Background Identifying the causes of unexpected pediatric deaths is a clinical, medicolegal, and humanitarian requirement. This study included autopsied children aged < 18 years who suddenly died due to natural causes and excluded nonnatural deaths. The study was performed over 5 years in the Egyptian Forensic Medical Authority. Results The study included 244 cases, consisting of 51.6% of neonates (< 1 month), 18% of infants (1–12 months), and 30.3% of children (1–18 years). The cause of death

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... n neonates and children was "explained natural diseases" in 73.8% and 91.9%, respectively, while it was only 45.5% in infants. Infection-related deaths account for 30.4% of all explained natural deaths. Infections were responsible for 11.8% of explained deaths in neonates, while 55% and 48.5% were in infants and children, respectively. Of the fatal infections, 60% occurred at the age of > 1 year. Pneumonia accounted for 61.8% of infection-related deaths, followed by myocarditis (12.7%) and septicemia (12.7%). Regarding systems that had fatal pathologies, respiratory causes were responsible for 64% of explained natural deaths, whereas cardiovascular and central nervous system diseases accounted for 11% and 7.7% of explained natural deaths, respectively. Considering prodromes, alarming symptoms were reported before death in 51.2% of cases, whereas death occurred without alarming manifestations in 29.9% of cases. The rest of the cases (18.9%) were abandoned children with unavailable antemortem data. Conclusions Present results serve as a valuable reference dataset for deaths in developmental stages in Egypt that guides forensic practitioners in managing child deaths.