Forensic interpretation and age distribution patterns in substance‐related child deaths

We thank Yang & Wei [1] for their interest in our article [2] and for the opportunity to clarify several points regarding our interpretation of the cited literature. First, regarding the study by Chasnoff et al. [3], the correspondents correctly note that approximately 15% of women continued substance use after the recognition of pregnancy. Our intention in citing this study was to highlight the substantial proportion of women screening positive for substance use in prenatal care settings. We acknowledge that distinguishing between screening positivity and continued use during pregnancy provides greater precision, and we appreciate the opportunity to clarify this point. Second, concerning the breastfeeding recommendation cited from Chomchai et al. [4], our discussion was intended to reflect a cautious clinical approach. Owing to reference limits for the article format, we were unable to include an additional pharmacokinetic study [5], which similarly recommends that mothers who use methamphetamine avoid breastfeeding for at least 48 hours after use. We appreciate the opportunity to clarify this point. Third, our study relies on forensic autopsy findings to determine the cause of death. In forensic pathology, such determinations represent structured causal inference based on pathological, toxicological and investigative evidence, and form the medical and legal basis for death certification. Our intention in citing the relevant literature was to provide context for mechanisms potentially contributing to these deaths, while recognising the inherent limitations of retrospective forensic data. Finally, Yang and Wei note that the cited literature describing bimodal age distributions relates to painkiller poisoning. Our reference was intended as a general comparison with patterns reported in paediatric poisoning epidemiology rather than a direct extrapolation. For transparency, the age distribution of all substance-related deaths in the database is shown in Figure S1 in the original article, allowing readers to examine the broader data set underlying this observation. We appreciate the correspondents’ careful reading of our work and the opportunity to provide these clarifications. Shyh-Yuh Wei: Conceptualisation; writing—original draft. Chih-Hsin Pan: Supervision; writing—review and editing. This work was supported by the National Health Research Institutes (Grant numbers: NHRI-EX115-11420NC) and Ministry of Justice, Taiwan (Grant numbers: 113-1301-10-28-03). The funders had no role in study design, data collection and analysis, interpretation of data, decision to publish, or preparation of the manuscript. None.