CDR/FIMR Case Review Teams
Child death review and fetal and infant mortality review teams shape what families carry — often without ever meeting them.
Every review is routine for you. For the family, it was the worst day of their lives.
Whether this review is your fifth or your five hundredth, it may be the family’s first. Your team reduces child and infant mortality by reviewing deaths, identifying system gaps and contributing factors, and recommending changes to community resources, service delivery, and policy. Much of that work happens without the family in the room, and it still determines how their child is described in the record, whether they are contacted, and what changes as a result of their loss.
When your team does conduct interviews, you enter a home during the hardest period of a family’s life. Review team composition, authority, and interview practice vary by state and jurisdiction, but the guidance below applies broadly.
How bereavement affects brain function
Bereavement impairs memory, concentration, and the ability to process and retain information. The people you serve may struggle to absorb what you tell them in the moment. Slow down, keep communications clear, and provide written information whenever possible.
Cultural and religious practices
Honoring cultural and religious practices respects family values and mourning rituals, reduces trauma, and builds trust. Practices vary widely — in the timing of burial, who cares for the body, whether the name of the person who died is spoken aloud, and how long formal mourning lasts. Ask the family what matters to them rather than assuming, and take care that your team does not read unfamiliar practice as evidence of neglect.
The language of the record
A child’s understanding of death develops with age. Younger children may not grasp that death is permanent and will ask the same questions repeatedly; school-age children understand permanence and often begin to worry about who else might die. Match your language to the child’s stage, and expect to repeat yourself without correcting them.
Practical Tips
When your team is conducting a review
Approach each review as an opportunity to reduce harm.
Use practices that acknowledge the family’s loss, avoid unnecessary repetition of painful details, and keep interactions respectful throughout the process.
Coordinate across disciplines and agencies.
Communicate with the other agencies on your team about the needs and care of the family. Coordination reduces the number of times a family must retell what happened.
Decide who contacts the family, and how.
Families should not receive duplicate or conflicting outreach from multiple agencies. Agree in advance on who makes contact, what they will say, and what the family can expect next.
Ensure the family is referred to a medical provider.
Bereavement affects physical health. Newly bereaved parents and caregivers face elevated risk of cardiac events and other conditions, and changes in sleep, appetite, mood, and concentration are common.
Refer families to bereavement care.
Provide a written list of mental health professionals with expertise in bereavement and trauma, including providers who work with children and adolescents. Most people are not ready for long-term engagement for six to nine months following a death, but short-term sessions can help sooner.
Give families basic information about what to expect.
Understanding what is common after a death helps families make sense of what they are experiencing.
When your team is conducting interviews
Use the child’s name.
Confirm with the caregiver that you are saying it correctly and ask whether there is a preferred name or nickname. Using the name honors the child and their importance to the family.
Explain the process clearly and confirm consent.
The person being interviewed should understand what the review is, what their participation involves, and that it is voluntary. Participation must never be coerced.
Pace your questions.
Keep questions simple, ask one at a time, and speak slowly. Bereaved people need more time to take in a question and answer it than you may expect.
Understand that every interaction is a hallmark memory.
Every contact with the family has the potential to create lasting memories, both caring and painful. Manage each interaction accordingly.
Acknowledge the death and listen.
Giving people room to talk — or not talk — can be a relief. No one expects you to solve anything or to say the right words. There are none.
Do not provide therapy or counseling.
Short-term psychotherapy for stabilization and long-term bereavement care should come from licensed professionals. Your role is to review, to refer, and to listen.
Telling families what the review is for
Families frequently want to know that their child’s death produced something. Many will never learn that a review took place, and some will assume silence means their child’s death was unremarkable.
Confidentiality requirements differ significantly by jurisdiction, and much of what your team discusses cannot be shared. What can almost always be shared is the purpose: that deaths are reviewed in order to identify what failed and to recommend changes, and that their child’s death is part of that record. Where your jurisdiction permits more — a published report, an annual summary, a notification when recommendations are adopted — offer it.
Say plainly what you can and cannot tell them, and do not promise what the process cannot deliver.
Caring for yourself
Taking care of yourself is fundamental to your work and to your long-term health. The effects of sustained exposure to stress, death, and trauma are not only psychological — they are physical. Sleep disruption, immune dysfunction, cardiovascular strain, and cumulative emotional fatigue are occupational realities in roles like yours.
Practical steps matter. Getting enough sleep, drinking water, moving your body, and spending time with people you care about are not small things. Reaching out to a mental health professional is not a sign of weakness. These are acts of professional maintenance. Caring for yourself makes you better able to do your work.
Because review teams carry this exposure together, some of it can be addressed at the team level. Building breaks into long review meetings, providing water, and closing meetings deliberately rather than abruptly are small changes that take little from the agenda.
Reframe common questions
“How are you doing?” can be reframed as “How are you coping?” — which acknowledges the weight of what the person is carrying. It may be more helpful to say “I have been thinking of you” or to make a specific offer rather than a general one.
Ask about the death only when the review requires it
Your work requires asking questions most people should never ask. Confine them to the review itself, prepare the family for them, and do not return to painful details in passing conversation.
Say the name
Using the name of the deceased acknowledges the importance of their life. Confirm pronunciation and ask whether there is a preferred name or nickname. Do not worry about reminding them — they are already thinking about it.
All deaths are not equivalent
Resist any urge to share your own experience of death or to compare one loss to another. Every experience of loss is different. If you have experienced a death yourself, you may offer a private moment to share — but be sensitive to the impact on both of you.
Bereavement lasts a long time
Bereaved people will not be feeling better in a few weeks, or even in a year. Adjusting to a significant loss takes years. Their lives are permanently changed.
It is their story, not yours
Being a consistent, non-judgmental presence — without redirecting attention to yourself — is one of the most valuable things you can offer.
There are no stages
The idea that bereavement proceeds in stages is a misconception. Families feel a wide range of things at different times. Avoid assumptions about how someone should be coping or where they should be by now.
If you say something hurtful, address it directly
Acknowledge the impact, apologize, and move forward. Leaving it unspoken is worse than naming it.
Be mindful of the “How many children do you have?” question
After a perinatal or child death, this is one of the most difficult questions a bereaved parent will face. There is no right answer, but be prepared for them to include all their children, whether living or dead.
Professional Resources
Resources
For grieving people and those who support them
10 Ways to Support
10 Ways to Support a Grieving Person
Bereavement 101
Learn more about the basics of bereavement
Community Homepage
Information for professionals who serve bereaved people
