Sudden Unexplained Deaths in Childhood: A Scoping Review

Sudden unexplained death in childhood (SUDC) affects children 1-18 years whose deaths remain unexplained after thorough investigation. SUDC lacks a coordinated research strategy to clarify causes and reduce incidence.

To conduct the first scoping review of the SUDC literature and characterize prevalence, study designs, key findings, knowledge gaps, and research recommendations.

PubMed, Embase, Scopus, Cochrane Library, Virtual Health Library, and ProQuest Dissertations searched through December 2025.

Included articles comprised original research, reviews, and commentaries addressing unexplained deaths 1-18 years, with symptom onset <24 hours before death.

Two reviewers screened studies and extracted data; a third assessed risk of bias and limitations.

We reviewed 101 studies published from 1951-2025, 75% after 2012. SUDC was rare, with variable prevalence and differing death-investigation practices. Most cases involved children aged 1-4 years, were unwitnessed, occurred during sleep, and found prone. Febrile seizures were reported at approximately 10-fold higher rates than expected. Older cases were less common and more heterogeneous. Genetic findings suggested possible cardiac and neurologic contributions. Autopsies usually showed mild, noncausal findings. Neuropathologic studies identified hippocampal anomalies of uncertain significance; proteomic studies found differences between explained and unexplained deaths.

Generalizability was limited by mixed populations, inconsistent terminology and investigative standards, and possible case duplication.

SUDC research has grown but remains constrained by small datasets and methodological inconsistency.

Progress will require multidisciplinary collaboration, standardized data collection, biospecimen access, and dedicated funding.