1.Does your Emergency Department receive cases of unexpected child death? If “yes”, please proceed
to question 2. If “No”, please respond to question 1 only.
Yes.
The Emergency Department at Royal Blackburn Teaching Hospital, part of East Lancashire Hospitals NHS Trust, receives all serious paediatric emergency cases in the region, including those involving the sudden and unexpected death of infants and children. This includes children up until their 18th birthday.
2.Did your Emergency Department have standard procedures or guidance for the management of unexpected child death in place on 1st Sept 2025? If “yes” please proceed to questions 3&4, answering using the guidance available on 1st Sept 2025. If “no” please respond to questions 1 & 2 only.
Yes.
The Trust follows the Joint Agency Response (JAR) protocol for sudden and unexpected child deaths. This includes coordinated action between emergency services (NWAS and Police), hospital staff, and bereavement teams, as outlined in national guidance. The documentation by the MDT is recorded in a paper handwritten booklet called the Sudden Unexpected Death in Childhood (SUDC). This has been devised by Lancashire Constabulary.
3.Does your standard procedures or guidance document ask whether a parent is breastfeeding the child that has died?
Yes.
The SUDC booklet does not specifically have a set question that asks the direct question as to whether the infant/child was being breastfed, but this data is captured within the booklet.
The SUDC History Booklet should be used to record all information obtained. This is a multi-agency document that is available to all professionals involved with the Joint Agency Response (on Sherlock for the Police and hospital systems for the Paediatrician). The SUDC Nurse will generally lead on completing this documentation however, out of hours the Police or Consultant Paediatrician must use the SUDC History Record when obtaining an account from the parents.
The booklet has numerous sections including:
Past medical history - the author will usually incorporate whether a baby is bottle or exclusively or partially breastfed in this section.
History of events - the author should include time and type of last feed here. (As per guidance as below).
Examination of body - which asks the question 'state of nutrition' - this usually includes reference to the diet of the baby/child, which would refer to the method of feeding or diet type.
There is a separate document named 'The management of SUDC', this document outlines the guidelines and roles and responsibilities in completing the SUDC booklet. Section 3.7 of this document states as follows: 'The events leading up to death should give a detailed narrative account of the last 24-48 hours. Whilst each case will be different the professional recording the history may want to focus particularly on:
The details of all activities and carers during the last 24-48 hours.
Any alcohol or drugs consumed by infant or carers.
Health history and when last seen by a health professional.
Full details of the last sleep including where and how put down, where and how found, feeding
pattern, any changes in routine and care given.
-Further details of previous 2-4 weeks, including the child’s health should be obtained.
Section 18 of the document under the role and responsibility of the midwife states 'The mother should receive a full postnatal risk assessment and if she was breast feeding, a management plan on the suppression of lactation and given appropriate support. Refer to the GP if necessary'. However, this would only be relevant if the baby was still under the care of the midwife, which may not be applicable to an older baby/child.
In addition, the Trust utilises an electronic documentation system known as Cerner. Upon arrival to the Emergency Department, every child undergoes an initial assessment followed by a secondary assessment. Within the secondary assessment section, there is a mandatory field that must be completed regarding the child’s diet. Completion of this field is required before the staff member can proceed further in the documentation. Notably, breastfeeding is included as an option within the dietary choices, so a breastfeeding parent would be identified through this compulsory process.
4.Does your standard procedures document or guidance include management of the bereaved breastfeeding parent to reduce risk of engorgement, mastitis, and additional emotional distress?
Yes.
As above in Q3, the Trust SUDC guideline (Part II – Roles & Responsibilities, Section 18: Midwife) states that if the mother was breastfeeding, she should receive a postnatal risk assessment and a management plan for suppression of lactation with appropriate support, with GP referral as required. However, within the Emergency Department it is acknowledged that this process may not always be consistently initiated, highlighting a gap in practice and an identified need for further education and training.
