SEXUAL JURISPRUDENCE

INFANTICIDE
AND
CHILD ABUSE
DR. GAGAN MATHUR
 PART 1

BASICS OF INFANT
AND CHILD

1. BASIC DEFINITIONS AND LEGAL ASPECT

2. AGEING OF FOETUS AND INFANT
3. CAUSES OF INFANT DEATH
4. POST MORTEM EXAMINATION OF INFANT

DR. GAGAN MATHUR

 1. BASIC DEFINITIONS
CRITERIA DESCRIPTION
KILLING
Infanticide* • Killing of an Infant from Birth to 12 months
Feticide * • Killing of Foetus from fertilisation (Conception) to Birth
Filicide • Killing of a child whose age is more than 1 year
Parricide • Killing of one’s father
Matricide • Killing of one’s mother
TIMELINE***
Conceptus • Any product of conception including embryo, foetus and extra
embryonic layers and tissues from fertilisation till Birth

Pre-embryo • From fertilisation to implantation (14 days)

Embryo • From implantation to end of 8th week ( 2 months / 56 days)
Foetus • From 8th week till Birth
Neonate • From birth till 28 days after birth
Infant • From birth till 1 year after birth
FEATURES
Viability* • Ability of a foetus to live a separate life apart from mother
womb, means foetus is capable of independent existence, by
virtue of certain degree of maturation

Meconium • Mixture of bile, mucous, shredded mucosa

Vernix • White cheesy substance which cover the skin of foetus,
caesosa consist of sebum and desquamated cells

Lanugo hair • Fine, soft, unpigmented hair which present over the skin

DR. GAGAN MATHUR

 2. LEGAL ASPECTS
• Law states that every child is born dead → Hence in cases of infanticide→
we have to prove that child was born alive
• In cases of Infanticide → the 1st question to answer is → whether the child
born was Live born or still born or Dead born

• If a part of foetus has come out of womb (means if any part of that child
has been bought forth through vagina)
o 101 BNS – Definition of infanticide –
▪ Acts which causes death of living child in mother womb will be
considered as culpable homicide amount to murder
▪ if any part of that child has been bought forth, irrespective the
child breathed or not
o 103 (1) BNS**** – Punishment for infanticide **
▪ Infanticide is equivalent to murder
▪ punishment - life imprisonment to death sentence + fine

• If all parts of foetus are inside womb and no part came out yet
o 88 BNS – Punishment for Voluntarily Causing miscarriage with
consent
▪ Punishment – 3-7 years + fine
o 89 BNS – Punishment for Causing miscarriage without woman’s
consent
▪ Punishment – 10 years to life + fine
o 90 BNS - Punishment for Acts done with intent to prevent child from
being born alive
▪ Punishment – 10 years + fine
o 91 BNS***** – Punishment for Acts done by a person, which causes
death of a Quick unborn child,
▪ Punishment – 10 year + fine
o 92 BNS – Punishment for Abandoning a child < 1 year by the parents
▪ Punishment – 7 year + fine
o 93 BNS - Punishment for secretly disposing of a child body and
concealing birth of that child
▪ Punishment - 2 year + fine

DR. GAGAN MATHUR

 3. AGEING OF FOETUS AND INFANT
CRITERIA
Age of • Cab be determined by examining
Foetus o Length ( crown –heel, crown-rump)
(Before o Weight
Birth) o Foot length
o Ossification centres
o Features
o mathematical calculation
o development of surfactant by Type II cells
• Ageing according to above criteria’s given in the table
• Mathematical calculation********
o Estimate crown heel length
o In 1st 5 months – Rule of Hass – age in month = √CHL in cm
o In last 5 months – Morrison rule - age in month = CHL(cm) ÷ 5

Age of • Cab be determined by examining

Infant o Height ( crown –heel, crown-rump)
(After o Weight
Birth) o Head circumference
o Chest circumference
• Weight of infants
o Birth − 3 Kg
o 6 months − 6 Kg ( two times)
o 1 year − 9 Kg ( three times)
o 2 year − 12 Kg ( four times)
o 3 year − 15 Kg ( five times)
o 7 year − 21 Kg ( seven times)
o 10 year − 30 Kg ( ten times)
• Height of infant
o Birth − 50 cm
o 6 months − 65 cm
o 1 year − 75 cm
o 2 year − 85 cm
o 3 year − 100 cm

AGE OF FOETUS BASED ON LENGTH, WEIGHT, OSSIFICATION AND FEATURES –

given later – only memorise the month and star marked feature of that age

DR. GAGAN MATHUR

 4. CAUSES OF INFANT DEATH

CRITERIA DESCRIPTION
Natural • Prematurity
causes • Post maturity
• Congenital malformations
• Early separation of placenta
• Birth trauma
• Neonatal infection
• Sudden infant death syndrome
• Birth asphyxia (M/C finding is petechiae on pleura)
• Debility ( baby is full term but lack development milestones)
• Maternal conditions (Pre-eclampsia, cephalopelvic disproportion,
Abruptio placenta)
• Laryngeal spasm ( due to aspiration of liquor amni or meconium)
UNNATURAL CAUSES
Accidental • Injury to mother ( causes Early separation of placenta)
Perinatal • Prolonged labour (causes compression head, asphyxia, brain
causes injury)
• Cord prolapse (decrease fetal circulation, asphyxia, brain injury)
• Twisting of cord around neck ( strangulation, asphyxia, brain
injury)
• Death of mother ( a child can be saved up to 25 min after death
of mother)
Accidental • Suffocation (due to unavailability of good nursing care, infant
Postnatal aspirate blood or amniotic fluid after birth, leading to smothering
causes and choking and infant dies due to asphyxia and brain injury)
• Precipitate labour*
o All 3 stages of labour occur in very quick succession
o So that delivery occur very quickly
o Infant dies due to head injury or bleeding from torn end of
umbilical cord.
o Death due to precipitate labour can be confused with
infanticide but it is actually accidental
o The mother can sue doctor for negligence, charging that
because of his mistake the infant died.

Criteria Head injury due to Head injury due to blunt

precipitate labour trauma

situation Present on presenting Can be present anywhere

part of skull on skull

Fracture Fissure fracture Communited fracture

Brain Brain injury absent Brain injury present
Laceration Not associated Associated with laceration

DR. GAGAN MATHUR

Criminal • Strangulation by a ligature
causes due • Poisoning ( M/C opium)
to Act of • Smothering by a cloth
commission
• Head injury by banging
• Concealed puncture wound
• Twisting of neck
• Drowning
• Cut throat injury
Criminal • Failure to provide assistance during labour
causes due • Failure to clean air passage after birth
to Act of • Failure to tie cord after cutting it
Omission
• Failure to feed the child
• Failure to protect child from temperature changes
• Failure to take care of child after birth

DR. GAGAN MATHUR

 5. POST MORTEM EXAMINATION OF INFANT
CRITERIA DESCRIPTION
EXTERNAL EXAMINATION
Clothing • Retain for identification
Anthropometry • Weight, Length , Head circumference, Chest circumference,
Foot length
General • Look for any deformity or abnormal feature
appearance • If present we should consider Karyotyping
Head • Look for hair distribution and quality
• Look for abnormal shape, moulding, trauma, bleeding
Face • Look for abnormal facial configuration
• Look for configuration of ear, plasticity, and relation with
lateral canthus, in full term it is above lateral canthus level
Extremities • Look for position of limbs and fingers
Genital area • Look for patency of anal canal
• In males – meatus and scrotal sac content
• In females – meatus and size of labia and clitoris
Vernix caseosa • If absent it means foetus has been washed after birth
Placenta • Normal – length 20 cm, width 2-5 cm, weight 500 gm
• Examine for abruptio placenta, placenta previa, abnormal
structure, abnormal weight
Umbilical cord • Normal 50-60 cm
• Short cord <30 cm -compression of blood flow due to traction
• Long cord > 100 cm – compression of blood flow, prolapse,
torsion, knotting
Putrefaction • To determine time since death
changes • Concept – foetus inside the mother wound is sterile, it
acquires outside micro organism only after 1st breath.
• In dead born – maceration seen (sterile autolysis)
• In still born – putrifaction is outside to inside
• In dead born – putrifaction is inside to outside
INTERNAL EXAMINATION
General • Skin incision – Modified Y shape incision from both mastoid to
tip of sternum, then to pubic symphysis
Head • Skin incision – ear to ear incision
• Vault opening – Benecke technique > sutural opening
• Look for – subscapular hematoma, dura intact or not, intra
cranial haemorrhage, brain parenchyma injury
Thorax & • Cavity - Abdomen is open first followed by Thorax
Abdomen • Organ removal – Letulle’s en masse technique
• Look for – free blood, free fluid, position of diaphragm, any
organ injury, organ developmental anomaly, stomach content
Skeletal • Look for presence of ossification centres specially – calcaneum
system (5th month), Sternum four parts ( 6th month), talus (7th month),
lower end femur (9th month), upper tibia humerus (10th month)
Samples • Blood, tissues for DNA analysis, organs, swabs from orifice
DR. GAGAN MATHUR
 PART 2

LIVE BORN

[Link] OF LIVE BORN

[Link] MORTEM EXAMINATION OF LIVE BORN
[Link] TEST

DR. GAGAN MATHUR

 1. BASICS OF LIVE BORN
CRITERIA DESCRIPTION
Definition* • Born after > 28 weeks
• Alive before birth in the uterus
• Alive during the process of delivery
• Show signs of life even when only a small part is out like cry,
pulse, limb movement
• Hence respiration is not the only criteria of live born
Evidence given • During the trial of infanticide, the first question that arise is
in court to whether the born child was live born, still born or dead born
prove birth of • Evidences that supports that the birth was a live born are –
a live born*
• If it is a Civil case
o Acceptable evidences are
− Saw cry
− Saw sneezing and yawning
− Feel pulse
− Saw movement of limb
o Not acceptable are
− Hear Cry ( as a child can cry inside uterus vaginitis
uterine or can cry inside the vagina vaginitis
vaginale)
− Saw muscle movement ( as muscles can twitch
after somatic death)
• If it is a criminal case acceptable evidence are
o Attainment of certain Degree of maturation
− A fully mature infant has 3 kg weight, 50 cm
length, 33 cm head circumference, eyes open and
no pupillary membrane.
o Appearance of ossification centre
− At period of viability – Talus
− After period of viability – lower end of femur ( 9th
months) and upper end of tibia and humerus (10th
month)
o Signs of respiration
− Given after post mortem examination of lungs
− Respired lungs have increased volume, increased
weight, pink in colour, soft in consistency, oozes
frothy blood on cut section , shoes positive
hydrostatic test, and have dilated alveoli with
squamous epithelium.

DR. GAGAN MATHUR

 2. POST MORTEM EXAMINATION OF LIVE BORN
EXTERNAL EXAMINATION
CRITERIA DESCRIPTION
General • Presence of clothes and absence of vernix caseosa suggest live birth.
finding
Chest • Chest is dilated, arched and drum shapes
finding • Chest circumference > abdominal circumference at umbilicus by 2 cm
Umbilical • Cutted end of umbilical cord helps to determine whether the delivery
cord done by a skilled or unskilled person.
finding* • Umbilical cord changes can be helpful even when putrefactive
changes have set in.
• Changes in umbilical cord are
o 2 hour − Drying of cutted end
o 1 day − Drying of whole cord
o 2 day − Inflammation
o 3 day − Mummification
o 6 day − Detach off
o 12 day − Scar form
Changes • Changes of skin are
of skin o 0 hour − Red
o 2 day Dark red
o 6 day − Normal colour
Presence • We examine for two hematomas externally, cephalo-hematoma,
of hemat caput succedaneum which present as swelling over head***
oma • The difference between two are*** –
Criteria Cephalo-hematoma Caput Succedaneum
Basic • Collection of blood • Collection of edema fluid
• Between periosteum • Between skin and
and bone aponeurosis
• Due to rupture of • due to stagnation of fluid
vessels • seen in stagnation or
• Seen in forceps delivery stucking of presenting part
at dilated os or vagina
situation • Not crosses suture line • Crosses suture line
• Hence unilateral • Hence Bilateral
Appear • Not at birth, develop • Present at birth
24 hour after birth
Disappear • In 6-8 weeks • In 24 hours
MLI • Its Appearance helps to • It is a definitive sign that
conclude separate foetus was alive in uterus
existence after birth • But during prolonged labour
• Its disappearance helps it might die during the
to conclude how many process (still born)
days the infant
survived after birth

DR. GAGAN MATHUR

 INTERNAL EXAMINATION (SIGNS OF LIVE BORN)
CRITERIA DESCRIPTION
Lungs • Volume
findings**** o Increase in volume
o Margins are round
o Thin tense pleura
o Occupy the whole cavity
• Consistency
o Spongy, soft and elastic
o On rubbing crepitations heard hence crepitant lung
• Colour
o Salmon pink colour
o Air cells are mottled in appearance
• Cut section
o Oozing of frothy blood
• Weight
o Fodere / static test – increase in weight to 80 gm
o Ploucquet’s test – ratio of weights of lung and body = 1/35
• Histology
o Increase blood to alveoli
o Alveoli dilated
o Alveolar membrane present
o Alveoli lined by Squamous epithelium
• Hydrostatic test
o Positive as lung pieces floats on water surface
• Diaphragm
o Convex and up to 6th rib
Heart • Foramen ovale closes at 2 months after birth
Blood • Obliteration of vessels
vessel* o Umbilical artery • 3 day (medial umbilical ligament)
o Umbilical vein • 4 day ( ligamentum teres)
o Ductus venous • 5 day (ligamentum venosum)
o Ductus arteriosus • 10 day ( ligamentum arteriosum)
Blood • Nucleated RBC disappear by 24 hours after birth
• Foetal Hb disappear by 6 months after birth
stomach • Presence of blood, milk, meconium or liquor amni in stomach
• Presence of air in stomach
• Breslau 2nd life test / stomach bowel test
o Release of air bubbles during underwater dissection of
stomach
Middle ear • Wreden test – presence of air in middle ear
Meconium • Large intestine become free of meconium 24 hours after birth
Teeth • Neonatal incremental line forms after Birth
Fontanelle • Posterior fontanelle closes at birth
• Anterior fontanelle closes by 6 months after birth
Ossification • Presence of these ossification centres suggest separate existence
centre o Lower end of radius
o Capitulum of humerus & head of femur

DR. GAGAN MATHUR

 3. HYDROSTATIC TEST*************
CRITERIA DESCRIPTION
Also known as • Raygat test
• Floatation test
• Breslau 1st life test

Principle • Specific gravity of water is 1.000

• Specific gravity of unrespired lung is 1.05 hence it sink in water
• Specific gravity of respired lung is 0.950 hence it floats in water
• Residual volume of lungs forms the basis of this in test not the
tidal volume

Procedure • Dissect out the foetal lungs

• Squeeze the lung to remove its tidal volume
• Cut it into pieces
• Put pieces in water tank
• Also put some pieces of liver as control

Inference • If lung pieces floats – respired lung – positive test

• If lung pieces sink – unrespired lung – negative test
• If lung and liver both float – false positive

False positive • Pieces of lung and liver both floats

• Putrefaction
• Artificial respiration

False negative • Lungs respired but still sinks

• Congenital syphilis
• Broncho pneumonia
• Pulmonary oedema
• Obstruction of alveolar ducts
• Atelectasis (non-expanding lung)

Hydrostatic • Anencephaly
test is not • Presence of milk in stomach
required • Umbilical cord separated and scar form
• Macerated or mummified foetus
• Born < 7 months
• Bruising of lungs indicating artificial respiration tried

DR. GAGAN MATHUR

 PART 3

DEAD BORN
AND
STILL BORN

1. DEAD BORN
2. STILL BORN
3. DIFFERENCE BETWEEN DEAD BORN AND STILL BORN
4. DIFFERENCE BETWEEN LIVE BORN AND STILL BORN

DR. GAGAN MATHUR

 1. DEAD BORN***
CRITERIA DESCRIPTION
Introduction • Born after > 28 weeks
• Died in uterus
• Also known as intra uterine death
causes • Congenital malformation
• Rh incompatibility
• Early placental separation
Important* • Two cardinal feature- Maceration and Absence of respired lung
Rigor Mortis • Present before birth or present at birth
Maceration* • Most important sign of dead born
• It is an example of Aseptic autolysis
• Conditions required
o Membranes intact
o Liquor amni present
o Air absent
• Time to develop 3-4 days
• Features
o Slippage of skin ( earliest sign within 12 hours)
o Sweet ammoniacal smell
o Soft and flaccid body
o Blebs
o Bloating of abdomen
o Increased joint movements
o Organs soft due to autolysis ( except lungs & uterus)
o No gases forms (as bacteria are absent)
o Overlapping of suture line
o Mouth wide open
Putrefaction • Condition
o Membrane ruptured
o Liquor amni present
o Air present
• Feature – greenish, fowl smelling, bloating
Mummification • Condition
o Membrane intact
o Liquor amni absent or very less
o Air absent
• Feature – blackish, NO smell, shriveled
Adipocere • Not seen
Radiological* • Robert sign – 12 hours - Gas in aorta and great vessel
• Dual halo sign – 3 days - On CT-scan Halo around skull
increase due to increase in fat
• Spalding sign – 7 days - On X ray Overlapping of skull bones
due to liquefaction of brain
• Bald sign – On X ray hyperflexion of spine and crowding of ribs
DR. GAGAN MATHUR
 2. STILL BORN***
CRITERIA DESCRIPTION
Definition • Born after > 28 weeks
• Alive before birth in the uterus
• Dies during the process of delivery
• Not Show any signs of life at any time, even when complete
foetus is out
Causes • Prolonged labour leading to asphyxia (most common)
• Anoxia
• Prematurity
• Birth trauma
• Cord prolapse or twisting
Mostly seen • Illegitimate child
in • Immature Male child
• primigravida
How to • With dead born – in still born maceration is absent
differentiate • With live born – in still born respired lungs is absent
Features • Maceration absent
• Respired lungs absent
• Sign of prolonged labour
• Moulding of skull
• Bleeding into scalp
• oedema into scalp
• Caput succedaneum
It is difficult • In cases of dead born – if death occur very recently,
to diagnose maceration will be absent as it takes 3-4 day to develop
• In cases of live born – if death occur soon after the birth,
there can be a chance of no respiration or very little
respiration.
• In cases of precipitate labour – due to quick succession of
labour processes, there is rapid chest compression followed by
rapid chest expansion, which can cause air to enter lungs,
without any active inhalation by infant
Still born and • Activities of doctors like
dangers to o Improper positioning
the doctors o Use of some medications
o Use of manoeuvre’s
o Use of instruments
o Use of surgical interventions
• Such activities can lead to Prolonged labour and birth
asphyxia leading to Still born
• Due to which doctor can be charged with negligence and
become liable to pay the damage

DR. GAGAN MATHUR

 3. DIFFERENCE BETWEEN DEAD BORN AND STILL BORN*
Criteria DEAD BORN STILL BORN
Definition • Born after > 28 weeks • Born after > 28 weeks
• Died in uterus • Alive before birth in the uterus
• Dies during the process of
delivery
• Not Show any signs of life at any
time, even when complete foetus
is out

Most No predominance • Illegitimate child

commonly • Immature Male child
seen in • primigravida

Causes • Congenital malformation • Prolonged labour & birth asphyxia

• Rh incompatibility • Anoxia
• Early placental separation • Prematurity
• Birth trauma
• Cord prolapse or twisting

Features • Maceration present • Maceration absent

• Respired lungs absent • Respired lungs absent
• Rigor mortis • Sign of prolonged labour
• Putrefaction • Moulding of skull
• Mummification • Bleeding into scalp
• Spalding sign • oedema into scalp
• Roberts sign • Caput succedaneum
• Bald sign
• Double halo sign

DR. GAGAN MATHUR

 4. DIFFERENCE BETWEEN LIVE BORN AND STILL BORN**

LIVE BORN STILL BORN

1. Lungs*
• volume • More in volume • Less volume
• Margins are round • Margins are sharp
• Thin tense pleura • Thick pleura
• Occupy the whole cavity • Occupy the posterior cavity
• Consistency • Spongy, soft and elastic • Firm, rubbery, liver like
• On rubbing crepitations heard, • On rubbing No crepitations
crepitant lung heard, Non crepitant lung
• Colour • Salmon pink colour • Brown liver like colour
• mottled in appearance • Not mottled, uniform in
appearance
• Cut section • Oozing of frothy blood • Oozing of froth less blood
• weight • 80 grams • 40 grams
• Ratio with body weight 1/35 • Ratio with body weight 1/70
• Histology • More blood to alveoli • Less blood to alveoli
• Alveoli dilated • Alveoli contracted
• Alveolar membrane present • Alveolar membrane absent
• Alveoli lined by Squamous • Alveoli lined by cuboidal
epithelium epithelium
• Diaphragm • Convex, up to 6th rib • Flat, up to 4th rib
• Hydrostatic • Positive • Negative
test • Lung pieces floats on water • lung pieces sinks in water
• Chest • Drum, arch or dilated • Flat antero-posteriorly
• More than abdominal • Less than abdominal
circumference at umbilicus circumference at umbilicus
2. Heart • Foramen ovale close at 2 month • Foramen ovale remain open
3. Blood • Obliteration of umbilical vein • NO Obliteration of umbilical
vessel and artery and ductus venosus vein and artery and ductus
and arteriosus at a particular venosus and arteriosus
time
4. Blood • Nucleated RBC and Foetal Hb • Nucleated RBC and Foetal Hb
disappear at a particular time remains present
5. stomach • Milk, blood or air Present • Milk, blood or air Present
• Air bubbles during under water • No Air bubbles during under
dissection water dissection
[Link] • Intestine free from it by 24 hrs • Remain in intestine
[Link] ear • Air in middle ear • Gelatine in middle ear
[Link] • Neonatal incremental line • Neonatal incremental line
present absent
[Link] • Posterior fontanelle closes at • Posterior fontanelle remain
birth open
10. • Lower end of radius, capitulum • All are absent
Ossification of humerus, head of femur can
centre be present at a particular time

DR. GAGAN MATHUR

 PART 4

CHILD ABUSE

1. CHILD ABUSE
2. BATTERED BABY SUNDROME
3. SUDDEN INFANT DEATH SYNDROME
4. MANCHAUSEN SYNDROME BY PROXY

DR. GAGAN MATHUR

 1. CHILD ABUSE
CRITERIA DESCRIPTION
Definition • Causing or permitting
• Of any harmful or offensive
• Contact, communication or transaction
• To a child body
• which humiliate, shames and frightens a child

Physical Abuse • It involves non accidental physical injuries

• By parent / guardian
• Eg- beating, battery

Sexual Abuse • It involves inappropriate sexual behaviour

• By a parent / guardian
• Examples
o Fondling with genitalia
o Making child to fondle with abuser genitalia
o Rape, incest, sodomy
o Producing pornographic material
o Exploitation through prostitution

Emotional • It involves acts of omission or acts of commission which

abuse potentially affects the child psychologically
• It is a form of Mental, verbal or psychological abuse
• Example
o Use of extreme or bizarre punishments
o Confinement of a child in a dark room
o Tied to a chair for a long time

Neglect • It involves acts of omissions and failures to provide for

child’s basic needs
• Example –
o Physical neglect
o Health neglect
o Educational neglect
o Emotional neglect

DR. GAGAN MATHUR

 2. BATTERED BABY SYNDROME*********
CRITERIA DESCRIPTION
Introduction • Also known as
o Caffey syndrome
o Caffey Kempe syndrome
o Parent infant traumatic stress syndrome
• Definition – a child , who received repetitive physical injuries,
as a result of Non-accidental violence, produced by a parent
or guardian
Risk factors • Related to child
o Unwanted child
o Age < 3 years
o Male > female
o Eldest or youngest
o Disobedient behaviour
o Frequent crying
o Trifling acts of child
o Refuse to take food
• Related to parents
o Unmarried couple
o Young couple
o History of childhood battery with themselves
o Uneducated
o Impulsive and aggressive personality
o History of addiction
o Financial problem
o Problem at work
o Lack of harmony in family
Features • Repetitive injuries
arising • Discrepancy between parent narration and degree of injuries
suspicion of • Gap between injury and medical attention
BBS • Injuries at different stages of healing
• Child dies suddenly

Injuries • Head injuries

o Injuries can be inflicted by throwing, striking, dropping,
vigorous shaking
o Symptoms – altered mental status, unresponsiveness,
focal neurological deficit, convulsions, coma
o Head injuries are the most common cause of death
o Shaken Baby Syndrome / Infantile Whiplash syndrome
− Injury can occur by mere 5 seconds of shaking
− Triad – Sub-Dural haemorrhage, encephalopathy,
retinal haemorrhage
− SDH is the most consistent of the trial and
1st clinical sign to be seen on CT scan

DR. GAGAN MATHUR

 • Eyes injuries
o Retinal & vitreous haemorrhage
o Lens displacement
• CVS injuries
o Contusion of lungs
o Haemothorax and Pneumothorax
o Cardiac tamponade
• Visceral injuries
o Bruises, laceration, tear of organ
o 2nd most common cause of death
• Genito urinary injuries
o Features of sexual abuse
o Haematuria, painful micturition
• Surface injuries
o Abrasion, bruises, laceration
o Laceration of oral mucosa and labial frenulum is the
Most characteristic injury
o Bruise marks of slap, lash, knuckle punch, pinch marks
(butterfly bruise)
o Traction alopecia
• Skeletal injuries
o Type of fractures that occur – transverse, impacted,
spiral, multiple, sub periosteal hematoma
o Bones involves – skull, ribs, long bones, vertebrae
o Skull – Fissure fracture, eggshell fracture
o Long Bones – Corner and Bucket handle fracture at
metaphysis of long bones
o Ribs – Mid-axillary fracture due to antero-posterior
compression
− Posterior angle fracture due to side to side
compression, Fracture heals by callus formation,
giving them knob appearance, hence also called
as knobbing fracture
− Multiple rib fractures, at different stages of
healing appear on X ray as Pearls on string
• Other injuries
o Scalds
o Circular pitted marks of cigarette
Differentials • Café Coronary – a type of Suffocation, in which a healthy
patient suddenly collapse during meals due to obstruction of
airway by large food particles.
• Caffey sign – crescent shaped radiographic sign seen in
fracture of femoral head
• Caffey disease - Infantile Cortical Hyperostosis is a self-
limiting disorder. It is characterized by a triad of systemic
symptoms fever, soft tissue swelling and underlying cortical
bone thickening

DR. GAGAN MATHUR

 3. SUDDEN INFANT DEATH SYNDROME***
CRITERIA DESCRIPTION
Introduction • Also known as Cot Death, Crib Death
• Definition
o Sudden and unexplained death of a
o Seemingly healthy infant
o Whose death remain unexplained
o Even after complete autopsy
• It is an autopsy diagnosis, NOT a clinical diagnosis
• Incidence is 0.2-0.4 %

Risk factors • Age – 2 week to 2 year

• Sex – male > female 3:2
• Infant – prematurity ,twins
• Social – poor socioeconomic status
• Condition – more during night, rainy and winter season
• Parent – smoking and drug addiction
Possible • Prolong sleep apnoea leading to hypoxia (most common)
mechanism • Respiratory infection leading to respiratory depression
• Nasal oedema and excess mucous secretion leading to
airway obstruction and hypoxia
• Laryngospasm due to hypersensitivity to cow milk
• Pillow falling or overlying of parent on the child leading to
suffocation of the child
• GERD
• Adrenal insufficiency
• Deficiency of Vitamin B, C, D, E
• Deficiency of Selenium, calcium, magnesium
• Hypothermia
• hypoparathyroidism

Post mortem • Most common autopsy finding are negative

examination • Froth around mouth
• pulmonary oedema
• Petechiae haemorrhage on heart, lung, thymus
• Trachea contain milk vomitus, blood, epithelial cell
MLI • It is a natural death → but sometimes parents can be
wrongfully charged for infanticide
• On the contrary → patient who actually committed
infanticide → puts SIDS as their defence to save themselves

DR. GAGAN MATHUR

 4. MANCHAUSEN SYNDROME BY PROXY***
CRITERIA DESCRIPTION
Definition • It is a form of child abuse
• in which Parent or guardian
• Fabricate or produces symptoms of an illness
• In order to gain sympathy and attention for themselves
• The child is not admitted in hospital for abuse but for some
fictitious illness
• Also called as Factitious disorder
Features • Child bought to hospital for vague complaints repetitively like
vomiting, fever, bleeding, and seizures.
• Child bought to hospital for vague complaints inflicted by parents
o Fever – by injecting some drug
o Vomiting – by ipeac syrup
o Bleeding by giving anticoagulants or using exogenous blood
o Seizures – by suffocating, intoxicating or shaking
• Mostly parent maintain a constant relation with a doctor, or
sometime they do doctor shopping
• Parent derive non economic benefit at the expense of the child
• On confronting parent, they deny for being responsible for child’s
illness

Diagnosis • History of multiple admissions to multiple hospitals

• Childs condition become worsen when the parent or guardian are
around them
• Signs and symptoms of illness not consistent with the usual
presentation and course of the illness
• Signs and symptoms of illness does not corroborate with
laboratory finding
• Child is positive for toxicological analysis for medicines , that
were not prescribed to the children
• Failure of wounds to heal

DR. GAGAN MATHUR

AGE OF FOETUS BASED ON LENGTH, WEIGHT, OSSIFICATION AND FEATURES
(Only memorise the age and star marked feature of that age)

Month/ Length Weight Foot Centre of Features

week Of Of length of Ossification
Eyes Testis* Meconium appendages others
Foetus Foetus Foetus appear
In cm In In cm
gram
1/4 1 2.5 - - - - - - -

2 / 8* 4 10 - Clavicle, Recognisable - - - Placenta

mandible, form*
frontal, parietal
3 / 12 9 40 - Sacrum Pupillary - - Nail form* Neck form
membrane
appear
4 / 16 15 120 - Temporal, - - In small Lanugo External Sex
occipital intestine appear* recognisable*
5 / 20 25 400 - Calcaneum - - Upper end Scalp hair Vernix
of Large appear* caseosa
intestine
6 / 24 30 800 4.5 Sternum Eye brow & Near Upper Skin -
eye lashes* kidney large wrinkled
intestine
7 / 28 35 1200 5.5 Talus* Eyes open* At whole Thick skin -
(Viable) inguinal large
ring intestine
8 / 32 40 1600 6.5 - - Left Lower Thick scalp -
testis in large hair
scrotum* intestine
9 / 36 45 3000 7 Cuboid, - Right lower end Lanugo at -
capitate, femur testis in of Large shoulder
lower end* scrotum* intestine
10 / 40 50 3500 8 Tibia, humerus - - In Rectum Nail project -
upper end beyond
finger tips