Breaking bad news and supporting a bereaved family after a SUDI — communication OSCE

Candidate brief

This is an unexpected death of an infant under one year — a SUDI. The death was sudden, of unknown cause, and not anticipated. Your task in this station is to break the news to the parents with compassion and clarity, offer family time and memory-making, and explain the coronial and multi-agency process without overwhelming them. Remember the two operational rules you must not break: do not certify this death, and report it to the coroner.[2][3]

Structured approach — SPIKES plus memory-making

Setting. Sit down with both parents together in a private room, turn off your pager if you can, and ensure a nurse or social worker is present. Introduce yourself and confirm who you are speaking to.[7]

Perception and Invitation. Ask what they already understand about what has happened ("Tell me what you have been told so far") and how much detail they want. This calibrates your disclosure to their state.[7]

Knowledge — the warning shot and the news. Give a warning shot ("I am afraid I have very serious news"), then deliver the news in short, unambiguous words: "Despite everything we did, your baby has died." Stop. Allow silence. Do not soften "died" into "passed away" or "lost". Do not pile on technical detail.[7]

Emotions. Allow the reaction — tears, silence, anger, denial — and acknowledge it ("I am so sorry"). Stay present. Do not flee the room when the reaction comes. Parents remember presence more than words.[7]

Strategy and next steps. Explain what happens now in plain language. Because the death was sudden and unexpected, the coroner will be involved — this is routine for every unexpected infant death and is not an accusation. A paediatrician and a police officer will visit the home to understand the circumstances, and a post-mortem will look for a cause. Be honest that an answer is not always found.[2][3]

Family time and memory-making

Offer unhurried time with their baby. They can hold, bathe, dress and be with their child for as long as they need. Offer memory-making: handprints and footprints, a lock of hair, photographs, the baby's name on a card, and a keepsake box. Explain that these mementoes are associated with better bereavement outcomes and a lasting sense of parenthood, and that the window cannot reopen.[10]

Reassure them that the brief steps taken to preserve evidence do not prevent this — time with their baby is almost always possible.[3][10]

Avoid the common traps

Do not propose a cause at the scene or call the death SIDS — that label comes only after the complete investigation. Do not blame the parents for the sleep setting, even if it was suboptimal; guilt is already crushing and a lecture worsens bereavement. Do not issue or promise a death certificate — the coroner authorises release of the body. Do not rush removal of the baby.[2][3]

Follow-up you will arrange

Tell the family you (or the designated paediatrician) will stay in contact: an early phone call within days, a face-to-face review at 2 to 4 weeks to share what is known so far, and a meeting at 3 to 6 months for the final results. Give written information and the details of a bereavement support service and a named key worker before they leave.[7]

Examiner prompts

1. The mother says, "It must have been my fault, I put her down on her tummy." How do you respond?
2. The father asks, "Will we ever know why this happened?" How do you answer honestly?
3. The mother is pregnant again in six months' time — what is your safe-sleep message, and how do you frame the triple risk model without guilt?[1][5]