Forensic warning over child deaths

Pathology

In 2005, a total of 135 children died in South Australia - most of them less than a month old. It's a sobering statistic, but what makes it harder to accept is that a number of these deaths were preventable.

How do you tell a grieving parent that their child could be alive today if they had bought the right cot, shunned big, soft U-shaped pillows and steered clear of unsuitable foods?

It doesn't remove their guilt, said University of Adelaide forensic pathologist Professor Roger Byard, but it could save the life of another child.

"It's no use doing an autopsy report, establishing a cause of death and then doing nothing about it. That's just a recipe for another tragedy," Professor Byard said.

Over the past 20 years, Professor Byard has investigated the causes of Sudden Infant Death Syndrome (SIDS) and other childhood deaths - both accidental and from natural causes.

Paediatricians and researchers have learned far more about SIDS in that time and significant inroads have also been made into accidental deaths.

"Poisoning deaths are not as common because toxic products are now fitted with child-proof lids and people are better educated. But we still have a long way to go in other areas," he said.

In the 1990s Professor Byard and his colleagues launched a safe sleeping campaign and lobbied for mandatory standards for cots sold in Australia. Their efforts also resulted in parental guidelines for preparing foods for toddlers.

But despite the written material available on safe sleeping practices, many parents are still risking their babies' lives without realising it.

"Soft mattresses and big fluffy pillows are no good because babies can suffocate in the bedding. The same applies to soft toys - keep them out of cots," Professor Byard said.

All cots must now meet national standards but some parents still opt for the cheaper second hand cots that may not meet safety standards, unaware they are putting their child's life at risk. "I've seen too many children die from falling through gaps in unsafe cots, or getting their head caught."

Likewise, the safe feeding campaign was initiated by a little boy who choked to death on food. "Many parents don't realise that it can be deadly to give a small child foods that require chewing when they only have one tooth."

Professor Byard said it was important to take the lessons from the mortuary to the community to prevent tragic accidents.

"That's the whole basis for 'preventative pathology'. People are very uncomfortable dealing with death, but forensics underpins the whole of medicine. Pathologists have a real insight into what is dangerous and bad, and if we can get that message back to people it will help save a lot of unnecessary deaths."

Professor Byard has spent the past year working on both adult and paediatric forensic issues with a number of international institutions, including universities in the UK, Germany, Denmark and the US.

His research has incorporated studies of hypoxic brain damage (lack of oxygen supply to the brain) in infants and young children, histologic dating of bruises (by studying tissue cells), markers for freshwater drowning and diagnostic criteria for SIDS.

Last year Professor Byard was awarded the Humanitarian Overseas Service Medal for his forensic work in Thailand, identifying bodies in the wake of the 2004 tsunami. He was one of two University of Adelaide staff (the other was Dr Helen James) honoured for their work in the Phuket mortuaries.

Story by Candy Gibson