11. Child death

Question 1

In children under 1 year, deaths are often collectively referred as …

Answer 1

sudden unexpected death in infancy (SUDI)

Question 2

examples of natural diseases leading to death in children 4

Answer 2

infection
congenital heart disease
tumours
epilepsy

Question 3

define SIDS

Answer 3

SIDS = sudden infant death syndrome is a sudden death of an infant, under 1 year of age which is unexpected by history and which remains unexplained after a full post mortem examination and investigations

i.e. cases of natural death in which no cause is found despite extensive investigations

Question 4

list characteristic features of SIDS (5)

Answer 4

1. most between 1-6 months (peak at 3 months)
2. M>F, most in winter
3. increased risk if premature and if parents smoke
4. often history of preceding minor upper respiratory tract infection
5. usually found dead in the morning - be suspicious of babies dying at other times of day

Question 5

list risk factors in SIDS (3)

Answer 5

1. prone sleeping, sleeping on front, incr risk by 9x
2. overheating, covering head
3. exposure to cigarette smoke during and after pregnancy

Question 6

cause of SIDS (2)

Answer 6

• the cause is probably a combination of vulnerable infants and external factors
• these probably result in disturbances in the cardiac and respiratory systems

Question 7

list two causes of asphyxia in infant/baby death

Answer 7

1. overlaying form co-sleeping (baby sleeps in parents bed)
2. deliberate smothering - placing smth over baby’s face to prevent them from breathing

Question 8

list examples of accidental trauma leading to death in child (3)

Answer 8

1. falls
2. road traffic accidents
3. crushing under heavy objects when playing

Question 9

list categories of homicide of child (3)

Answer 9

neonaticide
child abuse
older children

Question 10

describe situations where older children are killed (5)

Answer 10

• usually killed by a parent
• the motive is often to get at the other parent when a relationship breaks down
• it is not primarily to get rid of the child, although occasionally it is
• methods used could be smothering, strangling, stabbing, drowning, CO poisoning
• occasional pedophile killings

Question 11

describe neonaticide

Answer 11

• this is the killing of young infants (usually within 24h of birth)
• usually doe to a concealed pregnancy or a mother who did not know she was prgenant
• the mother is young, single, poorly educated
• motives may be: shame of being pregnant or perhaps an extra-marital pregnancy, poverty, fear of losing a job, mental illness
• baby is allowed to die from lack of care (feeding or not tying off the cord) or deliberately killed
• body hidden in a cupboard, in rubbish bin, waste ground

Question 12

what questions do we ask when examining the remains of a newborn infant? (4)

Answer 12

1. gestational age
2. born alive or stillborn
3. cause of death (inattention or deliberate killing)
4. who is the mother (may need medical help)

Question 13

what are 4 forms of abuse?

Answer 13

physical
sexual
neglect
psychological

Question 14

what is a definition of abuse

Answer 14

a child is considered to be abused if he or she is treated by an adult in a way that is unacceptable, in a given culture at a given time

this takes into account :

what is acceptable and normal behavior in one society is an abuse in another

what was acceptable and normal behaviour 100 years ago is not so today

Question 15

risk factors for children being abused, i.e. features which are commonly present in these cases: the child (4)

Answer 15

male, under 3
firstborn
racial minority
physical or mental handicap

Question 16

risk factors for children being abused, i.e. features which are commonly present in these cases: the family (5)

Answer 16

1. socially deprived
2. unemployed
3. young mother
4. living with new partner
5. little family support

Question 17

risk factors for children being abused, i.e. features which are commonly present in these cases: the offender (5)

Answer 17

1. male (but not always)
2. typically the new partner,i.e. not the biological father of the child
3. unemployed
4. alcohol or drug abuse
5. was abused himself as a child (risk x20 times)

Question 18

physical injuries inflicted on a child can be (according to repetion)

Answer 18

1. one-off incident (out of exasperation, perhaps genuine regret)
2. reptetitive abuse over period of time (variable motivs)

Question 19

External injuries seen in physical abuse and their cause (4)

Answer 19

1. bruising (gripping, slapping,punching, striking with object)
2. torn frenulum (tearing of the membrane on the inside of the upper lip - from punching or from an object forced against the mouth and gum)
3. biting
4. burning

Question 20

Fractures seen in physical abused and their cause (3)

Answer 20

1. skull (from impact against a solid surface)
2. ribs (from squeezing or direct blows)
3. long blows (from twisting, pulling or direct blows; most often at the growing ends i.e. metaphysis/epiphysis)

Question 21

Internal injuries due to physical abuse and their cause

Answer 21

head injury: skull fracture, subdural hemorrhage, brain damage, retinal hemorrhage (from the head being struck against a solid surface, from a direct blow from a heavy object, from shaking)

abdominal injury - tears in mesentery, tears in liver (from blow to the abdomen by a punch, knee or stamp

Question 22

What 3 things is shaken baby syndrome made of?

Answer 22

also known as inflicted head trauma

1. subdural hemorrhage
2. retinal hemorrhage
3. microscopic brain damage (Encephalopathy)

Question 23

what are some characteristic features of the behavior of parents in cases of physical child abuse?

Answer 23

1. they claim the injury was an accident (fell from their arms, from chair, walked into the door)
2. there is a delay in seeking medical help (sometimes several hours)
3. their account of the accident (vague and lacks details, often changes with re-telling, does not match the medical findings)

Question 24

what is Munchausen syndrome by proxy

Answer 24

a parent making up symptoms or signs in child so that he/she is forced to undergo unnecessary and unpleasant medical investigations