Death of a Child in the Emergency Department

The death of a child in the Emergency Department (ED) is most often a sudden, unexpected event. A pediatrician working in the ED should remain sensitive to the grief of the family while obtaining a medical and social history and conducting a thorough physical examination and evaluation, attempting to determine the cause of the child's death. Pediatricians are in a unique position to help formulate ED policy and procedure and to help provide support and guidance for the family. In addition, the needs of the nursing staff, emergency medical services responders, and other ancillary personnel involved in the child's care should be considered. Uniform protocols for the investigation of child and infant deaths would contribute to progress in the understanding of sudden infant death syndrome (SIDS), missed cases of child abuse and neglect, undiagnosed familial genetic diseases, and the detection of public health threats and inadequate medical care.1 A response to this problem by many states has been the formation of child death review teams.2 Since 1978 when the first team originated in Los Angeles, CA, child death review teams have been established to cover 40% of the nation's population. Multiagency child death review involves a systematic multidisciplinary and multiagency process to coordinate and integrate data and resources from coroners and medical examiners, law enforcement, courts, Child Protective Services, and health care providers. Pediatricians are encouraged to support the implementation of child death review teams in their county or state. In addition, they are encouraged to participate in the process as a member of the team.