Care after death, unexpected child death and family support — formative SAQs

SAQ 1 (10 marks)

A previously well 10-week-old infant is found limp and not breathing in the parental bed at 6 a.m., lying between both parents on a soft doona, with the mother a smoker. Resuscitation is unsuccessful. You are the paediatric registrar in the emergency department.[2][3]

Question. Outline your immediate care-after-death response, including the legal duties regarding certification and coroner referral. (6 marks) Describe the subsequent multi-agency SUDI investigation. (4 marks)[2][4]

Model answer

Immediate response (6 marks). Confirm death by the clinical signs — fixed dilated pupils, absent heart sounds and central pulse on auscultation, absent respiratory effort and absent brainstem reflexes — and record the time.[3]

This is an unexpected death (sudden, not anticipated, of unknown cause), so it must be reported to the coroner and must NOT be certified with a Medical Certificate of Cause of Death; only the coroner authorises release of the body. Preserve the scene and any clothing and bedding — do not wash the infant or remove lines.[2][3]

Break the news using SPIKES: a private Setting, Perception of what the parents know, an Invitation, a Knowledge warning shot then the news in plain words ("your baby has died"), allow the Emotions, and a Strategy for next steps. Note the high-risk sleep setting (bed-sharing with a smoker, soft doona) without blaming.[3]

Offer family time and memory-making — holding, handprints, a lock of hair, photographs, a keepsake box — after the brief evidence-preservation steps. Involve the SUDI team and designated paediatrician, and arrange a staff hot debrief.[10]

Multi-agency SUDI investigation (4 marks). A designated paediatrician and a police officer conduct a joint home visit, usually within 24 to 48 hours, to review the scene, take the structured sleep-environment history (position, bedding, heating, smoke exposure, feeding, intercurrent illness, family history), and refer for a specialist post-mortem with histology, microbiology, virology, metabolic and toxicology, plus time-critical samples (blood, urine, vitreous, skin for fibroblast culture). A skeletal survey and, increasingly, post-mortem imaging and a molecular autopsy (cardiac gene panel) are performed. SIDS is only assigned if the investigation is completely negative.[2][4]

SAQ 2 (10 marks)

You are counselling the parents of a new baby in your outpatient clinic about reducing the risk of sudden infant death.[1][6]

Question. Give the AAP 2022 safe-sleep recommendations you would communicate. (6 marks) Explain the triple risk model and how you would use it to counsel a family who has suffered a previous SUDI loss without inducing guilt. (4 marks)[1][5]

Model answer

Safe-sleep recommendations (6 marks). Summarise as ABC plus three: Alone (no pillows, doonas, bumpers, soft toys or loose bedding in the sleep space); on the Back for every sleep, day and night, until one year; in a clear Cot (a separate, firm, flat, non-inclined cot or bassinette).[1]

Room-share without bed-sharing (same room, separate surface) for at least 6 months. Keep the household smoke-free — the strongest non-sleep modifiable risk. Breastfeed to the family's goal and offer a pacifier at nap and bedtime once feeding is established. Avoid overheating and avoid alcohol, marijuana, opioids and illicit drugs. Avoid weighted bedding and inclined sleepers; provide supervised awake tummy time.[1]

Name the highest-risk bed-sharing situations to avoid: with a smoker, with a parent impaired by alcohol or drugs, on a sofa or soft surface, with a term infant under 4 months, or with any premature or low-birth-weight infant.[1]

Triple risk model and counselling (4 marks). SIDS occurs only at the intersection of a vulnerable infant (brainstem serotonergic and autonomic arousal abnormality), a critical developmental period (peak 2 to 4 months), and an exogenous stressor (prone sleep, smoking, overheating).[5]

Use the model to remove blame: the vulnerability was invisible and unchangeable, the age window is universal, and the safe-sleep message targets the only leg a family can change — applied to the next baby and the next family, delivered before a death, not as an inquest into the one that has occurred.[5]