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The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhood 

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Old 04-20-2016, 10:09 PM
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The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhood

*Strong/ objectional images removed

Pediatric forensic pathology deals with forensic issues arising in childhood and covers a wide spectrum of case types, ranging from abandoned fetuses/infants to birth-related deaths, sudden infant death syndrome (SIDS), natural childhood deaths, suicides, and homicides.

*Abandoned Fetuses/Newborn Infants:

Cases that have presented difficulties for centuries are those where the concealed body of a newborn infant or fetus is found where the birth was not attended by medical personnel or witnessed by other individuals. A number of questions need to be answered including whether the infant was born alive, was stillborn, or died during delivery? If the infant was born alive, the cause of death needs to be established. Other points that need to be addressed are whether the infant was of sufficient gestational age to survive, and who the mother might be. Unfortunately, there are many problems in this area, not the least of which lies in trying to determine whether live birth has occurred. Pathologic findings are unreliable and tests such as the flotation test that were designed to determine whether an infant had inhaled air, are inaccurate, as resuscitation may partially inflate the lungs, and decomposition may result in gas formation by bacteria. An additional difficulty involves legislative specifications for live birth, as these differ greatly among jurisdictions. Thus, determination of the sequence of events may simply not be possible.

*Birth-Related Deaths:

Deaths during delivery may result from complications related to the infant–maternal–placental interface that are integral to the birth process, or to those that are ‘‘iatrogenic’’ (due to complications of medical therapy). In all cases of birth-related fetal/infant deaths, the pregnancy and birth records must be reviewed and the placenta must be examined grossly and microscopically.

*Infant Deaths:

An infant death is one that occurs within the first year of life, which includes the neonatal period (the first 28 days). A wide variety of natural diseases may result in death during infancy that are well described in standard texts. These include congenital and/or genetic disorders that may be identified at delivery or that may cause health problems sometime after birth. On occasion, such conditions may remain undiagnosed until sudden and unexpected death occurs, and this may not happen for a number of years. This is particularly the case with some developmental abnormalities of the heart or blood vessels. Other causes of sudden death in children include respiratory, gastrointestinal, central nervous system, hematological, metabolic, and infectious disorders.
A common scenario for the pathologist is to have a case of a previously well infant who is found unexpectedly dead in his or her crib. The autopsy examination including full histology and extensive ancillary testing fails to reveal a cause of death. Under these circumstances, the death falls under the umbrella of SUDI, or sudden unexpected death in infancy. The characteristics of these deaths are that they: occur between 7 and 365 completed days of life and are unexpected and unexplained at autopsy, occur during an acute illness that was not recognized as life-threatening, are due to an acute illness of less than 24 h duration in a previously healthy infant (or death after this if life had only been prolonged by intensive medical care), result from a preexisting occult condition, or result from any form of accident, trauma or poisoning. Deaths attributed to SIDS or sudden infant death syndrome are included as a subcategory of SUDI. SIDS is defined as ‘‘the sudden unexpected death of an infant <1 year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation, including performance of a complete autopsy and review of the circumstances of death and the clinical history.’’ A number of these cases of unexpected infant death may be due to occult disease, or to accidental asphyxia from a ‘‘sleeping accident’’ in an unsafe crib or other unsafe sleeping environment. Some forensic pathologists list possible risk factors as potentially contributing causes in these deaths. The most appropriate manner of death in these cases is ‘‘undetermined.’’ The alternate terminology ‘‘sudden unexplained infant death’’ (SUID) is favored over ‘‘SIDS’’ in some jurisdictions.
Accidental asphyxia must be considered a possible explanation for a number of unexpected infant deaths. These may occur in a shared sleeping situation if an infant lies against an adult, or older child, or under an arm or a leg. These cases are referred to as overlaying and have occurred while infants have been breast fed in the parental bed due to obstruction of the mouth and nose by the breast. Co-sleeping is the term used for situations where an infant sleeps in close proximity to another person. Infants and young children are also at risk of hanging if their clothing gets caught on projections on the inside of their cribs, or from wedging if they slip down between a mattress and a wall, or a mattress and a crib side.

*Childhood Deaths:

A wide variety of natural illnesses may cause death in child- hood that differ from the degenerative diseases of adult life such as coronary artery atherosclerosis. Children often suffer from infectious diseases, including many bacterial and viral conditions that are usually harmless; however, on occasion fulminant infection with death may occur. Children may also suffer from cancer, particularly leukemias (blood cancers), brain, bone, and endocrine cancers. Other conditions that may cause unexpected childhood deaths include coronary artery anomalies, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, cerebral palsy, spina bifida, seizure disorders, diabetes mellitus, cystic fibrosis, and sickle cell disease.

*Accidents:

The types of accidental deaths that occur in childhood tend to differ depending on the age range of the victims. For example, accidental asphyxial deaths tend to involve infants in their cribs, toddlers with various sorts of entanglements, and young adolescents via the choking game, whereas vehicle-related deaths are more commonly reported in older adolescents. Drowning deaths have two age peaks – in those under 3 or 4 years of age who are unable to extricate themselves from swimming pools when they have fallen in, or in older adolescents who may be impaired from intoxication. Infants are also vulnerable to drowning in bathtubs. Older children and adolescents may also die from participating in various risky behaviors such as recreational drug use.

*Suicide:

Suicides occur mainly in teenagers but have been reported in children as young as 9 years. Teenage suicides are uncommon compared to such deaths in those aged between 25 and 35 years and the methods used tend to differ from older individuals, with, for example, less deaths due to carbon monoxide inhalation. Adolescents may also undertake ‘‘copycat’’ suicides, resulting in clusters of cases. Use of social sites on the Internet to announce suicidal intentions or to facilitate suicide has also been documented in the young.

*Homicides:

Homicides in children can be divided into those occurring in the very young who are unable to defend themselves against larger and stronger assailants, and those occurring in older children who die of the same causes as adults. The younger children include the typical ‘‘battered child’’ and die from blunt injuries, suffocation, and starvation/neglect. They may also be drowned. As children get older, they are more likely to be killed by other means such as gunshot and stab wounds. These deaths may relate to various illegal activities, such as those involving the drug culture. At autopsy, the findings in childhood homicides may be minimal and quite subtle, or extremely obvious with evidence of multiple injuries and of severe and long-standing neglect and injury. A common cause of death in child abuse
deaths involves blunt head trauma, although deaths resulting from blunt abdominal trauma are not uncommon. A variety of classification schemes have been proposed for the various subtypes of child abuse deaths, one of which separates cases into the following subtypes (although they are not mutually exclusive) that are characterized by: a violent outburst, negligence/neglect, sadistic acts of punishment, factitious illness by proxy, unwanted child, unwanted pregnancy (neonaticide), spouse revenge, postpartum mental disorder, acute psychosis, altruism, euthanasia, sexual abuse, violent older child, drug or alcohol abuse, seizure disorder, and innocent bystander.
It must be stressed, however, that the finding of inflicted but not lethal injuries in an infant or child does not mean that a homicide has occurred, and that lethal injuries in a child do not automatically mean that they were intentionally inflicted. Head and/or brain and abdominal trauma are common underlying causes of death in these cases. At autopsy, it is important to look for evidence of repeated abuse with injuries of varying ages. In addition, certain types of injuries, including various types of bone fractures, should be considered highly suspicious for abusive trauma.

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Old 04-20-2016, 11:15 PM
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Re: The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhoo

I can handle seeing someone with their throat slashed open or someone's head smashed to bits underneath a semi truck.or even a bloated (my favorite btw) ..but this.. I can't handle this.

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Old 04-20-2016, 11:16 PM
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Re: The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhoo

I meant to say BLOATER. Damn autocorrect.

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Old 04-20-2016, 11:26 PM
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Re: The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhoo

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Originally Posted by thecuriousgeorge View Post
I meant to say BLOATER. Damn autocorrect.
Haha so i figured yeah they're favourites of mine also, floaty, stinky things they are

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Old 04-20-2016, 11:47 PM
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Re: The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhoo

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Haha so i figured yeah they're favourites of mine also, floaty, stinky things they are
I'm glad I'm not the only one :) I also wanted to say great post. Very informative nonetheless. I'm not a father and I don't have the resources to raise my own children(I still live at home with my parents, in my mid 20s) but I yearn to be one..the evil men do to children...shit, I will take them in and raise em. No need to kill them.

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Old 04-21-2016, 11:59 AM
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Re: The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhoo

That child with his head in the drawer and the poor soul starved to death are images that have stayed with me for ages.

One makes me really upset.

The other makes me feel livid

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Old 04-21-2016, 01:19 PM
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Re: The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhoo

I have this book. you could probably hit someone over the head with it and kill 'em. that summabitch is heavy!

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Old 04-21-2016, 05:55 PM
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Re: The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhoo

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Originally Posted by Sharon76 View Post
That child with his head in the drawer and the poor soul starved to death are images that have stayed with me for ages.

One makes me really upset.

The other makes me feel livid
Completely agree. Some of those were very difficult to see. The child abuse ones made me absolutely livid. Beyond words.

Very interesting post though. Thank you.

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Old 04-21-2016, 06:01 PM
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Re: The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhoo

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I have this book. you could probably hit someone over the head with it and kill 'em. that summabitch is heavy!
Yeah the .pdf is far more convenient, and cheaper!

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Old 04-21-2016, 06:10 PM
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Re: The Atlas of Forensic Pathology, Chapter 20: Deaths in Infancy and Childhoo

Love those books

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