Forensic pathology
Types of injuries
Pediatric Deaths

Author: Lindsey Harle, M.D. (see Authors page)

Revised: 12 January 2017, last major update July 2012

Copyright: (c) 2012-2017, PathologyOutlines.com, Inc.

PubMed search: pediatric death forensic

Cite this page: Pediatric Deaths. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/forensicspediatricdeaths.html. Accessed March 27th, 2017.
Sudden Unexplained Infant Death (SUID)
  • Term currently favored by many forensic pathologists / pediatricians to replace Sudden Infant Death Syndrome (SIDS)
  • Defined as sudden, unexpected death of an otherwise healthy infant, less than 1 year of age, in which scene investigation, clinical history and complete postmortem evaluation fail to determine a cause of death
  • Diagnosis of exclusion, and likely represents a group of as yet unidentifiable natural causes of sudden death (i.e. congenital cardiac arrhythmia, occult infection, etc)
  • Risk factors: prematurity, male gender, poor socioeconomic status, colder climate, maternal smoking or illicit drug, young maternal age (less than 20 years old)
  • Death usually occurs during sleep
  • No specific autopsy findings; may see thymic / pleural / epicardial petechiae, pulmonary congestion, sparse pulmonary inflammation
  • Natural causes of death that may at first appear to be SUID: myocarditis, respiratory infection, cardiac channelopathies, meningitis, gastroenteritis, inborn errors of metabolism
  • Accidental causes of death that may at first appear to be SUID: asphyxia (overlay in shared bed or poor bedding material), poisoning
Homicide of infants and children
  • Neonaticide: the deliberate killing of an infant
    • Mother is most common perpetrator
    • Usually death via asphyxia (e.g. smothering) or environmental exposure (due to abandonment)
    • With newborns, mother may claim child was stillborn; air in lungs indicates child was breathing prior to death
      • Hydrostatic test: lungs are placed in a container of water; if they float, they are presumably filled with air, suggesting the child was breathing prior to death
      • False positive hydrostatic test with attempted resuscitation or decomposition; false negatives can also occur
  • Child homicide
    • In first year of life, most homicidal deaths are due to head trauma
    • In second year of life, head trauma and abdominal trauma are both common
    • Battered child syndrome: multiple bruises, abrasions and boney fractures of various ages; this category also included neglected children suffering from malnutrition
    • Other causes of death include thermal injury due to scalding, smothering (autopsy usually negative)
    • Shaken baby syndrome: controversial cause of death due to violent shaking of infant with subdural or subarachnoid hemorrhage and retinal hemorrhages
      • Many believe shaking alone cannot produce significant injuries and death, and most of these infants actually suffered from blunt force trauma