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Forensic Pathology of Child Death Assessment
Forensic Pathology of Child Death Assessment is a concise educational text based on Dr. Mary Case's groundbreaking, in-depth textbook. This assessment is a self-directed evaluation that guides readers through historical and contemporary understandings of the causes, manners, and mechanisms of child death. In total, this text includes over 150 clinical images and more than 30 case studies. The comprehensive assessment section gives readers the opportunity to engage in critical analysis of case studies with detailed diagrams, autopsy reports, and images.
eBook
Whole-body post-mortem computed tomography compared with autopsy in the investigation of unexpected death in infants and children
Objectives
To investigate the contribution of whole-body post-mortem computed tomography (PMCT) in sudden unexpected death in infants and children.
Methods
Forty-seven cases of sudden unexpected death in children investigated with radiographic skeletal survey, whole-body PMCT and autopsy were enrolled. For imaging interpretation, non-specific post-mortem modifications and abnormal findings related to the presumed cause of death were considered separately. All findings were correlated with autopsy findings.
Results
There were 31 boys and 16 girls. Of these, 44 children (93.6 %) were younger than 2 years. The cause of death was found at autopsy in 18 cases (38.3 %), with 4 confirmed as child abuse, 12 as infectious diseases, 1 as metabolic disease and 1 as bowel volvulus. PMCT results were in accordance with autopsy in all but three of these 18 cases. Death remains unexplained in 29 cases (61.7 %) and was correlated with no abnormal findings on PMCT in 27 cases. Major discrepancies between PMCT and autopsy findings concerned pulmonary analysis.
Conclusions
Whole-body PMCT may detect relevant findings that can help to explain sudden unexpected death and is essential for detecting non-accidental injuries. We found broad concordance between autopsy and PMCT, except in a few cases of pneumonia. It is a non-invasive technique acceptable to relatives.
Key Points
• Whole-body post-mortem computed tomography (PMCT) is an effective non-invasive method.
• Whole-body PMCT is essential for detecting child abuse in unexpected death.
• There is concordance on cause of death between PMCT and autopsy.
• Whole-body PMCT could improve autopsy through dissection and sampling guidance.
• PMCT shows findings that may be relevant when parents reject autopsy.
Journal Article
What do bereaved parents want from professionals after the sudden death of their child: a systematic review of the literature
Background
The death of a child is a devastating event for parents. In many high income countries, following an unexpected death, there are formal investigations to find the cause of death as part of wider integrated child death review processes. These processes have a clear aim of establishing the cause of death but it is less clear how bereaved families are supported. In order to inform better practice, a literature review was undertaken to identify what is known about what bereaved parents want from professionals following an unexpected child death.
Methods
This was a mixed studies systematic review with a thematic analysis to synthesize findings. The review included papers from Europe, North America or Australasia; papers had to detail parents’ experiences rather than professional practices.
Results
The review includes data from 52 papers, concerning 4000 bereaved parents. After a child has died, parents wish to be able to say goodbye to them at the hospital or Emergency Department, they would like time and privacy to see and hold their child; parents may bitterly regret not being able to do so. Parents need to know the full details about their child’s death and may feel that they are being deliberately evaded when not given this information. Parents often struggle to obtain and understand the autopsy results even in the cases where they consented for the procedure. Parents would like follow-up appointments from health care professionals after the death; this is to enable them to obtain further information as they may have been too distraught at the time of the death to ask appropriate questions or comprehend the answers. Parents also value the emotional support provided by continuing contact with health-care professionals.
Conclusion
All professionals involved with child deaths should ensure that procedures are in place to support parents; to allow them to say goodbye to their child, to be able to understand why their child died and to offer the parents follow-up appointments with appropriate health-care professionals.
Journal Article
Bon voyage, Mister Rodriguez
\"Every day, the children in the village wait to watch the mysterious Mr. Rodriguez go by. His odd but charming ways are eventually revealed to be part of his preparation for the afterlife in this moving intergenerational tale.\"-- Provided by publisher.
Book
Rigour and Rapport: a qualitative study of parents’ and professionals’ experiences of joint agency infant death investigation
Background
In many countries there are now detailed Child Death Review (CDR) processes following unexpected child deaths. CDR can lead to a fuller understanding of the causes for each child’s death but this potentially intrusive process may increase the distress of bereaved families. In England, a joint agency approach (JAA) is used where police, healthcare and social services investigate sudden child deaths together and a key part of this is the joint home visit (JHV) where specialist police and paediatricians visit the home with the parents to view the scene of death. This study aimed to learn of bereaved parents’ experiences of JAA investigation following Sudden Unexpected Death in Infancy (SUDI).
Methods
This was a qualitative study of joint agency investigation of SUDI by specialist police, healthcare and social services including case note analysis, parental questionnaires, and in-depth interviews with parents and professionals. Families were recruited at the conclusion of the JAA. Data were analysed using a Framework Approach.
Results
21/113 eligible families and 26 professionals participated giving theoretical saturation of data. There was an inherent conflict for professionals trying to both investigate deaths thoroughly as well as support families. Bereaved parents appreciated the JAA especially for the information it provided about the cause of death but were frustrated with long delays waiting to obtain this. Many parents wanted more emotional support to be routinely provided. Most parents found the JHV helpful but a small minority of mothers found this intensely distressing. In comparison to JHVs, when police visited death scenes without paediatricians, information was missed and parents found these visits more upsetting. There were issues with uniformed non-specialist police traumatising parents by starting criminal investigations and preventing parents from accessing their home or collecting vital possessions.
Conclusions
Overall most parents feel supported by professionals during the JAA; however there is scope for improvement. Paediatricians should ensure that parents are kept updated with the progress of the investigations. Some parents require more emotional support and professionals should assist them in accessing this.
Journal Article
Police practice in cases of sudden and unexpected child death in England and Wales: an investigative deficit?
PurposeThe system in England and Wales involves a joint agency response to the sudden and unexpected death of a child (SUDC) and, for various reasons, the police contribution to that investigation is sometimes inadequate. The purpose of this paper is to explore some of the dilemmas which explain this inadequacy.Design/methodology/approachThe arguments presented in the paper are made on the basis of empirically derived findings, drawing from original research based upon qualitative interviews with nine senior detectives working in the areas of child abuse or major crime, as well as focus groups of senior detectives, and a limited contribution from pathologists.FindingsThis paper explores whether there is an investigative deficit in respect of potential child homicide when compared to an adult domestic homicide, and it concludes that in some areas the most vulnerable people in society may be at risk because of issues such as inadequate training, inflexible force policies and under-resourced police investigation of child death.Practical implicationsIt is possible to kill a child and leave few, if any, physical clues on the body. To determine if homicide is the cause of death, the overall police investigation therefore has to be of high quality to identify any clues that have been left by the perpetrator at the scene or in other ways. It is usual for Child Abuse Investigation Unit detectives to investigate SUDC but they are often trying to do so with little training and few resources. Cuts to police service budgets since 2010 have affected all elements of policing, including Major Crime Teams. As a result, these teams are more discerning about which cases they take on and there is evidence they are not taking on child death investigations even if there are suspicions of homicide. The findings reveal important implications for police investigative training and a clear and significant deficit in the investigative resources available to the lead investigator on a SUDC investigation which may or may not be a homicide, compared with the resources available to the senior investigating officer on a straightforward domestic homicide when the victim is an adult. If homicide is missed, then siblings or future siblings with that family may be left at risk of harm. The College of Policing suggested standards for SUDC investigation are sometimes not being adhered to in respect of training and resources.Originality/valueThe paper is informed by original qualitative research conducted in 2019. The findings are of value to police policy makers, the College of Policing, and police senior leadership teams.
Journal Article