Infant injury deaths with unknown intent: what else do we know?
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OBJECTIVES: Strong evidence based on case record reviews indicates that the incidence of child homicide reported from death certificates is under ascertained. The characteristics of infant injury fatalities with undetermined, but suspicious, intent were compared for the probability that they should be considered homicides. METHODS: Using linked birth and death certificates for all birth cohorts in the US from 1983-91, 2345 injury fatalities reported as intentional, 7594 as unintentional, and 431 as undetermined intent were identified. Maternal and infant variables potentially predictive of injury fatalities were selected based on increased bivariate associations. Relative risks of injury death by intentional, unintentional, and undetermined intent were assessed for maternal and infant characteristics. RESULTS: Relative risks were consistently higher across all intent categories for infants of mothers with the least education, no prenatal care, young maternal age, and single marital status, as well as for infants who are second or later born, preterm, black, or American Indian. Fatalities with undetermined intent have larger relative risks in the highest risk categories than either intentional or unintentional injuries. Deaths with undetermined intent have risk profiles that more closely resemble profiles for intentional deaths than unintentional. CONCLUSIONS: Injury homicide rates would be almost 20% greater than official classifications indicate if deaths with undetermined intent were included. In analyses of infant homicide, excluding deaths of undetermined intent may lead to an underestimation of the magnitude of the public health problem of intentional injuries among infants. Other studies based on record reviews from multiple sources indicate that misclassification and under ascertainment of homicides may be even greater. (+info)
Step-parents and infanticide: new data contradict evolutionary predictions.
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Evolutionary psychologists have hypothesized, inspired by evolutionary biology, that parents should care less for children with whom they are not genetically related since these young do not contribute to the genetic fitness of the parents. Based on this, evolutionary psychologists have predicted that there will be an overrepresentation of step-parents as offenders in family-related killings of children. Data on child homicide, particularly from Canada, have supported this prediction in that the frequency of children killed was relatively high in families where one of the two parents was a step-parent. Here we present a survey of all child homicide that occurred in Sweden between 1975 and 1995. In contrast to the Canadian data, children in Sweden living in families with a step-parent were not at an increased risk compared with children living together with two parents to whom they were genetically related. In addition, there were no other indications that step-parents are overrepresented as offenders. (+info)
Nasal and intrapulmonary haemorrhage in sudden infant death syndrome.
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BACKGROUND: Fresh intrapulmonary and oronasal haemorrhages in cases of sudden infant death syndrome (SIDS) might be markers for accidental or intentional smothering inappropriately diagnosed as SIDS. AIM: To compare the incidence, epidemiological association, and inter-relation of nasal haemorrhage, intrapulmonary haemorrhage, and intrathoracic petechiae in infant deaths certified as SIDS. METHODS: In SIDS cases from a large nationwide case-control study, a wide range of variables were compared in cases with and without reported nasal haemorrhage and, in a subgroup of cases, in those with and without pathologically significant intrapulmonary haemorrhage. RESULTS: Nasal haemorrhage was reported in 60 of 385 cases (15%) whose parents were interviewed. Pathologically significant intra-alveolar pulmonary haemorrhage was found in 47% of 115 cases studied, but was severe in only 7%. Infants with nasal haemorrhage had more haemorrhage into alveoli and air passages than age matched cases without nasal haemorrhage. In multivariate analysis, nasal haemorrhage was associated with younger infant age, bed sharing, and the infant being placed non-prone to sleep. Intrapulmonary haemorrhage was associated with the same three factors in univariate analysis, but in multivariate analysis only younger infant age remained statistically significant. There was no significant association between nasal or intra-alveolar haemorrhages and intrathoracic petechiae. CONCLUSIONS: Nasal and intrapulmonary haemorrhages have common associations not shared with intrathoracic petechiae. Smothering is a possible common factor, although is unlikely to be the cause in most cases presenting as SIDS. (+info)
Unfinished feticide: the ethical problems.
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Dr. Jansen's paper raises three main issues. The one with which he himself is most concerned is the question of which methods of abortion are ethically right, and whether methods which risk the birth of a damaged baby are wrong. But there are two others: first, how the (originally unintended) birth of a live but damaged child alters the moral situation, and secondly, whether the overcoming of sterility by inducing a multiple pregnancy in which some of the fetuses have to be killed in order for any of them to survive is at all morally acceptable. (+info)
Murder misdiagnosed as SIDS: a perpetrator's perspective.
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AIMS: Child murder misdiagnosed as sudden infant death syndrome (SIDS) is a difficult area to study. We present a perpetrator's descriptions to enrich clinicians' knowledge of possible presenting features of this phenomenon. METHODS: Interview material was collected as part of a qualitative study of maternal filicide performed from a naturalistic paradigm in order to access the perpetrators' view of events. The woman participant has been convicted for three child murders and two attempted murders which were initially misdiagnosed as SIDS. Interviews were done in the participant's home with her partner present, while she was on leave from prison. Semi-structured interviews were conducted, recorded, transcribed, and analysed for themes. Specific ethical permission was gained to present this case in isolation and the paper was written in consultation with the woman described. RESULTS: She described initial intense attachment to her first victim and described killing her because she was unable to bear her apnoea attacks and her fear of losing her. She described difficulty grieving for this child and subsequent failure to attach to her next child or feel for the other victims. CONCLUSIONS: Expressions of intense attachment to an infant and description of intense grief over a death in a way which engages compassion should not deter a paediatrician from considering the possibility of the parent having killed the child. (+info)
Winner of the young physician's section of the Gowers' prize 2000. Too good to be true? Thomas Willis--neonatal convulsions, childhood stroke and infanticide in seventeenth century England.
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A case of neonatal convulsion reported by Thomas Willis (1621-1675) together with its post mortem findings is quoted as being congenital intracerebral haemorrhage or strongly suggested as being the earliest pathological description of childhood cerebrovascular disease. However these authors only reviewed the incomplete written record left by Willis, describing how this case was the fourth consecutive child that the mother had lost to neonatal convulsions. The medical record is completed by notes taken by John Locke from a lecture delivered by Willis 3 or 4 years before the case was first published. Here, Locke relates how the mother subsequently had three further children who were all treated by Willis soon after birth and all survived uneventfully. Reviewing the post mortem findings and the full case histories modern medical science gives a different interpretation. Instead, I suggest that the case history given and pathological features described are more in keeping with a whiplash shaking injury than with cerebrovascular disease or a stroke. I believe that this is the earliest pathological description of shaking injury in childhood. We can never know why Willis did not publish the full success of his management of the subsequent children but it may have been due to his dramatic experience of a similar mother early on in his medical career. (+info)
Fear of pregnancy and childbirth.
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Pregnancy is a major life event for all women. However, when a psychiatric disorder is added to or exacerbated by the pregnancy then the problem requires expert knowledge from more than one area of medicine. This paper looks at pregnancy and the relationship with depression, eating disorders, and pathological fear of childbirth or tokophobia. It also examines the outcome for these women and their babies. Mental illness is a serious concern. It is now recognised that death from suicide is the leading cause of maternal death overall. Research in these areas is relatively sparse but an attempt is made to collate what is known. (+info)
FORENSIC MEDICINE: AN AID TO CRIMINAL INVESTIGATION.
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Forensic medicine is medicine as applied to the problems of the law. The origins of both are hidden in the mists of antiquity, dating from the beginnings of family and tribal life. Recorded human history goes back for 6000 years. Sumeria, Babylon and Egypt all contributed to the development of forensic medicine. Imhotep was probably the first real medicolegal expert. Hippocrates, the Greek physician, and Galen, the Roman, made considerable contributions. Little advance was made during the millenium of the Dark Ages. But Renaissance medicine gave this branch of medicine an impetus in the seventeenth, eighteenth and nineteenth centuries, and in the twentieth, interest in forensic medicine is worldwide. The physician, the coroner, the pathologist, the medical specialist and the forensic laboratory contribute to the investigation of crimes against the person, and to the solution of such problems as identification, untoward deaths, apparent drowning and many others. (+info)