Death‐scene investigations contribute to legal protection in unexpected child deaths in Norway

Abstract

Every year an average of 30-35 children younger than 4 years die suddenly and unexpectedly in Norway. The cases require a careful balance between the children's right to legal protection, the duty to investigate criminal acts and the responsibility to care for the bereaved families. Doctors are legally obliged to report these deaths to the police. The police then initiate an investigation, independent of any suspicion of a criminal act, to gather information. The investigation includes ordering a forensic autopsy and sometimes also a death scene visit. Depending on the outcome, the police will either continue with a thorough investigation if a criminal act is suspected or postpone investigation pending the final forensic autopsy report.

Norwegian parents avoid placing infants in prone sleeping positions but frequently share beds in hazardous ways

“…In spite of this, the incidence of sudden infant deaths has continued to decline. An in‐depth study from Norway showed that there were approximately nine sleep‐related infant deaths each year between 2010 and 2016, which was an annual incidence of 0.16 per 1000 live births 16 . That incidence was approximately one‐sixth of what has been reported from the United States 4 .…”

“…It is very likely that some of the recent SIDS cases could also have been prevented by eliminating known risk factors. The Norwegian in‐depth study reported that 46% of those who died from SIDS were found in a prone position and 46% of the parents reported smoking 16 . Furthermore, eight infants who were less than 18 weeks of age were found dead when bed‐sharing with a parent who smoked 16 …”

Highlights in this issue

“…Bøylestad et al 8 analysed data from forensic autopsy reports and death scene investigations for unexpected deaths in children below four years of age in Norway during 2010‐2016. They found that death scene investigations increased the ability to rule out accidental suffocation, facilitated evaluations of environmental risk factors and enabled the detection of possible neglect, especially in unclear cases.…”

Amongst Norwegian paediatricians there is little agreement in management of cases of suspected child maltreatment

“…A substantial proportion of infant deaths are attributable to serious child abuse and neglect, and those numbers are likely underestimated 7 . Amongst infant deaths in Norway in 2010–16, 4% were ruled homicide and in 12% the forensic examination and death scene investigation raised concerns of physical abuse or neglect 8 . Child maltreatment has been deemed a public health crisis by local, national and international agencies and governmental bodies; however, on a practical level, this awareness has yet to adequately lead to changes in clinical practice 9–11 …”

“…were ruled homicide and in 12% the forensic examination and death scene investigation raised concerns of physical abuse or neglect. 8 Child maltreatment has been deemed a public health crisis by local, national and international agencies and governmental bodies; however, on a practical level, this awareness has yet to adequately lead to changes in clinical practice. [9][10][11] The crucial role of paediatricians in recognition and response to these cases has been acknowledged in the literature.…”