The AAP and the National Association of Medical Examiners recommend steps for a comprehensive assessment of every infant death to distinguish if they are a result of child abuse.
The American Academy of Pediatrics, citing the critical need to identify infant deaths caused by child abuse or neglect, urges a thorough investigation into every sudden unexpected death of a healthy infant.
The AAP details how deaths should be investigated in a clinical report, “Identifying Child Abuse Fatalities During Infancy,” written in conjunction with the National Association of Medical Examiners. The report will be published in the September 2019 Pediatrics (published online Aug. 26).
“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,” said Vincent J. Palusci, MD, MS, FAAP, lead author of the report. “Investigators should remain sensitive, unbiased and nonjudgmental when they talk with parents, who will need additional support for grief and stress.”
A thorough assessment of the death should include:
Since the 1960s, the medical community has worked to improve the definition of sudden, unexpected and unexplained deaths of infants and young children. Over time, medical professionals began to recognize the realities of child abuse through improved investigatory techniques.
In 2019, nearly half of 1,750 child maltreatment deaths involved infants younger than one year. The US National Child Abuse and Neglect Data System has noted significant undercounting of child abuse fatalities and estimates that the numbers are more than triple than what 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,” said Erich Batra, MD, FAAP, a coauthor of the report. “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.”
The AAP recommends that the assessments of infant fatalities should include the careful history taking by emergency responders and medical personnel at the time of death. There should be consultations with available local or in-state medical specialists -- especially in cases of unexpected infant death in siblings and those with a history of recurrent medical conditions such as cyanosis, apnea or other unresolved events.
Pediatricians can work with their state AAP chapters to advocate for and support state policies that require autopsies for sudden unexpected infant deaths. AAP calls for fully funded child death investigation and review systems, as well as funding for research into the causes, identification and prevention of sudden infant fatality.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds