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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Sudden unexpected death in infancy and childhood

Paediatrics and child health · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Unresponsive child with no signs of life

An unexpected collapse is treated as potentially reversible unless death is unequivocal or a valid agreed limitation applies. The scene may contain vital diagnostic and safeguarding information.

Action: Call the resuscitation team and begin age-appropriate life support, treating reversible causes and following local policy on termination with senior oversight. After death, leave tubes and lines in place unless removal is explicitly agreed, document every intervention and finding, preserve clothing and medical material, notify police and the coroner through the Joint Agency Response and provide the family with a named professional and private compassionate support.

Synopsis

Respond safely and compassionately to an unexpected child death, preserve diagnostic and forensic information, initiate the statutory multi-agency process, support the family and enable specialist post-mortem, genetic and child-death review learning.

  • SUDI or SUDC describes the presentation, not the cause; SIDS or an unexplained classification comes only after complete investigation.
  • Start paediatric life support unless death is unequivocal or a valid limitation applies; seek senior help for any doubt.
  • Resuscitation and evidence preservation coexist: record state on arrival, timings, access sites, fluids and medicines and retain tubes, lines, clothing and samples under protocol.
  • Activate the statutory Joint Agency Response promptly through police, coroner, paediatrics, social care and the child-death review system.
  • The reference-standard cause investigation is multi-agency: detailed history, scene examination, full paediatric examination, appropriately sampled specialist post-mortem and final case review.
  • Take a careful sleep, feeding, illness, medicine, pregnancy, birth, development, family, social and event history; record who found the child and the exact position and environment.
  • Perform and document a complete external examination including growth, temperature, skin, mouth, eyes, injuries and post-mortem changes with an agreed senior and police process.
  • Do not assume normal resuscitation artefacts are injuries and do not ascribe all injuries to CPR without expert assessment.
  • Retain blood, urine and other samples early according to the multi-agency protocol because post-mortem degradation can limit metabolic and toxicological diagnosis.
  • Offer parents clear honest updates, time with the child where safe, memory-making and cultural or spiritual care; explain that police and coroner involvement is routine.
  • A sudden or unexplained death can indicate inherited arrhythmia or metabolic disease: preserve DNA-quality material and refer the family to specialist services.
  • Complete child-death review and communicate final findings sensitively; provide bereavement, primary-care and sibling follow-up with a named key worker.

Key red flags

Any uncertainty about signs of life, temperature-related apparent death, poisoning or a reversible cause requires resuscitation rather than premature verification.

An unsafe scene, possible carbon monoxide, hazardous substance or ongoing threat requires emergency-service scene control before entry.

Unexplained injury, inconsistent accounts, delayed help-seeking, previous unexplained sibling death, neglect concerns or concealed pregnancy requires immediate safeguarding escalation without accusation.

Sudden death during exertion, in water, with a family history of young sudden death or with a normal post-mortem raises inherited cardiac disease and family-screening urgency.

Unexpected death with infection features, multiple affected people or public-health concern requires prompt microbiology and health-protection advice.

Parents must not be told that sudden infant death syndrome is the cause before the complete investigation and case review.

Investigation priorities

01
First-line resuscitation diagnosticsFirst stepFirst line

Identify reversible hypoglycaemia, hypothermia, arrhythmia, electrolyte disorder, poisoning or infection during active care.

Management branches

Initial responseResuscitate if in doubt

A child is unexpectedly found unresponsive without signs of life.

  1. Ensure scene safety, call emergency help and begin paediatric life support.
  2. Check temperature, glucose and reversible causes without interrupting resuscitation.
  3. Use senior and current policy for any termination decision.
  4. Document the child as found and every intervention precisely.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • RCPCH and RCPath sudden unexpected death multi-agency guidelinesUK framework for resuscitation, history, examination, scene investigation, post-mortem, family care and final discussion.
  • Child death review statutory and operational guidance for EnglandStatutory Joint Agency Response, child-death review, family engagement and learning pathway.
  • Child death review reporting formsCurrent national notification, analysis and review documentation framework.
  • Resuscitation Council UK 2025 paediatric basic life supportCurrent UK initial life-support sequence when reversibility remains possible.
  • Resuscitation Council UK 2025 ethics guidanceCurrent UK ethical framework for starting, continuing and stopping resuscitation and supporting families.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem ·

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Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom