Fatal Child Abuse Research Articles

Distinguishing Sudden Infant Death Syndrome From Child Abuse Fatalities

Fatal child abuse has been mistaken for sudden infant death syndrome. When a healthy infant younger than 1 year dies suddenly and unexpectedly, the cause of death may be certified as sudden infant death syndrome. Sudden infant death syndrome is more common than infanticide. Parents of sudden infant death syndrome victims typically are anxious to provide unlimited information to professionals involved in death investigation or research. They also want and deserve to be approached in a nonaccusatory manner. This clinical report provides professionals with information and suggestions for procedures to help avoid stigmatizing families of sudden infant death syndrome victims while allowing accumulation of appropriate evidence in potential cases of infanticide. This clinical report addresses deficiencies and updates recommendations in the 2001 American Academy of Pediatrics policy statement of the same name.

Unexplained infant and child death: a review of Sudden Infant Death Syndrome, Sudden Unexplained Infant Death, and child maltreatment fatalities including shaken baby syndrome

This review will examine the most recent published literature on Sudden Infant Death, Sudden Unexplained Infant Death, infant and child death due to maltreatment, and Shaken Baby Syndrome. New recommendations from the American Academy of Pediatrics about the evaluation and prevention of possible Sudden Infant Death Syndrome cases were published this year, with a focus not only on the Back to Sleep campaign, but other factors that may contribute to the risk of Sudden Infant Death Syndrome. Additionally, the controversial issue of bed sharing is addressed, with advice given not to bed share in the first 3 months of life. The possibility of a second sudden infant death within a family is discussed. Attention is also paid to the importance of considering inflicted injury in the differential diagnosis of every unexplained infant or child death, and the recent literature on child maltreatment deaths is reviewed. The grieving family who has lost an infant should receive immediate attention and support, and a multidisciplinary investigation team should be involved as soon as possible so that a full investigation can take place. Investigation of unexplained infant or child death should always involve a thorough interview with all adults involved, as well as a proper scene investigation and post-mortem examination.

Oro-facial trauma in child abuse fatalities.

Many children die as a result of abuse and neglect each year. Early recognition and effective intervention are crucial factors in the fight against this. Child mortality rates increased in South Africa between 1998 and 2004, with child abuse deaths constituting part of these statistics. Autopsies on children who have died of unnatural causes are often not specific as to the possibility of child abuse. This article presents the extra-oral and intra-oral signs of child abuse from a study of the autopsies of child mortality cases seen at Salt River Medico-Legal Laboratory in Cape Town from 1998 to 2004 with reference to the South African child mortality rates.

Sensitivity of autopsy and radiological examination in detecting bone fractures in an animal model: Implications for the assessment of fatal child physical abuse

Skeletal injuries are often strong indicators of child abuse and their detection is therefore crucial. The aim of this study was to compare the sensitivity of three diagnostic approaches, namely autopsy, traditional (conventional) radiology, and computed tomography on “battered” piglets, in order to verify the sensitivity of each method, with respect to the true number of bone fractures assessed once the piglet was skeletonised (osteological control). Four newborn cadaver piglets who had died from natural causes were severely beaten post-mortem in every district of the body. Traditional radiography, computed tomography (CT) and autopsy were performed. The piglet was then macerated until skeletonised and the number of all fractures present recorded (osteological control). On the cranium, traditional radiology revealed only 35% circa of actual fractures, autopsy detected only 31% ( P < 0.01 for both comparisons versus osteological control), whereas CT imaging detected all fractures actually present. For ribs, radiology detected only 47% of all fractures present, and autopsy 65% circa ( P > 0.05 for both comparisons versus osteological control), while CT scans detected 34% ( P < 0.01). In suspected cases of fatal child abuse, we suggest that the bones of specific districts be directly analysed either at autopsy or by collecting specific diagnostic sites, such as parts of the rib cage, and subjecting them to maceration. The removed areas could be replaced with artificial material for cosmetic purposes. The authors stress the importance of combined radiological, CT scan, autopsy and osteological survey in the detection of perimortem bone fractures.

Two fatal cases of child abuse in which neighbors were unaware of the victims' disappearance for a long period

We describe two fatal cases of child abuse in which neighbors were unaware of the victims' disappearance for 1.5 months and 1 year, respectively. Recently, there have been fatal child abuse cases in which neighbors have been aware of the signs of the abuse but not notified the Child Care Authorities. Lack of concern about child welfare in the community is the greatest obstacle to protecting children at risk of abuse. The most effective means of preventing child abuse is to educate the community about how to recognize the signs of abuse and to inform the authorities. We emphasize that the community has an obligation to protect children against crime, including child abuse. The roles of the Social Services in preventing child abuse have been extended. Forensic pathologists are required to play a key role in child abuse prevention, and in Japan their activity should be extended to the administrative field.

The Swedish Myth: The Corporal Punishment Ban and Child Death Statistics

Sweden is widely believed to have an exceptionally low incidence of child maltreatment deaths. Since Sweden is also the first country to have outlawed all forms of corporal punishment, proponents of a total ban on corporal punishment, in the UK and elsewhere,have argued that this demonstrates that such a ban prevents fatal child abuse. While not taking sides on the corporal punishment issue, this paper demonstrates that the argument is misleading on several counts. The available evidence suggests that Sweden has a low, though not uniquely low, incidence of child maltreatment deaths. Widely cited statistics suggesting that Sweden is in an entirely different league from other countries are, however, seriously misleading. Nor does the evidence really allow us to conclude that Sweden’s relative success in this area is attributable to the ban on corporal punishment. Other countries without a corporal punishment ban also have low or lower child maltreatment death rates; the figures that are commonly cited in any case pre-date Sweden’s corporal punishment ban and there are a number of other important variables, other than a ban on corporal punishment, that could account for international variations. The article concludes with some thoughts about the selective use of evidence in debates of this kind.

PEINKOFER, James R., SILENCED ANGELS; The Medical. Legal, and Social Aspects of Shaken Baby Syndrome

PEINKOFER, James R., SILENCED ANGELS; The Medical. Legal, and Social Aspects of Shaken Baby Syndrome. Westport, Connecticut: Auburn House Publishers, 2002, 291 pp., $44.95 hardcover..This has got to be one of the most distressing and sad books I have ever reviewed. It is dedicated shaken babies past and present: Your silence is heard. The book is an extremely well-written and detailed overview of everything we currently know about SBS or shaken baby syndrome, something which seems difficult to diagnose accurately in every instance and which community members, police and physicians may be reluctant to consider as a diagnosis.The book is divided into three parts and does an in-depth analysis of medical, legal and social aspects of SBS. Under medical aspects, in addition to all of the CT scans and X-ray evidence, the author also includes amazing chapters on the history and evolving understanding of SBS [it has been a long time coming, let me tell you] as well as myths and controversies surrounding the topic, missed cases and the impact on survivors. Under legal aspects, the author looks at the investigation of SBS as well as SIDS vs. SBS. Under social aspects, he provides a fascinating chapter on what we know about the perpetrators, the families of SBS victims, the psychological aspects, government interventions and prevention. The book ends with conclusions and recommendations but also appendices with developmental milestones in babies from birth through twenty-four months, a glossary of terms [needed in the rather more technical medical analysis of this syndrome] and a list of printed and online resources and support groups.SBS is not something that happens by accident as parents play with children; it involves the violent and repetitive shaking of an infant or toddler that causes brain injury and bleeding within the head and the retinas. To give you some sense of proportion about how violent this shaking is, research now shows that a child falling from a third-story window has about a 1% chance of dying while in SBS there is a 25% risk of death. Child abuse is the second leading cause of death in children and SBS is one of the leading causes of child abuse fatalities. A typical SBS case costs at least $100,00 or more in the first year, but more than that, we as a community and as a society should care deeply about the health, well-being, safety and future of all children.SBS is totally preventable and often occurs when several family risk factors are present: being the firstborn child to young parents who do not have adequate parenting skills; being male, since infant boys have a 60% greater risk of being shaken than infant girls; being young; a disruption [such as prematurity and hospitalization after birth] in the normal process from being born to going home; multiple births; any kind of physical impairment or chronic illness; and being unwanted or unaccepted by the new parents.The goal of this book is to save lives and to help bring justice to those who permanently damage and alter the lives of families through a moment of extreme violence. Those who suffer SBS can live with a number of consequences such as attention and balance problems, blindness, deafness, cerebral palsy, death, emotional problems, GI problems, and many different kinds of learning disabilities and mental retardation. …

A review of social factors in the investigation and assessment of non-accidental head injury to children.

Investigation and assessment work in non-accidental head injury cases is complex and challenging. This article discusses briefly the professional systems involved and the conditions necessary for effective practice. It then reviews briefly the literature on social factors in serious and fatal child abuse in order to provide a context for discussion of recent UK studies of non-accidental head injuries/shaken baby syndrome. The findings on social factors are compared and areas for further research are suggested. The article then considers how best to use the existing knowledge base about these cases within assessment frameworks currently in use and considers issues in presenting assessment conclusions to decision-makers.

World report on violence and health: What it means for children and pediatricians

World report on violence and health: What it means for children and pediatricians

Child Abuse Fatalities: Are We Missing Opportunities for Intervention?

Child Abuse Fatalities: Are We Missing Opportunities for Intervention?

Prevention of shaken baby syndrome: Never shake a baby

Shaken baby syndrome (SBS) represents injuries to the head, skeleton and eyes of a young child and is the leading cause of fatal or life-threatening child abuse. SBS is preventable. The dangers and consequences of shaking a baby are not well appreciated by the general public. Simple educational programs and community nursing support programs have been shown to be helpful. Inadequate physician training and knowledge in child maltreatment have also been identified as problems. This article outlines the evidence for interventions in the prevention of SBS and recommendations for health care providers and educators.

Technical communication: rationale and technique for examination of nervous system in suspected infant victims of abuse.

Most victims of fatal child abuse are under the age of 2 years and have a fairly typical pattern of injuries that involve the brain and spinal cord. Documenting these injuries in a systematic fashion is of paramount importance in establishing the cause and manner of death. Although the importance of recognizing these injuries is widely understood, there are few guidelines for the optimal examination of the central nervous system to document these changes. A standard procedure for postmortem dissection of the brain and spinal cord that preserves the anatomy of the cervicomedullary junction is outlined. Changes in the cervicomedullary junction and spinal cord are an underappreciated marker for shaking injury in children. This technique, along with examination of the eyes and optic nerves, will optimally identify the injuries associated with shaking injuries. A standard series of histologic sections are also outlined to document the corresponding microscopic changes.

Making the most of the Victoria Climbié Inquiry Report

AbstractThe principal findings of the Victoria Climbié Inquiry Report (Lord Laming, 2003) repeat those of most previous fatal child abuse inquiries or reviews, revealing problems with professionals' assessments, communications, skill base and resources. There is a danger that the recommendations of this latest report will be implemented in an overbureaucratic manner, reducing their potential to make a significant difference to practice. Instead, it is essential to build on the core lessons of this and previous inquiries, which is that professionals' capacity to think about their cases and their work must be enhanced. This has considerable implications for the training of professionals and the resources available to them. Copyright © 2004 John Wiley &amp; Sons, Ltd.

Childhood homicide: a 1990-2000 retrospective study at the Institute of Legal Medicine in Lausanne, Switzerland.

The authors retrospectively reviewed all homicides of children under 15 years of age referred to the Institute of Legal Medicine in Lausanne from January 1990 to December 2000. We report on 41 cases during this eleven-year period. Among those, 17 newborns and 24 older children, a higher proportion of males was found. Regarding newborn homicides, when the identity of the mother was known she was always identified as the perpetrator. With non-newborn homicides, the majority of the victims were killed at home and knew the offender. Two common profiles of these homicides could be determined. In the first scenario, one of the parents shot all the children and committed suicide afterwards. The second profile is defined as 'fatal child abuse' and concerned younger victims whose cause of death was the result of a cranio-cerebral trauma from battering or shaken baby syndrome.

Understanding communication in child protection networks

AbstractReviews of fatal child abuse cases regularly identify communication problems between the professionals. Understanding their origins requires an analysis of the psychology of communication as well as its technology, since it is a complex process in which interpersonal factors impact on the meaning that each person attributes to the messages given and received. The contexts within which the communications occur also colour how the messages are comprehended. Examples in practice from the Victoria Climbié Inquiry Report (Lord Laming, 2003) will be cited. Effective communication between professionals requires a mindset that can be developed through training. Copyright © 2003 John Wiley &amp; Sons, Ltd.

Book Review “Early Prediction and Prevention of Child Abuse”

This book is a new and updated version of a book published in 1988 on the prevention of child abuse and neglect in the early pioneering days of child abuse research. The editors are an all British team from the Universities of Birmingham and Leeds with 38 contributors from the U.K., U.S., and Australia. There are 21 chapters divided into 4 sections: prevalence and prediction; primary and secondary prevention; tertiary prevention; and working with offenders. In Section I it is interesting to note that over the last 25 years, when several countries started to collect data on child abuse cases on a regular basis, some evidence has been observed that the prevalence of child abuse has decreased. This positive information may be attributed to the focus on preventive public health approaches that many countries have undertaken after too many famous cases of fatal child abuse covered by the media. Section II is influenced by the 1979 book by Uri Bronfenbrenner on the ecology of human development; it is still very relevant today. In

Child Abuse Underestimated by Death Certificates

Child Abuse Underestimated by Death Certificates

Underascertainment of Child Maltreatment Fatalities by Death Certificates, 1990–1998

Child fatality review teams have emerged across the United States in the past decade to address the concern that systems of child protection, law enforcement, criminal justice, and medicine do not adequately assess the circumstances surrounding child fatality as a result of maltreatment. We compared data collected by a multidisciplinary child fatality review team with vital records for all children who were aged birth to 16 years and died in Colorado between January 1, 1990, and December 1, 1998. Odds ratios and 95% confidence intervals for ascertainment by the death certificate were estimated using logistic regression. Only half of the children who died as a result of maltreatment had death certificates that were coded consistently with maltreatment. Black race and female gender were associated with higher ascertainment, whereas death in a rural county was associated with lower ascertainment. Deaths resulting from violent causes (eg, shaking, blunt force trauma, striking) were more likely to be ascertained than those that involved acts of omission (eg, neglect and abandonment, drowning, fire). The most common perpetrators of maltreatment were parents. However, maltreatment by an unrelated perpetrator was 8.71 times (95% confidence interval: 3.52-21.55) more likely to be ascertained than maltreatment by a parent. The degree of underascertainment found in this study is of concern because most national estimates of child maltreatment fatality in the United States are derived from coding on death certificates. In addition, the patterns recognized in this study raise concern about systematic underascertainment that may affect children of specific sociodemographic groups.

Household composition and risk of fatal child maltreatment.

Approximately 2000 children die annually in the United States from maltreatment. Although maternal and child risk factors for child abuse have been identified, the role of household composition has not been well-established. Our objective was to evaluate household composition as a risk factor for fatal child maltreatment. Population-based, case-control study using data from the Missouri Child Fatality Review Panel system, 1992-1994. Households were categorized based on adult residents' relationship to the deceased child. Cases were all maltreatment injury deaths among children <5 years old. Controls were randomly selected from natural-cause deaths during the same period and frequency-matched to cases on age. The main outcome measure was maltreatment death. Children residing in households with adults unrelated to them were 8 times more likely to die of maltreatment than children in households with 2 biological parents (adjusted odds ratio [aOR]: 8.8; 95% confidence interval [CI]: 3.6-21.5). Risk of maltreatment death also was elevated for children residing with step, foster, or adoptive parents (aOR: 4.7; 95% CI: 1.6-12.0), and in households with other adult relatives present (aOR: 2.2; 95% CI: 1.1-4.5). Risk of maltreatment death was not increased for children living with only 1 biological parent (aOR: 1.1; 95% CI: 0.8-2.0). Children living in households with 1 or more male adults that are not related to them are at increased risk for maltreatment injury death. This risk is not elevated for children living with a single parent, as long as no other adults live in the home.

Victim, perpetrator, family, and incident characteristics of infant and child homicide in the United States Air Force

Objective: The present study describes factors related to fatal abuse in three age groups in the United States Air Force (USAF). Method: Records from 32 substantiated cases of fatal child abuse in the USAF were independently reviewed for 60 predefined factors. Results: Males were over-represented in young child victims (between 1 year and 4 years of age) and child victims (between 4 years and 15 years of age) but not in infant victims (between 24 hours and 1 year of age). African-American infant victims and perpetrators were over-represented. Younger victims were more likely to have been previously physically abused by the perpetrator. Perpetrators were predominantly male and the biological fathers of the victims. Infant and young child perpetrators reported childhood abuse histories, while child perpetrators reported the highest frequency of mental health contact. Victims’ families reported significant life stressors. Families of young child victims were more likely divorced, separated, or single. Incidents with infants and young children tended to occur without witnesses; incidents with child victims tended to have the victim’s sibling(s) and/or mother present. Fatal incidents were more frequent on the weekend, in the home, and initiated by some family disturbance. Conclusions: Differences among groups in factors related to infant and child homicide across age groups may assist in the development of more tailored abuse prevention efforts and may also guide future investigations.