There are logistical, cultural, political, financial and legal barriers to the effective utilisation of paediatric postmortem imaging as an adjunct to the identification of cause of death. Societal consensus will determine how this imaging tool is applied via the political and legal systems in place, but the radiologist will help determine how easily these barriers are overcome by demonstrating the usefulness of the technique. Postmortem imaging must add reliable information of value to society via the coroner, family of the deceased and the medical profession. Scientific technique must be applied to the information gathered via autopsy and any available antemortem imaging to ensure accurate correlation with other available factual information. We must collectively pool data and share observations with scientific rigour to ensure that postmortem changes and artefacts are reliably differentiated from critical findings. Appropriate application and dissemination of the acquired knowledge are the radiologists’ challenges.