A decade of pediatric homicide - A retrospective study at the Medical University of South Carolina

More than 3 million children are abused and/or neglected each year in the U nited States. Unfortunately, a significant percentage of these cases result in homicide by child abuse or child neglect. Causes of death range from bl unt force trauma and shaking to asphyxia to immolation. We retrospectively reviewed all pediatric forensic cases referred to the Medical University of South Carolina Forensic Pathology Section over the past 10 years, from Jan uary 1986 to December 1995. Of these, we looked only at children less than or equal to 5 years of age. The majority (342 cases, 69%) of these deaths w ere classified as natural, 96 (19%) as accident, and 60 (12%) as homicide. Of the homicides, we examined the cause of death; age, gender, and race of the victim; relationship to the perpetrator; time interval between injury a nd death; and the initial history given as to the cause of the injury. The cause of death fell into nine categories, the number one category being hea d trauma. Forty-five percent of the homicides were by head trauma, 12% by a bdominal or body trauma, 25% by asphyxia (with half of these due to drownin g), 109/0 by carbon monoxide poisoning or thermal injury, and the remaining 8% involving cases of neglect, stabbing, and poisoning. The majority of th e homicide victims were male (67%) and black (67%). Forty-six percent were less than or equal to 1 year of age. Approximately 25% of the homicide case s were designated as shaken baby syndrome (SBS). In 97% of the cases, the a ssailant was known to the victim and was a family relative in 77%. Sixty-th ree percent of the assailants were female and 45% of the assailants were ma le; in 12%, the assailants were both parents, and in 1 case, the assailant remains unknown. Of the asphyxia deaths, 87% of the assailants were female. The time interval between injury and death ranged from minutes to hours in most cases to months in cases of repeated abuse and chronic injury and seq uelae. The time interval between injury and the onset of symptoms remains u nknown in most cases due to inconsistencies in the history and lack of cred ibility of the caretaker. The most common initial history given was "a fall " (20%). We report our findings of a decade of pediatric homicides to incre ase awareness of the common scenarios and case histories, demographics of t he victims, causes of death, and perpetrators of pediatric homicide.