SUDIC; Sudden, Unexpected, Death in Childhood- ( 0-18years )

Publication: 18/11/2014  
Next review: 30/06/2024  
Standard Operating Procedure
CURRENT 
ID: 4028 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2021  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

SUDIC; Sudden, Unexpected, Death in Childhood- (0-18years)

Background and indications for standard operating procedure/protocol

The death of any child (under 18 years) is reviewed by the Child Death Overview Panel Procedure.

Within this are two components

  • A rapid response by a key professionals enquiring into and evaluating each unexpected death of a child (SUDI/C process).
  • An overview of deaths in children, undertaken by the Child Death Overview Panel.

This document pertains to the first component, the rapid response by professionals following the unexpected death a child (SUDI/C process). It aims to assist professionals in striking the balance between the sensitivities of handling a bereaved family, and securing/ preserving evidence relevant to why the child died.

This team response to a tragedy for the family should balance forensic, medical and family support needs. Clarity of roles and definitions is important.
Please refer to General Advice for further information

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Procedure method (step by step)

The SUDI/C process starts at the unexpected death but is a long process that continues to support the family and to establish the cause. The role of the health professionals at the beginning of the process has the following elements.

  1. Confirming the death falls under the SUDIC process using the definitions
  2. Documentation
  3. Sampling
  4. Sharing this information

These comprises the Joint Response to an unexpectedly bereaved family; providing support, care and seeking to identify the cause of death.

1. Definition

Unexpected death, in this context, is defined as either :-

  • Death not being anticipated as a significant possibility 24hours before the death (this will include trauma and suicide)

or

  • Death was subsequent to a similarly unexpected collapse leading to or precipitating the events that led to death (this will include those children who die subsequent to admission,  

However:-

  • Revised guidance (2016) defines ‘unusual clinical situations’ whereby a differing process to previous should be considered to be enacted:-
  1. Infant or child who is unwell at presentation, but who deteriorates rapidly and dies of possible septic shock and multi-organ failure due to presumed sepsis
    If the attending Consultant can certify the death as being due to sepsis, there is NO requirement for a SUDI/C investigation. In this situation we would advise discussing with the coroner acutely and discussion with the SUDIC team when open. If in any doubt discuss with SUDIC team and coroner.

  2.  Infant or child who is successfully resuscitated from an out of hospital arrest, but who dies subsequently, or may survive for a period of time
    The case should be discussed with the SUDI/C team, despite the infant remaining alive

  3. Infant or child with a life-limiting or life-threatening condition who dies unexpectedly
    A SUDI/C investigation might not be required.If there are concerns then the lead health professional should discuss with the Coroner. If the death was not expected then the case should be referred to the SUDI/C team.

  4.  Infant Twins and multiples
    The surviving twin/triplet/multiple siblings should be admitted for at least 24hrs. Investigations to exclude infection, inherited metabolic disease, or a cardiac condition should occur prior to discharge.


2. Documentation

The police are often present at the time of starting the SUDIC process but if not they should be notified immediately. It is often helpful to wait for the police to speak to the family so that this is not done twice.

  • History and examination, SPECIFICALLY IDENTIFYING Lead Consultant (legible if sharing handwritten notes; otherwise typed letter/report to include)
    • In infants & Medical (<16yrs) deaths contact the on call Paediatric Consultant
      • Completion of Safeguarding Child Proforma with particular attention:
        • Pregnancy, delivery, post natal history
        • Feeding and developmental history
        • Parental smoking, alcohol usage
        • Sleeping routines, where, ?co-sleeping
        • Final 24hrs, leading up until the death

 

3. Sampling there is a panel on ice and guidance in the appendix

4. Sharing of information Please refer to the death in a child pathway in appendix 1. Sharing will done by both the medical and nursing team looking after the child.

 

Flowchart

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General Advice

  1. An unexpected death will be traumatic. Although the time professionals spend with the family may be brief their actions may greatly influence how the family deal with the bereavement process. A sympathetic, supportive and professional attitude towards the investigation is essential.

  2. All professionals must record the history and background information given by parents/carers in as much detail as possible. The initial accounts,  including timings must be recorded verbatim.

  3. It is normal and appropriate for a parent/carer to want physical contact with his/her dead child.  In all but exceptional circumstances, such as when crucial forensic evidence may be lost or interfered with, this should be allowed, albeit with observation by an appropriate professional.

  4. The child should always be handled as if he/she were still alive, remembering to use his/her name at all times as a sign of respect and dignity.

  5. All professionals should take into account any religious and cultural beliefs which may impact on procedures. These must be dealt with sensitively whilst ensuring the preservation of evidence. Relevant chaplains can be contacted via switchboard for advice and support.

  6. The parents/carers should be allowed time to ask questions about practical issues; this includes telling them where their child will be taken, when they are able to see him/her again and that a post mortem will be required.

  7. Where possible, written contact names and telephone numbers for relevant agencies and personnel should be given to the family.

  8. In unexpected child death cases there will be an inquest conducted by the Coroner to establish the cause of death.

  9. Staff from all agencies need to be aware that  on occasions, in suspicious circumstances, the early arrest of the parents/carers may be essential in order to secure and preserve evidence.

  10. Agency professionals must be prepared to provide statements promptly if requested.

  11. Where relevant; Safeguarding Children Procedures (including siblings) will be followed.

Police may require blood samples from parents for blood alcohol/drug levels.

 

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Provenance

Record: 4028
Objective:

To standardise and optimise the management of statutory processes following a child’s sudden, unexpected, death.

Clinical condition:
Target patient group: Children & Young People until 18th Birthday
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

Sudden Unexpected death in infancy and childhood. Multi-agency guidelines for care and investigations. The report of a working group convened by the Royal College of Pathologists and endorsed by the Royal College of Paediatrics and Child Health.  2nd Edition. London RCPath 2016
www.rcpath.org%2Fasset%2F874AE50E-C754-4933-995A804E0EF728A4%2F&usg=AFQjCNHO1AotWJ7rHHz9HBXqxrGfieQPVw&cad=rja

Working together to safeguard children. Department of Education. 2018, chapter 5. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779401/Working_Together_to_Safeguard-Children.pdf

Sudden Unexpected Death In Infancy; A multi-agency protocol for care and investigation. The report of a working group convened by the Royal College of Pathologists and the Royal College of Paediatrics and Child Health. London RCPath and RCPCH 2004

West Yorkshire  LSCB Consortium Procedures http://westyorkscb.proceduresonline.com/chapters/p_res_profdisag.html

Leeds LSCB Practitioners Guidance 

Evidence levels:
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 4.0

Related information

Not supplied

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