• Fetal death — the death of a fetus at any time prior to birth.

• Infant death — the death of a child under one year of age due to natural and unnatural causes.

• Child abuse — maltreatment of a child for sexual and nonsexual purposes.

27.1: Infanticide

• Infanticide — is defined as the deliberate, unlawful, destruction of a child under the age of one year, by an act of omission or act of commission.

Investigation in a Case of Death of a Newborn and Infant

• Whether the Child is Viable or Not?

  • Viable child — a fetus, which has completed of 210 days (7 months) of intrauterine life (IUL) and is capable of leading a separate existence after birth.

• Whether the child—live born or stillborn or dead born?

• Time of survival if live born.

• Cause and manner of death.

27.2: Live Born, Stillborn, and Dead Born Child

• A child is considered live born, if any of its parts is out of the mother's reproductive passage, though it has not breathed or is completely born.

• A stillborn is one who is born after 28 weeks (IU age) of pregnancy, and it did not show any signs of life, at any time after being completely born. In this, the fetus was alive in the uterus but dies in the birth canal after the birth process has initiated.

• A dead-born child is one which had died in the uterus before the birth process started and shows rigor mortis, maceration, or mummification at birth.

Establishing Whether Live Born?

• In civil cases: The following are considered signs of live birth:

  • Baby's cry.

  • Muscle twitching/movements of limbs, etc.

• In criminal cases:

  • Signs of live birth have to be demonstrated by autopsy examination of the newborn as usually, the law presumes that “Found dead is born dead”.

Establishing Whether Dead Born?

• Macerated fetus: It is a state of aseptic autolysis occurring after the intrauterine death of a fetus.

• On examination, a macerated fetus shows following features:

  • Emits a rancid odor.

  • The body is soft and pliable, it flattens when kept on a table.

  • Skin is sodden and coppery red/purplish with blisters, and peeling cuticle

  • Abdomen is distended.

  • Umbilical cord is thick, red smooth, soft.

  • Joints are abnormally mobile or flexible.

  • Body cavity presents reddish serum within.

  • Organs are soft and edematous, lose their morphology, but lungs and uterus remain unaffected for long period.

  • Skull bones are in loss of alignment and over-riding of bones of, cranial vault and overlapping.

• Maceration begins or sets in 5 to 7 days prior to expulsion, thus, it needs about 5 to 7 days time to form.

Cause of Death

• Acts of omission: This includes, not doing certain things necessary for an infant.

  • Avoid ligating the umbilical cord before cutting

  • Avoid feeding the infant, etc.

• Acts of commission: This includes doing certain deliberate acts resulting in the death of the infant.

  • Smothering the infant to death, strangulation, and head injury.

• Prolonged labor: Here the fetus dies in the uterus due to certain maternal causes such as the contracted pelvis, cephalopelvic disproportion, etc.

• Precipitate labor: Here the fetus dies at delivery. The victim is usually a newborn infant, alleged to have died in the toilet, bathroom, etc.

• Cord around the neck: During the delivery of a fetus the umbilical cord gets wound around the neck accidentally, resulting in death due to asphyxia, the cord acting like a ligature of hanging or strangulation.

27.3: Feticide

• Feticide — a unique form of violence killing of a fetus, before being born.

• It refers to total destruction of a female fetus.

• This is an atrocity against females and is actively being promoted by the sex determination clinics.

• New prenatal sex-determination techniques, such as ultrasound, have led to an increase in the abortion of female fetuses rather than female infanticide.

27.4: Battered Baby Syndrome

• Battered baby syndrome: A clinical condition in young children usually under three years of age, who have received nonaccidental violence or injury, on one or more occasions at the hands of an adult, a parent, guardian, or foster parent.

Causes

• The victim is often an unwanted child, an illegitimate child, or a child whose father's paternity is doubted.

  • The precipitating factor is usually a cry, which interferes with either a parent in sleep or the outing or their television program.

  • Battering is the result of a sudden loss of temper under such and allied circumstances.

• The type of persons involved in child battering has frequently a low IQ.

  • Some have a history of family discord, long-standing emotional problems, and financial stress, while others have a history of criminal background.

The syndrome must be considered in any child:

• In whom the degree and type of injury are at variance with the history given,

• When injuries are of different ages and in different stages of healing,

• When there is a purposeful delay in seeking medical attention despite serious injury,

• Who exhibits evidence of fracture of any bone, subdural hematoma, failure to thrive, soft tissue swelling or skin bruising, or

• Who dies suddenly?

Medicolegal Importance

• The history may be completely misleading as to the circumstances of death.

• The external and internal examination should be very thorough and supported by photographs, radiographs, microscopic sections of all pertinent lesions, and toxicological analysis.

• Charges of infanticide.

27.5: Sudden Infant Death Syndrome (SIDS)

• Sudden infant death syndrome (SIDS) — a condition in which apparently healthy infants are found dead without any signs or symptoms that would have enabled such an event to be predicted, and on postmortem examination, there is insufficient pathology to explain their death satisfactorily.

• Auto-beverage syndrome — The enzymatic content in the stomach converts the milk into alcohol, resulting in alcohol poisoning.

• Overlaying: If the mother has a habit of feeding her baby lying on the cot, there is every possibility that the mother may overlie the baby, the breast of the mother may press the face of the infant, resulting in smothering and death.

• Shaken infant syndrome — Violent shaking as a part of playing with the kid may produce intracranial hemorrhage due to hyperextension or hyperflexion.

27.6: Child Sexual Abuse

• The rape of a child is a form of child sexual abuse.

• When committed by a parent or other close relatives such as grandparents, aunts and uncles, it is a form of incest and when committed by another child, it is a form of child-on-child sexual abuse.

• When a child is raped by a family member, especially a parent, it can result in serious and long-term psychological trauma.

• When a child is raped by an adult who is not a family member but it a caregiver or in a position of authority over the child, such as school teachers, religious authorities, or therapists, to name a few, whom the child is dependent, the effects can be similar to incestual rape.

• Effects of child rape include depression, post-traumatic stress disorder, anxiety, the propensity to re-victimization in adulthood, and physical injury to the child, among other problems.

Examination of the CSA Case

• It is the appreciation of the quite wide range of normal appearances of genitalia and anus that is a keystone of a reliable opinion on the most serious of problems.

• Digital examination of a prepubertal child is rarely indicated and may need to be performed under general anesthesia if thought essential.

• Reflex Anal Dilation Test — the reflexive dilation of the human anus to a diameter greater than two centimeters in response to the parting of the buttocks or anal stimulation, such as brushing with a medical instrument.