The Soria Moria approach to pediatric forensic issues

Abstract

Pediatric forensic pathology has been a controversial and evolving area in recent years [1, 2]. High profile court cases in many countries, including the United Kingdom and Canada, have focused both professional and public attention on deficiencies in diagnoses and approaches to cases, sometimes with resultant highly unfortunate miscarriages of justice [3, 4]. Examples of irresponsible testimony in court by physicians in cases of child maltreatment and neglect, as well as the medicolegal consequences caused by a medical examiner’s inadequate expertise and experience in pediatric pathology, have been described [5, 6]. Attempts to redress this situation have included the involvement of professional organizations and courts in reviewing cases and in establishing protocols and guidelines. A special issue of Forensic Science Medicine and Pathology was published in 2010 in which a number of issues were reviewed and analyzed including terminology and classifications for unexpected deaths in infancy and the place of parents at infant death scenes [7–9]. Additional problems in the field include declining numbers of trainee pathologists who are interested in pediatric forensic issues and adult practitioners who sometimes make the mistake of extrapolating from adult cases back to children. One way of addressing these problems is to hold meetings that specifically focus on pediatric forensic issues. This has not, however, been a common occurrence. An exception to this is the annual meeting convened in Norway by the Department of Forensic Pathology and Clinical Forensic Medicine of the Norwegian Institute of Public Health at the Soria Moria Convention Center, outside the main city of Oslo. The meeting has been held on an annual basis since 1993; it is an international meeting with English as the official language, although often with a Norwegian meeting held on the preceding day. The meeting lasts for two and a half days and covers a wide range of topics focusing particularly on sudden infant death syndrome (SIDS) and on sudden and unexpected infant and childhood death. The meeting is quite small limited to between 40 and 60 participants, who come from a variety of forensic, clinical, and research backgrounds. To give an insight into the types of presentations that occur, the program for this year (2013) will be reviewed. On the first morning, a session was held on the epidemiology of SIDS and sudden death in infants and children. This included overviews of changing patterns in mortality and trends in classifications, the relationship of SIDS rates to immunizations, death scene investigations in Norway, and discussion on parental responses to death scene examinations and bereavement issues. The morning concluded with a session where participants were able to have short presentations of submitted difficult cases that had raised particular diagnostic or legal problems. Topics included concealed births, second impact syndrome, accidents with bicycle helmets, positional asphyxia, and dehydration. The remainder of the day was devoted to R. W. Byard (&) Discipline of Anatomy and Pathology, The University of Adelaide, Level 3 Medical School North Building, Frome Road, Adelaide, SA 5005, Australia e-mail: roger.byard@sa.gov.au