2nd Edition
Paediatric Forensic Medicine and Pathology
Child abuse and suspicious child deaths are very complicated matters for clinicians, pathologists, law enforcement officials and legal professionals to investigate. Meanwhile, the evidence base for forensic pathology, especially in paediatrics, is steadily growing. In Paediatric Forensic Medicine and Pathology, two internationally acclaimed editors have brought together a first class author team who provide an up-to-date, comprehensive, and thorough review of the contemporary problems encountered in practice today. Individual chapters explore the emerging role of imaging in the diagnosis of non-accidental injury and compare recent evidence contrasting sudden infant death and SIDS; the head and neck injury chapter carefully explores the 'shaken baby syndrome' and similar patterns of injury that have recently gained widespread media attention. Special emphasis is given to interview and assessment procedures, and useful clinical forms are included throughout the book. Whether in a clinical, laboratory, or legal setting, readers dealing with forensic inquiries or who are in preparation for court will find the comprehensive background and evidence base necessary to support their investigations. Paediatric Forensic Medicine and Pathology is an invaluable resource for forensic pathologists, paediatric pathologists, and paediatricians, as well as all practitioners in the judicial and legal, criminal investigation and social services systems that have to deal with such cases.
Contributors
Preface
Acknowledgements
List of abbreviations used
Clinical assessment in suspected child abuse Helen Hammond
Introduction
Alerting signs
Types of abuse
The need for comprehensive assessment
Significant harm
The interagency context (flow chart of process)
Joint working and the complementary skills of paediatricians and forensic specialists
Legislation
Consent and confidentiality
The process – joint paediatric/forensic examination
Documentation and report writing
Interpretation of the findings
Formulating an opinion
Ongoing health care
Involvement in ongoing legal and child-care processes
References
Investigation of suspected sexual abuse Jacqueline YQ Mok
Introduction
The colposcope in the medical examination
Forensic evidence
Skills and experience required
Consistent vocabulary
Normal female genital anatomy
Perianal findings
Acute, healing and healed anogenital trauma
Female genital findings in sexual abuse
Signs of anal abuse
Conditions that mimic abuse
Screening for sexually transmitted infections
Interpretation of clinical and laboratory findings
Summary
References
Radiology of child abuse Maeve McPhillips
Role of the radiologist
Radiological investigations
Skeletal injuries
Head injury
Visceral injuries
Soft-tissue injury
Differential diagnosis
Conclusion
References
Haematological abnormalities that can simulate abuse Angela Thomas
Introduction
Primary haemostasis
Secondary haemostasis
Laboratory tests
Measurements of primary haemostasis
Evaluation of a bleeding patient
Patterns of abnormal results
Normal coagulation screen with a normal platelet count
Abnormalities of platelet number or morphology
Coagulation defects
The neonate
Drugs associated with bleeding
Bone marrow failure syndromes
Systemic disease associated with a bleeding tendency
Activation of coagulation
Conclusion
References
Biochemical investigations on post-mortem specimens Denis R Benjamin
Introduction
General evaluation
Hypoxia
Inflammation
Anaphylaxis
Infection
Dehydration and electrolytes
Time of death (post-mortem interval)
Endocrine disorders
Genetic metabolic disorders presenting as sudden unexpected death
Technical considerations at the time of autopsy
References
Ocular involvement in non-accidental injury Harry Willshaw
Introduction
Scope of ocular and adnexal injury
Fundus haemorrhages
References
The death scene following the sudden death of a child Anthony Busuttil
Introduction
Scene management
The crime scene manager
Sequence of events at the death scene
Unclothing the body
A good look around
Sudden infant death syndrome or non-sudden infant death syndrome
External petechiae
Bruising
Abandoned neonates
Deaths from trauma
Dyadic and multiple deaths
Sudden deaths of older children
Sensitivity and stress of the investigation
Inquests and inquiries
References
Post-mortem examination in babies and children Jean W Keeling
Introduction
Death scene investigation
Rectal temperature
Medical and family history
Other important information
Radiological examination
Photography
Microbiological samples
Toxicological investigations
Biochemical and metabolic investigations
Weights and measurements
External examination
Estimating blood loss
Dissection (infants and older children)
Examination of the brain, spinal cord and eye
Examination of the newly born
Histological samples
Retention of organs
Exchange of information and multidisciplinary review
References
Pathology of neurological abnormality in early life Waney Squier
Introduction
Clinical manifestations of early brain damage: cerebral palsy
Timing of injuries by histology
Acquired intra-uterine damage
Birth-related injury
Stroke in the developing brain
Metabolic disorders
Infections
References
Fetal and perinatal death Jean W Keeling
Introduction
Definitions
The law
Background information
Concealed pregnancy
Unattended delivery
Was the baby born alive?
Is the baby of sufficient maturity to survive?
Is there evidence of prolonged or difficult labour?
Are there any significant injuries?
Fetal death following maternal injury
Is there a natural cause for death?
Can I give a cause of death?
Should the intrapartum still birth be a medicolegal autopsy?
References
Sudden unexpected death in infancy: sudden infant death syndrome or something else? Jean W Keeling
Introduction
The definition of SIDS
Epidemiology
Sleeping environment
Pathological findings in SUDI
Death certification
References
Sudden natural death in infants and children Dick Variend
Introduction
Cardiovascular causes of sudden death
X-linked hypohidrotic (anhidrotic) ectodermal dysplasia
Intracranial haemorrhage, neoplasms and malformations
Gastrointestinal causes
Fatal anaphylaxis
Sickle cell disease
Haemorrhage as a cause of sudden death
Respiratory causes of sudden death
Epilepsy and sudden death
Deaths from acute asthma
Diabetes mellitus
Genetic metabolic disorders
Other bacterial infections
Deaths related to obstetric events and premature birth
Miscellaneous causes of sudden natural death
Sudden unexplained death in older children
Sudden natural death in the early neonatal period
Sudden death associated with ‘intermediate’ pathology
References
Recent advances in paediatric toxicology Patrice Mangin and Christian Giroud
Scope of the problem
Specificity of paediatric toxicology
Techniques used in drug testing
Special techniques for analysis of volatile substances
Alternative specimens for drug testing
Pitfalls and limitations of drug screens
Specific applications
The importance of paediatric toxicology in specific cases
Conclusions and future considerations in forensic paediatric toxicology
References
Head and neck injuries Robert A Minns and TY Milly Lo
Definition
Epidemiology
Non-accidental head injury
Traumatic birth injury
Primary mechanisms of injury to the brain
Secondary mechanisms of brain injury
Injury to the cervical spinal cord
Genetic influence on recovery from traumatic brain injury
References
Heat-induced injury or death Anthony Busuttil
Introduction
House fire deaths
The pathologist’s role
References
Asphyxial deaths in children Anthony Busuttil
Petechiae
Scene of death
Traumatic asphyxia in children
Entrapment asphyxia
Foreign body inhalation
Plastic bag asphyxia
Overlaying and wedging
Strangulation
Hanging by a ligature
Drowning and near drowning
Imposed airways obstruction
Abuse of inhalants (solvent abuse)
Reverse suspension
Chemical asphyxia
Prevention
References
Accidental injuries in children Anthony Busuttil
Overview of paediatric trauma
Bicycle helmets
Falls
Playground injuries
Sports injuries on snow and ice
Riding injuries
Agricultural injuries
Prevention
Older children and substance abuse
Accidental poisoning
Hypersensitivity
References
Drowning and near drowning John Pearn
Introduction
The causes of childhood drowning: a perspective
The drowning medium
The pathophysiology of drowning
Forensic immersion syndromes
References
Sudden death of children in hospital Jem Berry
Introduction
Definition and frequency
Deaths due to natural disease
Deaths due to failure to monitor
Therapeutic misadventures
Deaths due to drug treatment
Deaths due to medical devices and procedures
Deaths in the dental chair
Sudden death in newborn babies
Accidents
Suicide
Filicide and homicide in hospital
Investigation of sudden unexpected death of children in hospital
References
Road traffic accidents in children Anthony Busuttil
Road traffic fatalities
Investigation of a fatal road traffic collision
Vehicular collisions
Other supervening problems in collisions
Pedestrian injuries
Child cyclists
Diffuse axonal injury
Whiplash injuries
Injuries to children in utero
Other vehicular accidents
References
Forensic DNA profiling in cases involving children Alex M Graham and David J Harrison
Introduction
Inheritance of genetic material
Forensic DNA analysis: history and techniques
Sample collection and processing
DNA evidence and child sexual offence
Y chromosome short tandem repeat typing
Mixed samples
Additional sample problems and solutions
Mitochondrial DNA
Paternity testing
Identification of body remains and missing persons
Identification of the ‘abandoned baby’ or fetal material and avenues for identifying the source of an unknown profile
DNA databases
References
The dentist’s role in child abuse and neglect David Whittaker
Introduction
Dental neglect
Facial and oral pathology
The dentist accused of child abuse
Bite marks
References
Paediatric dental identification G Howard Moody
Introduction
Comparison
Facial reconstruction and dental profiling
Age estimation
References
The expert witness and expert testimony Anthony Busuttil
Introduction
Mission statement of the expert
Claim to expertise
Professional witnesses
Opinions
Yes or no?
Admissibility of expert evidence
Communications from the expert witness
Declaration by the expert in the report
In the witness stand or box
Pre-trial communication
Conflict of interest
Rules of evidence
Conclusion
Recent developments
References
Appendix A: Child protection examination forms
Appendix B: Tables of standard measurements
Index
Biography
Anthony Busuttil is Emeritus Regius Professor of Forensic Medicine at the University of Edinburgh, and Medical Director, Forensic Medical Services, NHS Lothian, Edinburgh, UK
Jean W Keeling was formerly Consultant Paediatric Pathologist at the Royal Hospital for Sick Children, Edinburgh, UK
"a concise compendium on this fascinating sub-specialty of forensic pathology ... clearly written and lavishly illustrated"
Richard Jones, www.forensicmed.co.uk, 2009"This up-to-date book covers all aspects of investigating pediatric forensic cases, including assessment of injuries, postmortem examination, clinical testing, and investigation in a medicolegal setting. This is an excellent book that will be a valuable resource for medical or legal practitioners investigating cases in this complex field. 5 Stars!"
Katie Dennis, MD, Doody's Review Service, 2009"(This) is a well-written book in a clear format with well-chosen references ... I would expect this book to be enthusiastically received by its intended readership of medical and legal practitioners dealing with inflicted injury in childhood."
Professor R Anthony Risdon, The Bulletin of the Royal College of Pathologists