Whenever a healthy infant dies suddenly, that death should be investigated to determine if abuse or neglect was the cause.

So claims a new report from the American Academy of Pediatrics (AAP) and the National Association of Medical Examiners.

Other children at risk

In 2019, infants younger than one year accounted for nearly half of 1 750 child maltreatment deaths in the United States. However, the National Child Abuse and Neglect Data System says many child abuse deaths are missed and estimates that the actual number is more than triple is officially reported.

“It is important that we correctly identify deaths that occurred from abuse or neglect, because when they are missed, it leaves other children at risk,” report co-author Dr Erich Batra said in an AAP news release.

“A review team made up of professionals from various related fields – including the medical, child welfare and law enforcement communities – should review all data and prevention strategies with every case,” Batra said.

“When a baby dies of unknown causes, there must be a thorough investigation that includes a comprehensive review of the medical history, a scene investigation and an autopsy with appropriate testing,” report lead author Dr Vincent Palusci said in the release.

Death investigation and review systems

“Investigators should remain sensitive, unbiased and non-judgmental when they talk with parents, who will need additional support for grief and stress,” Palusci added.

A full assessment of a sudden unexpected death of a healthy infant should include: careful history-taking by emergency responders and medical personnel that’s provided to the medical examiner or coroner; prompt investigation with doll re-enactment at the scene where the infant was found; interviews with families and household members by police, death investigators, prosecutors and child protective services; a complete autopsy within 24 hours of death.

The AAP also called for fully funded child death investigation and review systems, and funding for research into the causes, identification and prevention of sudden infant deaths.

The report was published online in Pediatrics.

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