Autopsy & forensics
Types of injuries
Pediatric deaths and child abuse
Author: Lindsey Harle, M.D.
Last author update: 1 July 2012
Last staff update: 12 February 2024 (update in progress)
Copyright: 2012-2024, PathologyOutlines.com, Inc.
PubMed Search: Pediatric death forensic
Cite this page: Harle L. Pediatric deaths and child abuse. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/forensicspediatricdeaths.html. Accessed April 23rd, 2024.
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
