Petechiae of the baby's skin as differentiation symptom of infanticide versus SIDS

The successive killing of three siblings by their biological mother at two- year intervals is described. The children were 367 days, 75 days and 3 year s old. Although sudden infant death syndrome (SIDS) or interstitial pneumon ia could not be ruled out as the cause of death in the two younger children , who were killed first, the third child exhibited discrete signs of violen ce in the mouth and throat area which were interpreted as proof of infantic ide. All three children had petechiae of the skin of the face and throat, t he upper thorax. the shoulders and the mucous membranes of the mouth. None of the children exhibited signs of a disease-related hemorrhagic tendency. After the mother was convicted of murdering the three-year-old boy by smoth ering in combination with compression of the thorax, she confessed to havin g killed the other two children in a similar manner. In the absence of hemo static disease, the presence of petechiae of the skin extending over the en tire drainage area of the Vena cava superior can be regarded as evidence of an increase in pressure in the thoracic cavity secondary to obstruction of the airways with simultaneous chest compression.