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Pathology of Fatal Child Abuse and Neglect (From The Battered Child, P 247-285, 1987, Ray E Helfer and Ruth S Kempe, eds. -- See NCJ-111195)

NCJ Number
R E Zumwalt; C S Hirsch
Date Published
39 pages
Beginning with a discussion of types of child physical abuse, emphasizing the distinction between deaths of typical battered babies and those fatalities resulting from a single episode, this paper then covers homicide by starvation and subtle modalities of injury and neglect, followed by consideration of false accusations of child abuse and technical aspects of the autopsy protocol and guidelines for postmortem examinations.
The battered baby syndrome in infant fatalities refers only to those infants and children who have been victims of multiple repeated abuse. Approximately 15-20 percent of child abuse fatalities meet the criteria for the battered baby syndrome. This paper describes signs of this syndrome. Fatalities from an isolated or single beating are as common as fatalities from repeated physical assault, and these fatalities present unique problems for the pathologist and child abuse investigators. Guidelines for diagnosing nonaccidental fatalities in children focus on head injuries, thoracic and abdominal injuries, sexual abuse, soft tissue injuries, and stress cardiomyopathy. After discussing homicide by starvation, subtle fatal abuse, and the use of physical and chemical agents to inflict child abuse, the Munchausen syndrome by proxy is discussed. This occurs when a parent falsifies a child's medical history or alters a child's laboratory test or causes an illness or injury in a child to gain medical attention that may result in innumerable harmful hospital procedures. 55 references.