Paediatric forensic medicine Flashcards
Act concerning birth etc
Births and Deaths registration act No 51. of 1992
Define a major
- any person who has attained the age of 21 years or who has been declared to be a major (under 21 who is legally married)
Define birth
the birth of a child born alive
Define corpse
Any dead human body, including the body of any still-born child
Define still-born
Has had at least 26 weeks of intra-uteirne existence but showed no sign of life after complete birth
How does the criminal procedure act relate to children and birth?
Can be charged with murder or culpable homicide if a child that has breathed, was exposed, the birth concealed or if the body was disposed in order to conceal the fact of its birth
Define infanticide
The intentional killing of a newly-born child
Things that are important at autopsy in cases of infanticide
- whether the infant reached 26 weeks
- whether it breathed
- how long it lived
- cause of death
- if stillborn, why?
- how long had it been dead when found
- identity of child and mother
How to estimate gestational age according to body length
Use the square root (up to 25cm)
if more than 25, divide by 5
When do ossification centres close?
- calcaneum 5 months
- talus 7 months
- distal epiphysis of femur 9 months
How to identify lungs that have breathed
- mottled with round edges
- fill pleural cavity and overlap heart
- crepitate on palpation
- hydrostatic test
Typical parents involved in child abuse
- early twenties
- removed from family ties
- father often not biologic with criminal tendencies
- one parent battered as a child
- lack of remorse
Statory obligations for reporting of abused or neglected children
- any person who suspects must report and substantiate their report
- professionals are obliged to report
In terms of Children’s Act, a child in need of care and protection is identified as the following:
- abandoned or orphaned child without support
- displays behaviour that cannot be controlled by parent
- lives and works on the streets or begs for a living
- addicted to a dependence producing substance
- has been or currently exploited
- lives in or exposed to circumstances that may harm physical, mental or social well-being
- state of physical or mental neglect
- being abused, maltreated, neglected or degraded
Tell-tale signs of battered child at autopsy
- small tears at ear lobe, alae of the nose, frenulum of the upper lip
- cigarette burns
- bruises, lacerations and abrasions of varying ages
- evidence of fractures of bones and long bones
Possible causes of SUDI
- natural (obvious/obscure)
- non-natural (non-accidental/accidental)
- totally unexplained
Definition of SIDS
- the sudden death of an infant under 1 year that is unexplained after a thorough case investigation including performance of a complete autopsy, death scene exam and review of clinical history
Pathogenesis of SIDS
- vulnerable infant
- critical developmental period
- exogenous stressor
How can the umbilical cord be used to determine when a newborn died?
- dessication 24hrs
- inflammation 40hrs
- ulceration 60hrs
- separation 6-9 days
Possible causes of death in stillborn children
- placental
- maternal
- fetal
Peak incidence of SIDS
2-4 months
Babies more at risk of SIDS
- male
- twin
- low birth weight
- premature
- disadvantaged
- maternal and paternal smoking
Autopsy findings in SIDS
- froth at lips and nostrils
- normal external exam
- petechial haemorrhages in visceral pleura and epicardium
- moderate pulmonary oedema
Highly suspicious fractures for child abuse
- metaphyseal fractures
- posterior rib
- scapular
- spinous process
- sternal
