Legal Medicine: Infant Deaths and Child Abuse PDF

**OUTLINE** I. **Legal Aspect of Child Abuse and Infant Deaths** a. Child Abuse b. Neglect c. Infanticide II. **Non-Accidental Injuries (NAI)** a. Risk factors for NAI b. Features that would raise suspicion of NAI c. Injuries to Note Medical History III. **Sudden Infant Death Sy...

**OUTLINE** I. **Legal Aspect of Child Abuse and Infant Deaths** a. Child Abuse b. Neglect c. Infanticide II. **Non-Accidental Injuries (NAI)** a. Risk factors for NAI b. Features that would raise suspicion of NAI c. Injuries to Note Medical History III. **Sudden Infant Death Syndrome** a\. Risk Factors IV. **Physician's Role in Child Abuse Cases** +-----------------------+-----------------------+-----------------------+ | **LEGEND** | | | +=======================+=======================+=======================+ | ⭐ | 🖊️ | 📖 | | | | | | Must | Lecture | Book | | | | | | Know | *\[lec\]* | *\[bk\]* | +-----------------------+-----------------------+-----------------------+ I. LEGAL ASPECTS OF CHILD ABUSE AND INFANT DEATHS {#i.-legal-aspects-of-child-abuse-and-infant-deaths.TransOutline} ================================================= CHILD ABUSE (RA 7610 sec. 3b) {#child-abuse-ra-7610-sec.-3b.TransSubtopic1} ----------------------------- - 🖊️Special protection of children against abuse, exploitation, and discrimination. - Refers to the maltreatment, whether habitual or not, of the child which includes any of the ff: 1. Psychological and physical abuse, neglect, cruelty, sexual abuse, and emotional maltreatment 2. Any act by deeds or words which debases degrades, or demeans the intrinsic worth and dignity of a child as a human being 3. Unreasonable deprivation of his basic needs for survival, such as food and shelter 4. Failure to immediately give medical treatment to an injured child resulting in serious impairment of his growth and development or in his permanent incapacity or death - 🖊️Take note that the definition of a child or children refers to persons below 18 years of age or those who are over 18 but are unable to fully take care of themselves or to protect themselves from abuse, neglect, cruelty, discrimination, exploitation because of physical or mental disability or conditions. - 🖊️⭐Take note of number 2, "debases, degrades, or demeans the intrinsic worth and dignity of a child as a human being" because it is an essential requisite to prove cases of child abuse. - 🖊️⭐In the recent case of Pascua vs People \[of the Philippines\], which was promulgated last April 26, 2023. - 🖊️In this case, Pascua was a teacher in a school in Isabela, and the child was her former grade 6 pupil. The child was around 12 years old at that time. The child was noisy and unruly during the singing of the national anthem. Pascua called the attention of the student, but the student continued making noise. The teacher, in essence, pinched the shoulder of the child and slapped the back of the minor causing linear abrasions over the upper arm and tenderness over the right lumbar and scapular area of the child. - 🖊️⭐The court held that it was NOT actually child abuse. The infliction of slight physical injuries in this case may still be considered child abuse PROVIDED THAT it is proven that the act was done to [debase, degrade, or demean the intrinsic worth and dignity of a child as a human being.] - 🖊️So this doesn't mean that Pascua got free. She was still held liable and guilty of **slight physical injury.** - 🖊️Debase: an act of reducing the value, quality, or purity of something - 🖊️Degradation: lessening of a person's things, character, or quality - 🖊️Demean: to lower in status, condition, reputation, or character NEGLECT (IRR RA 7610 S 2f) {#neglect-irr-ra-7610-s-2f.TransSubtopic1} -------------------------- - **Failure to provide**, for reasons other than poverty, **adequate food, clothing, shelter, basic education, or medical care** so as to [seriously endanger] the physical, mental, social, and emotional [growth and development of the child.] INFANTICIDE (ART. 355 RPC) {#infanticide-art.-355-rpc.TransSubtopic1} -------------------------- - 🖊️ Killing of any child **less than 3 days of age** - 🖊️Do not confuse the definition of infant in pediatrics - **[Elements]** **1. The child was killed** **2. That the deceased child was less than three days of age** **3. That the accused killed the child** - **[Mitigating Circumstances]** - When the crime is committed by the mother of the child and/or the maternal grandparents for the purpose of concealing the mother's dishonor - 🖊️*Mitigated = penalty is lower* - 🖊️Any change in the elements will change the nomenclature or the crime itself. - 🖊️Comparing it to parricide, when any person kills his father, mother, or child, whether legitimate or illegitimate or any of his ascendants or descendants or his spouse. So, what is changed here is: who killed who (referring to element \#3). - 🖊️What if for example the child is more than 3 days old, and the accused or killer is a stranger? Killing of a young child even if it is over 3 days old is considered murder because it is attended with abuse of superior strength. Remember that, comparing murder with homicide, **the killing was attended with specific circumstances under the law, such as abuse of superior strength**. - 🖊️Note that infanticide is NOT committed if the child is NOT born alive. According to Article 41 of the Civil Code, the **child is born alive at the time** that it is completely delivered from the mother's womb. However, if the fetus had an intrauterine life of less than 7 months, this is not considered born alive if it dies within 24 hours after its complete delivery. II. NON-ACCIDENTAL INJURIES {#ii.-non-accidental-injuries.TransOutline} =========================== - 🖊️Non-accidental injuries (NAI) is a term used to describe physical injuries or signs of abuse in a child that may have been inflicted by the caregiver of the child or another person. - Is there an injury? → is it consistent with an accidental injury? → if the injury is non-accidental, is it consistent with the offered cause? RISK FACTORS FOR NAI {#risk-factors-for-nai.TransSubtopic1} -------------------- - Unwanted pregnancy - Social isolation - Scapegoating - Handicapped child - Drug and alcohol abuse - Previous domestic violence - Injured pets - Past problems with anger management FEATURES THAT WOULD RAISE SUSPICION OF NAI {#features-that-would-raise-suspicion-of-nai.TransSubtopic1} ------------------------------------------ - **Is the history consistent with the injury?** - 🖊️Consider the offered mechanisms of injury. Is the explanation credible? The development of the child must be considered in this case. Would the child at a bare age be capable of the actions or movements described by the caregiver in claiming that it was an accident or injury? - **Multiple injuries of differing ages** - 🖊️Bruises would have various colors or various stages. Bruises of different colors and fractures with different stages of callous formation are unlikely to have been caused at the same time or from the same accident. - **Discrepancies in varying and changing explanations** - 🖊️Usually fabricated stories are more difficult to be consistent than describing an actual witnessed event. The story may change if the abuser thinks that the original explanation is being doubted. - **Delay in reporting** - 🖊️Concerned parents are more likely to seek medical advice soon after an accident. But of course, this is not always the case. - **"Doctor shopping"** - 🖊️The parents may seek help from different outlets or become afraid or withdrawn. This may be seen both in parents who are worried and in parents with fabricated or imposed illnesses (seen in Munchausen syndrome). - **Denial and collusion** - 🖊️ When there are two caregivers, and one is trying to collude with the abusing partner or trying to cover up. - **Behavior of the child** - 🖊️Does the child show fear with one parent or one caregiver? Unwilling to make eye contact. Is there a wary, haunted look over the child? INJURIES TO NOTE {#injuries-to-note.TransSubtopic1} ---------------- - 🖊️If you suspect a NAI, it is important to perform a thorough assessment, marks may be **hidden by clothing such as long sleeve shirts or turtlenecks.** - **Spot Bruises** - caused by harsh fingertip pressure, sometimes in clusters. - 🖊️Usually **0.5 -- 2.5 cm** and would appear in clusters corresponding to the fingers of the grasping hand. Since the fingers are on one side, examine the opposite side for thumbmarks. - 🖊️Usually a cluster of 3-4 \[fingers\] and a thumb on the opposite side - 🖊️If you suspect the infant/child is shaken, there will be **thumbmarks on the trunk in front and spot bruises on the back.** - **Slap marks** - Clear lines of petechial hemorrhages with an outline of the individual fingers - 🖊️ Often involves parts of the face, and may also include part of the ears, so look behind the ears. Also, in the trunk or buttocks. - 🖊️There may be clear lines of petechial hemorrhages with the outline of the individual fingers. - **Knuckle punches** - Rows of three or four roughly round bruises - 🖊️Around **0.5 -- 1 cm** - 🖊️Favored sites are usually at the **head or back, particularly over the spine** - If over bony prominences, a **rounded swelling** may also be present. - 🖊️ Usually on the side of the head or the facial bones - **Patterned wounds or imprint wounds** - Bruising with a recognizable mark from the object used - 🖊️Ex. Belt buckle - **Bite marks** - Distinctive, **crescent-shaped lines** of discoloration - 🖊️If made by a child, the arch of the bite mark is narrower or smaller compared to that of an adult. - 🖊️Animal bites tend to puncture more with tearing of the tissues. - 🖊️Human bites tend to be more compressed causing the distinctive bruising with the crescent-shaped lines. - **Pinch marks** - Butterfly shaped bruise - 🖊️One wing is caused by the thumb which would be larger than the other wing - **Periorbital hematoma aka black eye** - Without a clear history of an accident - **Bruising on the inner side of the thighs** - 🖊️Due to pinching - **Bruised face in pre-mobile babies** - **Central spine bruising** - **Friction burns** - 🖊️On prominent areas -- **chin, cheek for incidences of dragging across the room** - **Bald spots/alopecia** - 🖊️Hair pulling - **Ligature marks** - Wrist and ankles - 🖊️Child may have been tied up - **Pinch or ligature marks on the inguinal area** - **Burns and scalds** - 🖊️Note patterned burns on the skin - Shape of the flat-iron - **"Stocking and glove" distribution** - ⭐Remember in Forced Immersion - Limbs: "glove and stocking" pattern - Trunk: often symmetrical involving left and right limbs equally with clear demarcation - Uniform depth of scald - **Cigarette burns** - Round, punched-out lesions - 🖊️1cm when directly applied at a right angle on the skin - 🖊️Compared to when a cigarette may have been dropped or grazed the skin -- burn is **elliptical and irregular and heals without scarring** - Arms, legs, back, between the toes, soles of the feet - **Bone and joint injuries** - 🖊️Consider the **age of the child** and the **osteal development appropriate to their age** - Spiral fractures of long bones - 🖊️Indicates a twisting force on the limb of the child - **Unexplained neurologic injuries with retinal hemorrhage** - 🖊️ Characteristics of Shaken Baby Syndrome MEDICAL HISTORY {#medical-history.TransSubtopic1} --------------- - 🖊️A thorough medical history is warranted as some disease conditions may mimic the injuries above - **Pigment anomalies** - 🖊️ Mongolian spots, skin discoloration may be mistaken for bruising - **Blood disorders/vitamin deficiency** - 🖊️May predispose to easy bruising - **Alopecia areata** - **Impetigo or chickenpox** - 🖊️Mistaken for cigarette butt burns - 🖊️ "Mamaso" in the vernacular due to the similarities in the round lesions of cigarette butt burns - **Accidental scalds** - (+) shielding injuries - **Possibility of self-Inflicted in older children** III. SUDDEN INFANT DEATH SYNDROME {#iii.-sudden-infant-death-syndrome.TransOutline} ================================= - 🖊️Sudden death of an infant or young child which is unexpected by history and in whom a thorough necropsy fails to demonstrate an adequate cause of death. - ⭐Sudden and unexpected - **Under the age of 1** - Lethal episode during sleep - 🖊️Pinatulog lang yung baby, pag tingin nila di na humihinga - Death is unexplained by clinical history - Unexplained death after review of the circumstances - Unexplained death even after autopsy RISK FACTORS {#risk-factors.TransSubtopic1} ------------ - ⭐**The exact cause is still unknown** - 🖊️**A diagnosis of exclusion.** - Exclusion of child abuse is a prime consideration. - More common in **male babies** - Peak incidence at around **3 months of age** - 🖊️Most cases are between 2 -- 7 months old or below 1 year old - Twins, previous SIDS in the family - Low birthweight, preterm - Low socioeconomic class IV. PHYSICIAN'S ROLES IN CHILD ABUSE CASES {#iv.-physicians-roles-in-child-abuse-cases.TransOutline} ========================================== - 🖊️**RA7610** -- Mandatory Reporting of Child Abuse - Failure to report a possible case of child abuse shall be punishable with a fine of not more than **P2,000.00** (IRR RA7610, § 7) - Mandatory reporting is not an accusation. - 🖊️If the child is experiencing abuse, it will remove the child from the possibility of further abuse to safeguard rights and the protection of the child from continued abuse. WHAT TO REPORT {#what-to-report.TransSubtopic1} -------------- - Suspicion of child abuse - 🖊️The mere suspicion of it is enough -- any abuse, habitual or not - Examination or treatment of a child who appears to have suffered from abuse - Medical diagnosis of child abuse WHO SHOULD REPORT? {#who-should-report.TransSubtopic1} ------------------ - Attending MD - Attending RN - Head or administrator of any public or private hospital, medical clinic, or similar institutions - A person who, acting in good faith, shall report a case of child abuse shall be free from any civil or administrative liability arising therefrom. - There shall be a presumption that any such person acted in good faith (IRR RA 7610, § 7). - (From 2025 trans) Note that there is no 'criminal' liability included, in case that the report was made maliciously. WHEN? {#when.TransSubtopic1} ----- - Within 48 hrs from knowledge HOW? {#how.TransSubtopic1} ---- - Orally or in writing - 🖊️Preferably in writing but the law provides that it can also be reported orally WHERE? {#where.TransSubtopic1} ------ - DSWD - Police or other law enforcement agency - Barangay Council for the Protection of Children REFERENCES {#references.TransOutline} ========== - 2025COM-Transcription - Mundin, Bianca Nympha (2024). Infant Death and Child Abuse APPENDIX ======== - No appendices