1st Edition

Investigating Infant Deaths

By Bobbi Jo O'Neal Copyright 2007
    256 Pages 52 B/W Illustrations
    by CRC Press

    It stands to reason that the most difficult cases to investigate are those in which the individual’s death was sudden, unexpected, and unexplained. Very few deaths occur where the deceased has no significant medical history, no trauma, no significant autopsy findings, and very little social history in which to investigate. Infant deaths almost always fit this category, making them consistently the most complicated and challenging deaths to investigate.

    Investigating Infant Deaths draws on the expertise of a forensic nurse and member of the CDC core team for the Sudden Unexpected Infant Death Investigation Reporting Form to provide medicolegal death investigators and law enforcement personnel with investigative techniques applicable to sudden unexpected infant deaths. Beginning with a general state-of-the-field, the author defines the role of the investigator and explains the benefits of “double-teaming” an investigation. The book emphasizes the importance of timing and gives crucial tips for examining the incident scene and performing an initial post-mortem external exam. Specific instruction regarding the “art” of interviewing the grieving parents and how to follow up with families gives investigators an important edge when autopsy findings are slim. Additional chapters cover how to use a doll re-enactment and how to review medical records, social service records, and criminal histories. It also illustrates how to set up task forces including State Child Fatality Teams and an Investigative Child Death Review at the local level.  Case studies are used throughout the book to give investigators real-life examples of the techniques at work.

    Presenting a workable approach that may facilitate a re-evaluation of current protocols, Investigating Infant Deaths provides the tools for continued improvement that will ensure all infant deaths are investigated thoroughly and thereby help prevent future premature infant deaths from occurring.

    Investigating Infant Deaths: Why Is It Important?
    The Process
    The Impact
    Why Are They Difficult to Investigate?
    What Is Being Done about It?
    Current Statistics
    Goal and Text Organization
    Maternal and Infant Health: What Investigators Should Know
    Maternal Health
    Infant Health
    Infant Growth and Development
    The Investigation Begins: Timing Is Everything
    A Common Beginning
    Think outside the Box
    Advanced Notification
    Following Death Notification
    Double-Team Approach
    First Responders: Their Observations Are Important
    9-1-1 Emergency Calls
    First Responders
    Initial Postmortem External Assessment
    Performing the External Assessment
    Equipment Needed
    Assessing the Infant’s General Appearance
    Skin Assessment
    Body Diagram
    Physical Evidence
    Transporting the Body
    Infant Death Scene Investigation: It Tells a Story
    Death Scene Investigation: When Does It Begin?
    Macro vs. Micro: What Is the Difference?
    Documenting the Macroenvironment
    Documenting the Microenvironment
    Evidence or Chain of Custody
    Day-Care Centers
    The Art of Interviewing
    Interview Basics
    Types of Interviews
    Initial Interview
    Clarification Interview
    Follow-Up Interview
    Doll Reenactment with Scene Walk-Through
    The Opposition
    Benefits of Doll Reenactments
    Preplanning: Doll Reenactment and Scene Walk-Through
    Preplanning the Doll Reenactment: What to Consider
    Explain Procedure to Law Enforcement
    Explain Procedure to Witnesses
    Initiating the Scene Walk-Through and Doll Reenactment
    Investigative Concerns
    The Forensic Autopsy: The Investigator’s Role
    Why Should MDIs Be Informed?
    Autopsy Basics
    The Infant Forensic Autopsy: Before, During, and After
    Records Review: Let the Records Speak
    Infant’s Medical Record Review
    Pharmacy Records
    State Health and Home Health Agencies
    Family Medical Records Review
    Social Service Records Review
    Birth Certificates
    School Records
    Criminal Records Review
    Previous Infant Deaths
    Child Death Review: It Brings It All Together
    Types of CDRs
    Retrospective CDRs
    Family or Caregiver Follow-Up and Referral
    Family Follow-Up
    Family Referrals
    Where Do We Go from Here?
    Death Investigation Guidelines
    Agency Policies and Protocols
    Professional Certification
    Death Certificate Completion
    Proactive Prevention Initiatives


    Bobbi Jo O'Neal

    “In this book, B. O’Neal, a registered nurse and board certified medicolegal death investigator with the American Board of Medicolegal Death Investigators, gives an extensive overview on the investigation of infant deaths including epidemiological background, the significance of the emergency helpers, the initial post-mortem external assessment, the death scene investigation, the parental interview, the forensic autopsy, the analysis of the medical history, the case conference and the family or caregiver follow-up.
    “The book shows that the author has an extended knowledge in this field and, moreover, a long-standing experience in doing such investigations. The book integrates different resources, refers the situation in the US, and reflects the relevant literature in this field. It is an excellent guideline for performing death investigations in infants. Besides the general overview, a number of special problems/tasks are discussed in great detail and always from a practical point of view. However, good experiences from outside the US, for example from projects in Australia or Norway, are not referred.
    “In summary, the book gives an excellent overview on all the relevant questions and problems in relation to the investigation of infant deaths and can be used as guideline for practical casework. It can be recommended without any limitation for specialists in legal medicine and specialists from other fields involved in the investigation of these deaths. “
    — T. Bajanowski,  Institute of Legal Medicine, University of Duisburg-Essen, in the International Journal of Legal Medicine (2008) 122:267


    "Anyone who participates in the investigation of infant death, or who may find themselves involved in infant medical resuscitation attempts, will find conceptual and practical guidance for what is often a daunting task."

    —Jennifer R. Schindell, Deputy Medical Examiner / Forensic Nurse, Linn and Benton Counties, Corvallis, Oregon, writing in Journal of the International Association of Forensic Nurses