Forensic Paediatrics chapter of forensic medicine

Forensic medicine

1. Dr. Siraj Nabi
Forensic
Paediatrics

2. Infanticide
Child abuse
Offences’ against children
1
2

3. LEARNING OBJECTIVES
►Define Infanticide & Infanticide Act
►Enlist Motives involving Infanticide
►Interpret Medico-legal Issues
►Classify Causes of Infanticide
►Tabulate Post-Mortem Findings

4. Definition
Infanticide means the
unlawful destruction of a
newly born child under
age of 1 year.

5. Infanticide act
►Where a woman by any wilful act of omission
or commission causes the death of her child
being under the age of 12 months, at the
time balance of her mind was disturbed
by the effect of child birth or lactation
she may be dealt with as if she had committed
manslaughter.
Punishment
Fine/Imprisonment

6. ►To get rid of an illegitimate child
►Sex discriminations
►Socio - economical conditions

7. 1. Was the child Still-birth or Dead-Birth?
2. Was the child mature or immature?
3. Was the child born alive? If so whether it had
breathed
4. If born alive, how long did the child survive.
5. What was the cause of death?
MEDICO-LEGAL Questions

8. 1. Was the child born dead? If so
was it still born or dead born?
❖Still birth:
❖Dead birth: Rigor Mortis
Maceration
Mummification
Spalding sign

9. Rigor Mortis

10. Maceration

11. Mummification

12. Spalding's sign

13. 2. Was the child mature or
immature? If immature was it viable
►Fetus is usually
considered to be viable at
the age of 210 days (7
months). (28 weeks)

14. Proof of Viability

15. Proof of Viability

16. 3. Was the child born alive? If so
whether it had breathed
►Legal presumption :
►Circumstantial evidence :
•Cry
•Muscular movements
•Pulsation / Heart beat
►Medical Evidence:
•Hydrostatic Test
•Stomach and Bowel test
•Milk in the Stomach

17. 3. Was the child born alive? If so
whether it had breathed
►Forensically, to diagnose live birth, certain
incontrovertible criteria should, therefore, be
present, e.g.
►(1) viable child,
► (2) well expanded lungs,
► (3) vital reaction in the stump of the
umbilical cord, and/or
► (4) presence of milk in the stomach.

18. 4. If born alive, how long did the
child survive
►Changes in the skin
►Changes in the Scalp
►Changes in the circulation
► Changes in the umbilical cord

19. Changes in the skin
►Vernix Caseosa
► Color Of Skin
►Desquamation

20. Changes in the scalp

21. Changes in the circulation
•UA – 2 to 3 days
•UV – 4 to 5 days
•DA – 7 to 10 days
•FO – closed at birth / 2 to 3 months / 2 years
or persist
•F Hb – 6 months
•Reticulocytes – 2 days

22. Changes in the umbilical cord

23. Changes in the umbilical cord

24. 5. What was the cause of
death?
►Natural
►Accidental
►Homicidal

25. Natural
•Immaturity
•Diseases in Mother
•Malformation
•Haemorrhage

26. Accidental
•Prolonged labor
•Cord prolapse
•Knots or twists in the cord
•Premature separation of placenta

27. Homicidal
•Act of commission
•Act of omission

28. Act of commission
►Smothering
►Strangulation
►Head injuries
►Multiple injuries
►Drowning
►Poisoning
►Live burial

29. Acts of omission
►Failure to remove the child from
discharge.
►Failure to tie the cord after dividing it.
►Failure to feed the child
►Failure to protect child from exposure
to heat and cold.
►Failure to arrange medical aid.

30. Autopsy to establish cause of death
►External findings:
•Clothing & wrapping
•Measurement
•Changes of decomposition
•Vernix caseosa
•Umbilical cord & placenta

31. Internal findings:
►Head
►Neck : Strangulation; Throttling; F. Bodies
►Thorax
•Shape
•Diaphragm position
•lungs consistency
•Weight
•flotation test

32. ►Abdomen
•Presence of air demonstrated radiologically
•Milk / food / amniotic fluids in stomach
►Other viscera's
►Genitals
►Limbs and sternum
►Center of ossification

33. Secondary issues
To examine the mother (women)
►To prove whether the mother has recently
delivered and the period of delivery coincide
with the probable duration life of the infant.
►Signs of recent delivery
► Blood grouping
► DNA fingerprinting

34. Signs of recent delivery

35. Striae gravidarum

36. Linea Nigra

38. Legal Consequences
1. Abandoning of children
2. Concealment of birth
3. Relevant Qisas & Diyat Laws:
a)Isqat-i-Hamal
b)Isqat-i-Jinin

39. 1. Abandoning of children
►child under the age of 12 years,
with the intention of abandoning
the child by the parents, is
punishable.
►Punishment will be counted as a
Murder or a Homicide.

40. 2. Concealment of birth
By secretly burying or otherwise
disposing of the dead body of a
child, is made punishable for this
offense.

41. Qisas and Diyat Laws

42. Qisas and Diyat Laws

43. THE END

44. Forensic
Paediatrics
Dr. Siraj Nabi

45. x
Child Maltreatment

47. LEARNING OBJECTIVES
•Define Child Maltreatment
•Enlist: Patterns of Maltreatment
•Interpret: Cases suspicious of Abuse & Neglect
•Classify: Later Life Consequences of Child Maltreatment

48. Synonyms
■ Non accidental injury
■ Child Abuse
■ Battered baby syndrome

49. Any act of commission or
omission by a parent/caregiver
that results in harm, potential
for harm, or threat of harm to a
child.
Child Maltreatment

50. •Physical abuse
•Emotional abuse
•Sexual abuse
Patterns of Maltreatment
Acts of Commission
(Child Abuse)
Neglect
Acts of Omission
(Child Neglect)

51. Physical abuse

52. Emotional Abuse

53. Sexual Abuse

54. Neglect

55. Neglect

58. ●Emotional effects: Depression, Generalised Anxiety,
Narcissist, Borderline Persoanlity Disorder
●Physical effects: Hypertension, Ulcers, Stress related diseases
●Behavioral effects: Conduct disorder and oppositional defiant
disorder
Later Life

60. S . I . D . S
BY: Dr. SirajDr. Siraj Nabi

61. S . Sudden

I . Infant

D . Death

S . Syndrome

62. aka >>>>>>>>> COT
Death

65. RISK FACTORS
• Premature & Low-birth weight
• Upper or lower R.T.I
• Tobacco smoke
• Inadequate temperature
(Hot or Cold)
•Sleeping prone

66. Protective FACTORS
• Vaccinated
•Breast feeding
•Pacifiers