Medical review to probe child deaths


The Japan Pediatric Society plans to establish a registration system to review and investigate child death cases in an effort to reduce their number.

A study committee set up by the society convened its first meeting at the end of 2011 and decided to start model projects in Gunma and Kyoto prefectures as well as in Kitakyushu, in April or later. The move is based on a proposal the working group made last October to establish an information system on child deaths.

Identifying the cause of a child’s death can be difficult, even in cases of illness. The latest move to establish a review system is an attempt to learn lessons from past cases.

A public symposium held at the University of Tokyo in December discussed issues associated with the causes of child deaths.

Japan boasts the lowest infant mortality rate in the world but its mortality rate for children aged 1 to 4 is one of the highest among advanced nations.

Michiko Kobayashi, adviser at the Osaka Prefectural Maternal and Child Health and Medical Center and head of the child death study group of the Health, Labor and Welfare Ministry, which organized the symposium, said: “Investigations have not been made sufficiently in the past regarding the causes of child deaths. Without knowing what has happened to them, we cannot protect children’s lives.”

University of Tokyo professor Takashi Igarashi, who heads the Japan Pediatric Society, said excellent pediatric service and accurate death reviews are two critical components in the effort to protect children.

“Long-term efforts are necessary to establish a review system. Our organization is prepared to take the initiative in crafting the system,” he said.

Systems to review child deaths are in place in the United States, Britain and Canada, where they are said to have improved pediatric medical care, welfare and accident prevention.

The symposium at the University of Tokyo, which attracted about 300 people from all over Japan, was held in response to increasing calls for the medical community to establish a similar review system.

Tatsuhiro Yamanaka, director of Ryokuen Child Clinic in Yokohama, is heading efforts at the Japan Pediatric Society to launch a review system.

Reporting about choking deaths caused by food, Yamanaka said causes of death must be determined, recorded, analyzed and followed by preventive measures with nationwide implementation to protect as many children as possible.

Fumitake Mizoguchi, a pediatrician at Saiseikai Maebashi Hospital in Gunma Prefecture, said child death reviews should be designed to minimize fatalities.

“Initiatives being taken overseas show that coordinators in charge of smoothing collaboration among multiple institutions in the areas of medical care, welfare, judicial procedures and education are the key to making the review system successful,” Mizoguchi said.

Fumihiko Kawasaki, research director at Kodomo no Niji Information Training Center in Yokohama, reported on efforts to review abuse-linked child deaths, a practice started in Japan some time ago.

Kawasaki said there are many child deaths linked to suspected abuse immediately following birth and emphasized that such hidden abuses need to be uncovered and preventive measures taken.

Noriko Aida, head of radiology at the Kanagawa Prefectural Child Medical Center, proposed using autopsy imaging to avoid missing abuses and said budgeting for such imaging is necessary.

The symposium showed that a range of issues need to be addressed before a child death review system can be established, including how to sympathize with grieving families and obtain their consent to investigate a child’s death.

The event also became a starting point for creating a review system.