Child AbuseThe Forensic Investigation ppt

Injuries in Child Abuse• Blunt injuries to any body surface most common injury.. • Head injury most common fatal injury.. Non-accidental Head Injuries• Formerly known as “Shaken Baby Syn

Child Abuse The Forensic Investigation

Michael Ward, MDChief Medical ExaminerGreenville, South Carolina

Child Abuse

• The physical, sexual, or mental injury,

exploitation or negligent treatment of a

child under the age of 18 years, by a person responsible for the child’s welfare

• Six patterns of abuse

Child Abuse

• In the United States, 1 – 2% of children reported to be abused

• Incidence is 700 to 1,200 per million

• 2,000 – 4,000 deaths per year

• Age-range:

– One-third less than one year.

– One-third 1 – 6 years

– One-third 6 – 18 years

Child Abuse

• The Abuser

– Parents (father more often than mother) – Other caregivers (boyfriends, babysitters) – Physically or emotionally exhausted

– Alcohol or other drugs often involved

Injuries in Child Abuse

• Blunt injuries to any body surface most

common injury

• Head injury most common fatal injury

• Blunt trauma to abdomen also common

• Skeletal injuries, burns, drownings are also seen

General characteristics of child

abuse

• Injury unexplained by the history given

• Delay in seeking care

• Changing, evolving, or inconsistent history

• Inappropriate affect of caregivers

• “Trigger event” precipitating loss of control

Non-accidental Head Injuries

• Formerly known as “Shaken Baby

Syndrome”

• Common findings include:

– Subdural hemorrhage

– Retinal hemorrhage

– Diffuse axonal injury

– May or may not have external injuries

Non-accidental Head Injuries

• The term Shaken Baby Syndrome has lost

popularity in the United States and Great Britain Many investigators disagree on the biomechanics

of shaking infants, and many feel these injuries do not happen in this way For this reason, many

forensic pathologists have dropped the diagnosis

of Shaken Baby Syndrome for the more general

Subdural Hemorrhages

• Results from tearing of bridging veins

extending from arachnoid to dura

• Hemorrhages are generally small and are markers of trauma

• Not a space occupying hemorrhage

• May be exceptionally small, or associated with focal sub-arachnoid hemorrhage

Subdural hemorrhage

Head injuries may or may not be present

Differential Diagnosis of

Retinal Hemorrhage

• Birth Trauma-seen in 1/3 of vaginally

delivered babies, resolve quickly (weeks)

• Increased intracranial

pressure-arterio-venous mismatch

• Shaken baby syndrome

• Head trauma-Tearson syndrome, severe

head injuries, acceleration-deceleration injuries

Differential Diagnosis of

Retinal Hemorrhage

• Sepsis

• Coagulopathy

• Subacute bacterial endocarditis

• Sickle cell disease

• Acute leukemias

Subdural hemorrhage

Subdural hemorrhage: Cross sections of optic nerves

Subdural hemorrhage, optic nerve

Diffuse Axonal Injury

• Result from shear-force type injuries to the brain.

• May be associated with cerebral white matter

tears, often seen at gray-white junction

• Disruption of neuronal axons with formation of axonal “retraction balls”, best seen with silver impregnation or immunohistochemical stains.

Child abuse

• Head injuries are the most common cause

of death

• Other injuries include:

– Blunt trauma to abdomen

Child abuse

• Head injuries are the most common cause

of death

• Other injuries include:

– Blunt trauma to abdomen

– Skeletal injuries

Child abuse

• Head injuries are the most common cause

of death

• Other injuries include:

– Blunt trauma to abdomen

– Skeletal injuries

– Thermal burns

Child abuse

• Head injuries are the most common cause

of death

• Other injuries include:

– Blunt trauma to abdomen

– Skeletal injuries

– Thermal burns

– Sexual abuse

Child abuse

• Head injuries are the most common cause

of death

• Other injuries include:

– Blunt trauma to abdomen

– Skeletal injuries

– Thermal burns

– Sexual abuse

– Neglect

Children are our most precious resource, we

must strive to protect them!