in the Foundation for the Study of Infant Deaths research …

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