2nd Edition

Paediatric Forensic Medicine and Pathology

By Anthony Busuttil, Jean Keeling Copyright 2008
    522 Pages 211 Color & 100 B/W Illustrations
    by CRC Press

    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.

    List of abbreviations used

    Clinical assessment in suspected child abuse Helen Hammond
    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
    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

    Investigation of suspected sexual abuse Jacqueline YQ Mok
    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

    Radiology of child abuse Maeve McPhillips
    Role of the radiologist
    Radiological investigations
    Skeletal injuries
    Head injury
    Visceral injuries
    Soft-tissue injury
    Differential diagnosis

    Haematological abnormalities that can simulate abuse Angela Thomas
    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

    Biochemical investigations on post-mortem specimens Denis R Benjamin
    General evaluation
    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

    Ocular involvement in non-accidental injury Harry Willshaw
    Scope of ocular and adnexal injury
    Fundus haemorrhages

    The death scene following the sudden death of a child
    Anthony Busuttil
    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
    Abandoned neonates
    Deaths from trauma
    Dyadic and multiple deaths
    Sudden deaths of older children
    Sensitivity and stress of the investigation
    Inquests and inquiries

    Post-mortem examination in babies and children Jean W Keeling
    Death scene investigation
    Rectal temperature
    Medical and family history
    Other important information
    Radiological examination
    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

    Pathology of neurological abnormality in early life Waney Squier
    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

    Fetal and perinatal death Jean W Keeling
    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?

    Sudden unexpected death in infancy: sudden infant death syndrome or something else?
    Jean W Keeling
    The definition of SIDS
    Sleeping environment
    Pathological findings in SUDI
    Death certification

    Sudden natural death in infants and children Dick Variend
    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

    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

    Head and neck injuries Robert A Minns and TY Milly Lo
    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

    Heat-induced injury or death
    Anthony Busuttil
    House fire deaths
    The pathologist’s role

    Asphyxial deaths in children Anthony Busuttil
    Scene of death
    Traumatic asphyxia in children
    Entrapment asphyxia
    Foreign body inhalation
    Plastic bag asphyxia
    Overlaying and wedging
    Hanging by a ligature
    Drowning and near drowning
    Imposed airways obstruction
    Abuse of inhalants (solvent abuse)
    Reverse suspension
    Chemical asphyxia

    Accidental injuries in children Anthony Busuttil
    Overview of paediatric trauma
    Bicycle helmets
    Playground injuries
    Sports injuries on snow and ice
    Riding injuries
    Agricultural injuries
    Older children and substance abuse
    Accidental poisoning

    Drowning and near drowning John Pearn
    The causes of childhood drowning: a perspective
    The drowning medium
    The pathophysiology of drowning
    Forensic immersion syndromes

    Sudden death of children in hospital Jem Berry
    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
    Filicide and homicide in hospital
    Investigation of sudden unexpected death of children in hospital

    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

    Forensic DNA profiling in cases involving children Alex M Graham and David J Harrison
    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

    The dentist’s role in child abuse and neglect David Whittaker
    Dental neglect
    Facial and oral pathology
    The dentist accused of child abuse
    Bite marks

    Paediatric dental identification G Howard Moody
    Facial reconstruction and dental profiling
    Age estimation

    The expert witness and expert testimony Anthony Busuttil
    Mission statement of the expert
    Claim to expertise
    Professional witnesses
    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
    Recent developments
    Appendix A: Child protection examination forms
    Appendix B: Tables of standard measurements


    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