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Experimental modelling of imposed upper airway obstruction in infants and children
George Johnson1, Frederick Green2, Harriet Clift3
1Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, Merseyside, L9 7AL, UK. georgejohnson93@gmail.com.
Insights
Fingertip bruises on a child’s head may indicate deliberate upper airway obstruction. This finding suggests healthcare professionals should examine for mechanical asphyxia markers in cases of unexplained bruising.
Area of Science:
- Forensic Pathology
- Pediatric Trauma
- Child Abuse Investigation
Background:
- Interpreting injuries in children and infants presents challenges, including distinguishing accidental from non-accidental trauma.
- Non-fatal upper airway obstruction is a recognized pattern of child abuse that can precede fatal episodes.
- Medical conditions can increase a child's susceptibility to injury.
Purpose of the Study:
- To experimentally model digit marks on infant and child resuscitation dummies during simulated deliberate upper airway obstruction.
- To determine if digit marks can be reliably produced and to analyze their distribution patterns.
Main Methods:
- Utilized infant and young child resuscitation dummies for experimental modeling.
- Simulated various methods of deliberate upper airway obstruction to create theoretical digit marks.
- Analyzed the location and patterns of the resulting digit marks on the dummies' heads and faces.
Main Results:
- Digit marks can be imprinted anywhere on the head and face of infants and young children.
- The distribution of digit marks significantly varies depending on the method of airway obstruction.
- Reproducible patterns of linked digit marks were observed.
Conclusions:
- The presence of fingertip-type bruises on an infant or child's face or scalp should increase suspicion of deliberate upper airway obstruction.
- Healthcare professionals should investigate for markers of mechanical asphyxia when encountering unexplained bruising.
- This research aids in the accurate interpretation of head and facial injuries in pediatric cases, particularly concerning non-accidental trauma.
Abstract:
The interpretation of injuries to children and infants poses a number of difficulties to any medical practitioner involved in their care or tasked with the investigation their death. This includes differentiating accidental from non-accidental trauma and the consideration of medical factors making a child more prone to injury. Non-fatal but life-threatening upper airway obstruction is unfortunately a well-recognized pattern of abuse which may precede a fatal episode. In this experimental study, we aimed to model theoretical digit marks to the head using infant and young child resuscitation dummies, exposed to various methods of deliberate upper airway obstruction. This work has demonstrated that digit marks can be left anywhere on the head and face. However, the distribution of these marks varies dramatically based on how the airway was obstructed. Moreover, digit marks also appeared to be linked together in fairly reproducible patterns. Given the findings in this study, the identification of one or more fingertip type bruises anywhere on an infant or child's face or scalp, should raise the index of suspicion that the individual may have been subject to deliberate upper airway obstruction. This should prompt healthcare professionals to examine the child for markers of mechanical asphyxia, in order to accurately interpret any inadequately explained bruising to the head and face.
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