NCJ Number
203132
Journal
Journal of Forensic Sciences Volume: 48 Issue: 5 Dated: September 2003 Pages: 1148-1152
Date Published
September 2003
Length
5 pages
Annotation
This case study of the apparent inflicted compressional asphyxia of a small child reviews mechanisms and related controversy.
Abstract
A 2-year-old female toddler, weighing 13.5 kg, was found nonresponsive by employees of the licensed daycare center she attended, after having been put down for a nap several hours earlier. Because she had resisted lying down voluntarily during the nap period, she was taken into a hallway away from the other children, laid down on a soft rubber mat, and restrained by an adult until she appeared to have fallen asleep. Restraint was applied by the adult resting her legs across the prone child's back for an estimated 30-40 minutes. The adult weighed approximately 60 kg and had an orthopedic cast on one leg. The cast was determined to weigh 0.7 kg. The child was subsequently transported to a local hospital emergency department, where resuscitation efforts were unsuccessful. The coroner and police were notified and an autopsy authorized. The cause and manner of death were both initially listed as undetermined. Studies have supported the hypothesis that the prone-restrained or hog-tie position can contribute to a form of positional or restraint asphyxia. At the same time, debate regarding position or restraint as the sole cause of deaths in such instances have been published. These reports suggest that a constellation of other factors, including catecholamine release, may contribute to a physiologic disturbance that results in a fatal outcome. Autopsies on deaths following this scenario are usually unremarkable, which has not resolved the controversy. Death by overlaying and smothering of children is also a well-recognized scenario, which may result in no discrete anatomic findings at autopsy. The application of weight resting on the chest of a much smaller child may limit the child's thoracic excursion so that respiratory exchange is either hampered or completely prevented. In the case at issue, the thoracic compression applied to the prone child for an extended time period, combined with the child's struggle related to increased oxygen consumption, was sufficient to cause death from asphyxia. The mechanism of gradual application has been reported to demonstrate petechiae in the upper body in only a portion of well-documented compressional deaths. Mechanical or compressional asphyxiation deaths in children are often associated with minimal or no demonstrable injuries either internally or externally. 3 figures and 17 references