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Date issued: August 2022

Review date: August 2024 

Ref: D-379  Post Mortem Examination of Babies and Children final August 2022.pdf [pdf] 272KB

Talking it over

We understand that this is a difficult time to consider such an issue, but we hope this leaflet will help you understand the reasons for undertaking a post mortem examination, what is involved and its potential value.

You will probably have lots of questions, in the first instance, talk to the Doctor or Nurse who was caring for your child or baby, if they don’t know the answer to the question, they will know who else to ask.

It can sometimes help to talk to other people about the decisions you have to make, but remember the decision is ultimately yours.  Try to talk to your partner, family, and friends or perhaps, contact one of the organisations in the ‘When a Child Dies’ booklet.

If you don’t need a detailed explanation at present, please tell the Doctor who will inform the Consent Team of this when you are discussing the post mortem.

Types of Post Mortem

A post mortem examination is the final stage in investigating your child or baby’s illness.  It is a detailed physical examination of your child after he or she has died.  The post mortem and Bereavement Services undertake two types of post mortems; A Coroner’s and a Hospital voluntary consented post mortem.

Type 1:  Coroner’s Post Mortem: This examination is a legal requirement so you will not be asked to give your permission.  You should, however, be given an explanation of the process and the reasons for it. Please see further information below.

OR

Type 2:  Hospital Post Mortem: This examination is not a legal requirement, so your permission will be sought before this is carried out.

Your consent will be required for the following procedures:

• Consenting to a full or limited post mortem examination

• Consenting to an external examination only

• Consenting to the taking of tissue samples, whole organs or any fluids during the post mortem examination for further testing/investigations

• Consenting to the taking of appropriate photographs/images during the post mortem to assist the pathologist with the examination

You may be asked permission for a hospital post mortem to help increase understanding of your child or baby’s illness, or to contribute to teaching and medical knowledge.

No samples of tissue or organs will be kept without your explicit consent, for either type of post mortem.

In cases where a hospital post mortem is undertaken you will be able to see and hold your child or baby prior to him or her being transferred to the specialist Children’s Hospital, if you wish.  In cases where the Coroner is involved, permission to see your child or baby will have to be obtained from either the Coroner or Senior Police Officer in Charge. This can be done within the viewing facilities available to you in the Hospital Mortuary, or after the post mortem examination at your Funeral Directors’ Chapel of Rest. All signs of the post mortem examination will be hidden by your child or baby’s clothes and hair or bonnet, but your child’s skin tone and temperature may have changed, which is normal after death.

You will be able to arrange the details (but not the date) of your child or baby’s funeral, before the post mortem examination has taken place.  Once the post mortem examination has been completed, either the Hospital Mortuary staff or the Coroner’s Officer should be able to give you an indication of when your child or baby will be ready for release to your Funeral Director.

If you would like a more detailed discussion about the Hospital post mortem report when it is available, you can ask for an appointment with the Hospital Doctor to discuss it, this may be suggested to you during your consent meeting.

Further information about your Baby or Child’s Post Mortem Examination

A post mortem examination is another stage in investigating your baby or child’s illness or may provide an explanation as to why your baby or child has died.  It is a detailed physical examination of your child or baby after their death.  Some post mortem examinations are legally required, others are not.

Occasionally families ask questions that can only be answered with information obtained from a post mortem examination; the information gained could benefit other members of the family or other families who have a child with similar problems.

Coroner’s Post Mortem Examinations

This is an examination carried out by law under the instruction of H M Coroner.  Consent is not required for this type of post mortem examination, but the next of kin can be represented by a medical representative of their choice; for example your GP.

Deaths of babies and children, with the exception of stillbirths, must be referred to the Coroner to establish the cause of death; the Coroner will then decide whether it will be necessary to have a post mortem examination.  H M Coroner requests the services of a specialised Paediatric Pathologist; who is a Doctor that works within the mortuary at a Children’s Hospital, instructing them to carry out a full and thorough examination of the body.

There is a dedicated team of officers working for the Coroner, who are available to provide information to bereaved families on sensitive issues surrounding a post mortem, including why a post mortem is required and retention of tissues/organs to establish the cause of death.  They also discuss options available for disposal or returning organs and tissues once the Coroner’s investigations are complete.  As the law states that a Coroner’s post mortem is needed, you will not be required to give your permission.

Hospital post mortem examinations

This type of post mortem examination requires no involvement from the Coroner. It could mean that the Doctors have spoken with the Coroner who has instructed them to issue a Medical Certificate of Cause of Death.

A Senior Doctor involved in the care of your baby or child undertakes the responsibility for asking for a post mortem of this nature. It is not to establish the cause of death, but to help you and clinical staff to understand your baby or child’s illness in greater detail or to help increase medical knowledge.  If the next of kin accepts the request, then the post mortem and Bereavement Services Team will meet with the next of kin or nominated representative to provide the relevant information for them to peruse prior to making the decision to continue.

A Hospital post mortem may be ‘full’ or ‘limited’ but a limited examination may not provide a full explanation as to the cause of death; the Consent Team will discuss this issue if the latter type of examination is requested.

It is entirely your decision to give permission for a hospital post mortem.

About the Post Mortem examination

Whether the post mortem has been ordered by the Coroner or requested by your Hospital Doctor, the examination carried out is the same for both adults and children alike.  A Coroner’s post mortem will normally be carried out within a few working days of the death.  A Hospital post mortem may take slightly longer post mortem’s are performed in a Post Mortem Suite by a team of trained staff (Pathologist and Technicians).

The Pathologist is a fully qualified Doctor who has had specialised training in Pathology, the study of disease processes.  Post mortems on babies and children are usually carried out at a Specialist Children’s Hospital. The Pathologists, who work at these types of hospitals, are fully trained Doctors who have specialised in children’s medicine and had specialist pathology training.

Pathologists and Technicians, like all Doctors, are bound by a strict code of conduct and will treat your baby/child with respect at all times.  The Pathologist works to strict guidelines that are set out by the Royal College of Pathologists and also acts under the direction of the Coroner to do so.

The post mortem procedure involves the thorough examination of the outside of your baby’s or child’s body, sometimes taking photographs and possibly x-rays. The next step is to remove and examine all the major internal organs.  This is carried out in a similar way to an operation, with the incisions made to the chest and abdomen and under the hairline if the brain is also examined.  Each organ in the chest and abdomen is removed and examined.  This also includes the removal of small amounts of tissues for the Pathologist to look at microscopically should nothing be obvious to the naked eye (for hospital post mortems you can consent or refuse permission for any part of these processes). The organs are then put back inside the baby’s or child’s body.  If the brain is examined, this could be a longer process and may take up to two weeks, so therefore, cannot be returned to the body immediately.  You will be asked if you wish to delay funeral arrangements until the brain can be returned.  Once the examination is complete a team of trained Technicians will be on hand to close all incisions made by the Pathologist.

Retaining samples, tissues and organs

Sometimes it is difficult to get enough information from the outward examination of whole organs.  In this case, the Pathologist will remove small samples of tissue; these are sent to the Laboratory for processing. These samples will usually be treated with chemicals and have wax added so that they can be made into a block.  This can then be sliced very thinly so that sections can be examined under a powerful microscope.  These samples, blocks and slides, form part of your child’s medical records and so will be retained indefinitely unless you decide otherwise.

When your permission for a hospital post mortem is sought, you will also be asked for permission to keep samples of tissue, or sometimes, whole organs like the heart or brain for a more detailed examination.  As described earlier, if you do not want to postpone the funeral in the case of a detailed and lengthier examination, you will be briefed on the options available such as seeking a separate service to reunite them with your child or baby, or request disposal of them in a respectful way at the Hospital.

Occasionally a Doctor may ask your permission to retain samples or organs indefinitely so that they can be used to research your baby or child’s illness in more detail, or to teach other Doctors.  Whether or not you agree is entirely your choice and nothing will be kept without your express permission.  If you change your mind at any time, and wish to have the samples or organs returned to you, this can be arranged by contacting either H M Coroner’s Office or the Hospital where the post mortem was undertaken.

Consent for the retention of tissue during a Coroner’s post mortem is not required, as this may be needed to establish the cause of death.  Once the Coroner has completed their investigations you will need to decide which option you require for the disposal or return of your baby’s or child’s tissues and organs. A member of the Coroner’s Office will discuss this with you and the referring Hospital will be advised of your decision.

Seeing your baby or child after the post mortem examination

It is quite usual to want to see your baby or child again, and you may have questions about how your baby or child will look.  Each baby or child is different, but you should expect the following: the post mortem examination will have been done in a sensitive way, with all the incisions hidden by your baby or child’s clothes or hair, so you should not notice these while your child or baby is dressed.  You may also notice the normal changes that happen after death, which are unconnected with the post mortem examination.  Your child or baby’s skin may look dry or flaky and your child or baby’s lips and nails may look redder than previously.  You may also notice marks on your child or baby’s skin that look like bruises.  These are not bruises, but marks from where the blood settles when the heart stops beating.  Your child or baby will also feel very cold.  If you have any questions about your child or baby’s appearance when you see him or her, please talk them over straightaway with your Funeral Director.  They will almost certainly be able to reassure you.

Registering your Baby’s or Child’s death

You will have been given the Medical Certificate of Cause of Death before the post mortem is undertaken, unless the Coroner is involved.  Once the Coroner’s post mortem examination has finished, the Coroner will issue the Medical Certificate of Cause of Death, so you can register your baby’s or child’s death.  More details of how to do this are contained in the ‘When a Child Dies’ booklet, which your nurse will have given you.  After this you will be able to confirm the arrangements for your child or baby’s funeral.

If the Coroner opens an inquest, a Death Certificate will not be issued, but a Certificate for Burial will be.  The Coroner will also have to give permission if you wish your baby or child to be cremated.  In this case, a Death Certificate may not be issued until after the inquest.

Talking to the Doctor or Coroner

If you would like a detailed discussion about the results of the post mortem, you can arrange to speak with the Doctor or member of the Coroner’s Office, who will go through the report with you.  They will explain any medical terms or details that you don’t understand.  An appointment can be made with your baby’s or child’s Doctor or a Coroner’s Officer, depending on the type of post mortem your baby or child had, and they will go through the report with you.  The medical or legal terms in which the report is written may sound rather formal in relation to your baby or child, and you may like to have a partner, relative or a friend with you for support.

Your GP can also discuss the content of the Coroner’s post mortem report with you, should you require an explanation of the results available.