Fatal Child Abuse-Maltreatment Syndrome
A University of Toronto Study Researched Child Deaths from Abuse
Sep 24, 2009
Fatal child abuse or neglect is the fatal physical injury or negligent treatment of a child by a person who is responsible for the child’s welfare. Most child maltreatment deaths result from physical abuse, especially children receiving injuries to their heads. Known as abusive head trauma, these injuries occur when a child’s head is slammed against a surface, is severely struck or when a child is violently shaken (Understanding Child Maltreatment, CDC Fact Sheet 2006).
Fatalities from neglect include a number of different ways in which caregivers fail to adequately provide for or supervise their children. Caregivers may fail to provide food and nurturing to their child, leading to malnutrition, failure to thrive, starvation or dehydration. Caregivers may fail to seek medical care when their child is ill, leading to more serious illness and death. Neglect cases can also result from intentional or grossly negligent failure to adequately supervise a child, resulting in bathtub drowning, suffocations, poisonings and other types of fatal incidents.
In a 1990-1995 study by the Department of Laboratory Medicine and Pathobiology at the University of Toronto entitled “Fatal Child Abuse Maltreatment Syndrome: A Retrospective Study in Ontario, Canada,” injuries were characterized in a series of fatally abused or maltreated child to define objective diagnostic criteria for the CAMS. All deaths (age <17 years) investigated by the Office of the Chief Coroner for Ontario, Canada during the time period 1990–1995 were reviewed.
Classification of Injuries
Cases of CAMS were defined as death due to lethal recent injury or malnutrition in the presence of significant old (healing or healed) injuries indicative of repeated episode of inflicted trauma. The frequency of the shaken baby syndrome, and the types and frequency of ano-genital injuries were also studied. Twenty-one cases of fatal CAMS were found in the study period. The vast majority of cases had significant recent head injury with intra-cranial hemorrhage (71%).
Other significant recent injuries commonly observed included blunt injuries of the skin and soft tissues (67%), blunt abdominal trauma with visceral injuries (14%), and fractures (18%). Eight cases (38%) fulfilled accepted criteria for the shaken baby syndrome. Many children with fatal head injuries had evidence of older head trauma (38% of all cases).
Child Homicides and Head Trauma
A significant minority of cases had evidence of malnutrition due to neglect (10%) or ongoing ano-genital injuries (10%). Most cases of child homicides due to repeated episodes of abuse or maltreatment involved head trauma, including shaken baby syndrome. Fractures of long bone and ribs, the classical markers of child abuse, were relatively infrequent compared with head injury. A fraction of cases had ano-genital injuries due to repeated sexual abuse or punitive maltreatment.
All clinicians and pathologists must recognize the wide spectrum of injuries in child abuse to ultimately protect the victim or other children in an at-risk situation.
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