We had to wait seven months to find out how our child died

A parent’s struggle to uncover the truth behind a child’s unexpected death

We had to wait seven months – The emotional toll of waiting for answers after a child’s death can be overwhelming, as illustrated by the experience of Nathan and Fiona Robinson. When their two-year-old son Alfie passed away suddenly in his sleep, the couple faced a seven-month delay before the cause of death was finally determined. For many families in the UK, this kind of prolonged uncertainty has become a common reality, with a fifth now enduring waits of six months or longer for post-mortem results. Dr. Marta Cohen, a paediatric pathologist who returned to work after retirement, is working to alleviate this crisis, but the challenge remains daunting.

“It’s the most serious situation we have seen for 20 years,” says Dr. Marta Cohen, who has taken on extra responsibilities to address the growing backlog. Her efforts highlight a broader issue: the shortage of qualified pathologists in the UK, which has left families in limbo and strained healthcare systems.

The Robinsons’ ordeal began in May 2022 when Fiona woke to find Alfie unresponsive in bed. “I went over and tapped his back lightly, saying, ‘Come on dreamer, it’s time to get up now,’” she recalls. “I knew straight away, as soon as I rolled him over, he was gone.” The sudden loss left the couple grappling with a profound sense of helplessness, compounded by the lack of immediate answers. For seven months, they lived in a state of uncertainty, unable to move forward with their lives or prepare for the future.

Alfie’s death was not marked by any visible signs of distress, making the tragedy even more devastating. “He was a really big character and very affectionate,” Nathan says. “You could really feel the love he radiated towards his mum, dad and sister.” The emotional weight of the loss was exacerbated by the ongoing uncertainty, with the couple forced to relive the moment of Alfie’s death daily. “We no longer operate like normal parents,” Nathan explains. “You go over loads of scenarios in your head, wondering what happened and if you could have done something differently.”

Having another child added to their anxiety, as they feared the same fate might befall their newborn. “You’re constantly worried about her future,” Fiona says. This emotional burden is shared by many parents who face unexplained child deaths, often leading to a deep need for clarity. Dr. Cohen emphasizes that quick answers are crucial for families to rebuild their lives after such a devastating event.

The delays in post-mortem examinations are part of a larger systemic issue. A Royal College of Pathologists (RCP) report last year revealed that more than a third of pathologist positions remain unfilled nationwide. This shortage has created a bottleneck in determining causes of death, especially for children. Each year, approximately 40 children and young people under 18 die unexpectedly from unknown causes, with investigations failing to identify a reason. For families like the Robinsons, this means enduring months of unanswered questions and unresolved grief.

Dr. Cohen, who is currently handling 85% of sudden death cases at Sheffield Children’s Hospital, describes the situation as “the most serious situation that we have been in the last 20 years.” She attributes the problem to a combination of factors, including complex cases, a dwindling workforce, and high pressure on pathologists. “The cases are complex, the workforce is short, and the pressure is high. So the wellbeing of the pathologist is not good enough,” she says. This has led to a cycle of burnout and further staff attrition.

Sheffield Children’s Hospital, which conducts around 500 post-mortem examinations annually, is part of a “mutual aid” system where pathologists cover shortages in other regions. This means consultants like Cohen are often tasked with examining children from distant areas, such as Kent, Newcastle, and the West Midlands. Bodies sometimes arrive a month later because coroners struggle to find available pathologists. “It’s a shared burden,” Cohen notes. “We’re not just dealing with local cases anymore; we’re taking on the entire country’s need.”

The RCP report also highlights budget constraints and bureaucratic delays as key barriers to recruitment. With 25% of the current workforce expected to retire in the next five years, the crisis is set to worsen. This is particularly concerning for regions like the Midlands and South West, which lack any child pathologists. “If you don’t have enough consultants, how can you ensure timely results?” Cohen asks. “It’s not just about numbers—it’s about support and sustainability.”

The Robinsons’ case underscores the human cost of these systemic delays. An inquest held in November 2024 was unable to confirm a cause of death, despite extensive efforts, including a post-mortem examination, scene analysis, and review of medical histories. For Nathan, the final confirmation that “there was nothing that we could have done differently to stop this” was both a relief and a bittersweet moment. “It’s reassuring to know we’re not to blame,” he says. “But it’s also heartbreaking to wait so long for that peace.”

Families who experience unexplained child deaths often describe the waiting period as a form of emotional limbo. Without clear answers, they cannot fully process their loss or move forward with planning for the future. “You’re stuck between the past and the present, trying to find a way to live again,” Fiona reflects. This sentiment is echoed by other parents who have faced similar challenges, many of whom struggle to cope with the uncertainty while balancing daily life.

Dr. Cohen’s work is a testament to the resilience of those in the field. By stepping back into active service, she aims to reduce the backlog and provide quicker results for families. However, the scale of the problem is vast, with the UK currently home to just 52 consultant pathologists. This number has steadily declined over the past two decades, leaving the healthcare system stretched thin. “We’re dealing with a critical shortage that’s impacting every aspect of care,” she says. “It’s not just about post-mortems—it’s about the entire process of understanding a child’s death.”

The Robinsons’ experience is not unique. Across England, families are increasingly forced to wait for answers that could provide closure. For many, the prolonged uncertainty leads to a constant state of worry and anxiety. “You’re living in a fog, trying to make sense of a tragedy you can’t explain,” Nathan says. “It’s like you’re waiting for someone to tell you the story of how your child’s life ended.”

As the RCP continues to push for solutions, the focus remains on addressing the staffing crisis. With mutual aid schemes and extra shifts, pathologists are working tirelessly to meet demand, but the system is under immense strain. The hope is that these efforts will eventually lead to faster turnaround times and more support for those on the front lines. For now, however, families like the Robinsons are left in the dark, waiting for answers that could take months to arrive.

Dr. Cohen’s perspective is a reminder of the broader implications of this shortage. “If we don’t address this, more families will face the same fate as Alfie’s,” she warns. “It’s a matter of urgency.” As the deadline for the next round of retirements approaches, the pressure on the existing workforce intensifies. Without intervention, the waiting times for answers may only grow longer, deepening the emotional impact on grieving families and further straining the medical system.