Subtle fatal child abuse

The majority of homicide victims in infancy and childhood have been either beaten or starved to death. However, the pathologist must recognize a much broader range of fatalities in early life for which an adult appropriately bears criminal responsibility. To emphasize the diversity and potential subtlety of homicide in infancy and childhood, we present six instances of fatal child abuse that illustrate the types of unusual physical and chemical assault and the covert negligence that kill children. Unfamiliarity with the law, lack of suspicion in approaching cases, and failure to utilize necessary techniques to establish the mechanism of death can obscure recognition of the homicidal nature of such fatalities.